Interest of the Return to Primary Care of the "Low Back Pain Booklet" of Health Insurance in the Recovery of Common Acute Low Back Pain
Condition: Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      Low back pain is defined as pain or functional discomfort between the twelfth rib and the
      gluteal fold, which may be median or lateralised. It can radiate up to the thigh but never
      below the knee. Low back pain is said to be acute if it has been progressing for less than
      three months. In the acute form, it evolves on a mechanical rhythm, prevents the usual
      activity and occurs preferably in adults aged 20 to 55 years. 90% of these low back pains are
      mechanical and common, i.e. characterized by the absence of "red flags ". The red flags refer
      to a group of characteristic clinical signs that should alert the practitioner to the
      possibility of an underlying serious spinal pathology and the need for further investigation.

      Common low back pain is a public health issue since it is the leading cause of health
      expenditure in Europe and an economic challenge (900 million euros / year and 19.1% of work
      stoppages in 2015 compared to 13% in 2005).

      In 80% of cases, the general practitioner is in the first line of care in cases of acute low
      back pain. Indeed, it represents a frequent reason for consultation in general medicine (2nd
      reason for consultation among general practitioners in 2015).

      The doctor must: track down warning signs that call into question the diagnosis of common low
      back pain (red flags), relieve and reassure the patient. Common low back pain very often
      heals spontaneously but about 10% of patients will develop chronic low back pain (persistence
      of pain for more than 3 months). These chronicized patients account for 80% of the total cost
      of low back pain.
    

Detailed description: 
      According Paracetamol is often insufficient and it is necessary to switch to level 2
      analgesics (tramadol, codeine). NSAIDs are used in short courses.

      It is crucial to reassure the patient about the benign nature of the condition and to insist
      on maintaining activities. Bed rest should never be recommended, let alone prescribed. The
      usual activities of daily living should be maintained as much as possible within the limits
      allowed by pain. A work stoppage may be considered if the professional constraints are
      greater than those of daily life. The return to work has no deleterious effect and must be as
      early as possible.

      It is useful to detect early chronicization factors, especially psychosocial ones. Finally,
      in order to prevent lumbar disability, patient education, based on the bio-psycho-social
      model, must be an important part of patient care. The content of the physician's speech
      strongly influences the patient's beliefs and behaviour. However, if the information can be
      provided by the therapist, it can also be provided via brochures.

      This is why the Health Insurance launched a public information campaign in November 2017 to
      improve the management of low back therapeutic education, pain, spine sections], the French
      Society of Rheumatologyk pain. The French Society of Rheumatology, The French Society of
      Rheumatology, therapeutic education, pain, spine sections], the French Society of
      Rheumatology physical and rehabilitation medicine and the college of general medicine have
      worked together to publish a "booklet back": I suffer from low back pain: what is it and what
      to do? whose main objective is to fight against false beliefs concerning inter alia "the
      benefits of strict rest", to promote physical activity, and to recall the true indications of
      complementary examinations (radiography, CT, or MRI of the spine) Thus, the back booklet
      intended for the patient is distributed to general practitioners via the visits of the
      delegates of the Health Insurance. Nearly 1,600,000 brochures were printed and made available
      to delegates for distribution to health professionals, with 30 brochures per general
      practitioner. The brochure is also available for download on ameli.fr in the "insured" and
      "health professionals" sections (doctors, physiotherapists, care institutions, health
      centres). In this study, one of the 2 participating centres is the Groupe Hospitalier Paris
      Saint Joseph (GHPSJ), emergency department. Also, we contacted the health insurance to
      receive brochures. To our knowledge, there is no other emergency service that has done this.
      The 2nd service centre participating in the study is the general practitioner consultation
      centre at the Marie-Thérèse health centre (CMT).
    

Intervention name(s): delivery of the low back pain booklet
Intervention type(s): Other
Intervention description(s): When a patient arrives at the GHPSJ emergency room or in general medical consultation at the CMT and a diagnosis of common acute low back pain is made, the physician verifies the study selection criteria.
If it is randomized in the arm 2 "with booklet" group, the management will be the same as for the "without booklet" group but with the hand delivery of the booklet in addition.
All patients will be informed about the existence of the booklet. A link to the digital version on the ameli.fr website is included in the information note The patient will be contacted 3 months later by a Clinical Research Associate (CRA) to conduct a data collection.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Common Acute Low Back Pain; Low Back Pain Booklet; Health Insurance