Back Pain Treatment Sees Worsening Trends
Researchers from the Beth Israel Deaconess Medical Center published a study in the JAMA Internal Medicine which says that patient care could be enhanced and cost the health care system significantly less if health care professionals followed published clinical guidelines to manage and treat back pain.
John N. Mafi, MD, a fellow in the Division of General Medicine and Primary Care at BIDMC says, “back pain treatment is costly and frequently includes overuse of treatments that are not supported by clinical guidelines, and that don't impact outcomes. Improvements in the management of spine-related disease represent an area of potential for improving the quality of care and for potential cost savings for the health care system.” We spend $86 billion annually on back or neck-related pain/health issues in the United States. It’s the fifth most common reason to visit the doctor, or over ten percent of all appointments made with primary care physicians. Additionally, lost productivity at work due to these issues adds another $20 billion annually. And, as chronic back pain continues to rise, so will these approximate expenditures.
Currently, the published guidelines for routine back pain treatment advise the use of non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy or exercise. Research has shown that back pain usually resolves within three months of these types of treatments. These guidelines have stayed consistent since the 1990s, which suggests the need for imaging and other advanced treatments is generally unnecessary due to the high success rate from conservative treatment.
The researchers used about 24,000 nationally representative visits for spine-related problems between 1999 and 2010 for the study. They studied the changes in treatment choices, such as diagnostic imaging, physical therapy, referrals to a specialist, and use of medication. Mafi says, “we observed a significant rise in the frequency of treatments that are considered discordant with current guidelines including the use of advanced imaging, such as CT or MRI, referrals to other physicians (presumably for procedures or surgery), and the use of narcotics.”
Unnecessary treatment options are expensive and can also bring complications. Narcotics offer minimal benefit for acute back pain, and have no proven efficacy in treating chronic back pain. The data also revealed that over forty percent of the patients experienced concurrent substance abuse disorders. The researchers believe the increase in narcotic prescriptions is related to the rise in narcotic overdose deaths. Additionally, the increase of doctors’ requests for advanced diagnostic imaging is a concern. Exposure to ionizing radiation over the long term can lead to further health complications, such as cancer. Mafi notes, “despite numerous published national guidelines, management of routine back pain increasingly has relied on advanced diagnostic imaging, referrals to other physicians, and use of narcotics, with a concomitant decrease in NSAIDs and no change in physical therapy referrals. With healthcare cost soaring, improvements in the management of back pain represent an area of potential cost savings for the healthcare system while also improving the quality of care.”
Chiropractic care is a safe, non-invasive, and proven method to both treat and prevent back pain. If you are experiencing any symptoms, don't wait any longer to visit a chiropractor today.
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