Back Pain- mismanagement taking a toll on American Health care:

Jojy Cheriyan MD;MPH-August 2,2013

Back Pain affects 80 % of Americans at some point in their lives. Among primary care provider visits 10% are related to back pain or neck pain. Many people find relief from the symptoms with pain medications, mostly Over The Counter Drugs (OTC) like Advil or Aleve or Tylenol. But physician visits, especially visits to specialists, subject many to overuse treatment and unnecessary imaging studies (CT/MRI) that take a big toll on American Health care. The main reason is found to be the non adherence by physicians to follow the established guidelines in Back Pain management. There are well-established guidelines to promote use of non-opioid analgesics, avoidance of imaging tests, use of physical therapy-based exercises and management with in a primary care circle. But, disagreement among physicians about the guidelines and patient's insistence to get immediate relief are also barriers to physician's non-adherence to the guidelines.

The new studies published this week by the Journal of American Medical Association-Internal Medicine reports that Back Pain treatment has become costly and frequently involves overuse of treatments and unnecessary imaging studies (CT/MRI) that are unsupported by the established guidelines.

The study found that back pain is associated with $86 billion in healthcare spending each year and use of narcotics and imaging (CT/MRI) rose significantly during the last decade.

At the same time use of non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (Tyleneol) at a physician visit for back pain fell from 36.9% to 24.5%, over a 12-year period. Over the same period, use of narcotics rose from 19.3% to 29.1% and imaging with CT or MRI rose from 7.2% to 11.3%, they added.

The researchers studied changes in the treatment of back pain in the U.S. from Jan. 1, 1999, to Dec. 26, 2010, using data from 23,918 outpatient visits for spine problems recorded in the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey.

They included physician visits with a primary or secondary diagnosis of neck or back pain, and excluded those with concomitant fever, neurologic symptoms, or cancer. Outcomes included referral for physical therapy or to another physician, use of imaging, and use of medications, including NSAIDs, acetaminophen, muscle relaxants, and narcotics.

The study analysis also showed that white patients and male patients were more likely to get narcotics than patients who were black, Hispanic, another race, or female.

The limitations of the study include incomplete data on duration of symptoms, missing data on duration of symptoms and treatment patterns, and lack of measurement of co-morbidities before 2005.

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