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
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
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.
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).
Inclusion Criteria:

 -  Patient aged 20 to 55 years old

 -  Presenting an episode of acute common low back pain diagnosed in the GHPSJ emergency
 room or in general medical consultation at the CMT, evolving for less than 72 hours

 -  Capable of giving free, informed and express consent

 Exclusion Criteria:

 -  Existence of underlying chronic low back pain

 -  Associated radiculalgia descending below the knee

 -  Specific low back pain (with a "red flag")

 -  Patient not reading or understanding French

 -  Patient deprived of liberty

 -  Patient under guardianship or curatorship

 -  Patient under the protection of justice