Back Pain Treatment Trends Contradict Guidelines

back painTrends in the treatment of back pain in the United States are at odds with current guidelines, often including costly, overused imaging tests and addictive narcotics. 

Bruce Landon, MD, of Harvard Medical School, and colleagues used data from 23,918 outpatient visits for spinal injuries recorded by the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1999 and 2010 to measured the frequencies of treatment strategies including imaging tests, narcotics use, referrals, anti-inflammatory use, and physical therapy.
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Use of anti-inflammatorily drugs like NSAIDs and acetaminophen decreased from 36.9% into 24.5% between 1999 and 2010, but use of narcotics –unsupported by guidelines because of the risk of addiction– increased from 19.3% to 29.1%. 

Physician referrals to specialists, such as orthopedic surgeons, increased from 6.8% to 14%, while physical therapy referrals remained at approximately 20%.  

While radiographs were steadily used approximately 17% of the time, CT and MRI use increased from 7.2% to 11.3%.

"Well-established guidelines for routine back pain stress conservative management, including use of NSAIDs or acetaminophen and physical therapy, but avoiding early imaging or other aggressive treatments, except in rare cases," researchers wrote.

“Improvements in the management of spine-related disease represent an area of potential cost savings for the health care system with the potential for improving the quality of care,” they concluded. 

–Michael Potts

Reference

Mafi JN, McCarthy EP, Davis RB, Landon BE.  Worsening Trends in the Management and Treatment of Back Pain [published online ahead of print July 29, 2013].  JAMA Intern Med. doi:10.1001/jamainternmed.2013.8992.