August 1, 2013
Doctors Often Neglect Back Pain Treatment Guidelines
Brett Smith for redOrbit.com - Your Universe Online
Back pain is the fifth most common reason Americans visit their doctor, spending around $86 million annually. A new study suggests that doctors could improve treatment and reduce waste by simply following national guidelines when treating these patients.
"Back pain treatment is costly and frequently includes overuse of treatments that are not supported by clinical guidelines, and that don't impact outcomes," said study co-author Dr. John N. Mafi, a research fellow at Beth Israel Deaconess Medical Center in Boston. "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."
Current guidelines for treating back pain, which were established in the 1990s, include using non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen to relieve discomfort and physical therapy to treat an underlying problem. Studies have shown that this simple regimen often resolves any issues within three months.
The guidelines do recommend imaging or the use of narcotics for extreme cases, but these steps are supposed to be taken when the patient has a long history of problems or there is a neurological risk.
For the study, which was published in JAMA Internal Medicine, the researchers examined almost 24,000 consultations for spine problems from the National Ambulatory Medicare Care and National Hospital Ambulatory Care surveys taken from 1999 to 2010.
"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," Mafi said. "We also have observed a decline in the use of first-line medications such as NSAIDs or acetaminophen, but no change in referrals to physical therapy."
The study also found that there was some evidence doctors were treating patients differently based on sex or ethnicity.
"Although opiate prescriptions increased markedly over this time period, we also observed lower odds of receiving narcotics among female, Black, Hispanic, and other race/ethnicity patients, which may signify the potential disparities in pain management that have also been noted previously," Mafi said.
Research has suggested that using narcotics to treat back pain may be more trouble than it's worth since they offer little benefit and can often lead to dependency.
The potential overuse of imaging in back pain treatment is also an issue because it exposes patients to high levels of ionizing radiation that can lead to cancer or other health issues, the researchers said.
"Increased use of advanced imaging represents an area of particular concern" said co-author Dr. Bruce Landon, a policy expert at BIDMC. "Early in the course of back pain, such imaging is almost always wasteful. Moreover, there are almost always some abnormalities, which increases the likelihood that a patient will undergo expensive spine surgery that might not improve their outcomes over the longer term."
"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 or acetaminophen use and no change in physical therapy referrals," Mafi said. "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."