JAMA: Doctors are overtreating back pain

Patients want a magic cure and doctors want to give it to them, experts say

Most physicians do not follow guidelines for treating patients' back pain, instead exposing them to unnecessary imaging tests, prescribing narcotics, and referring them to specialists, according to a new study in JAMA Internal Medicine.

Study findings

For the study, Harvard University researchers studied data collected between 1999 and 2010 on about 24,000 doctors' visits for back pain. They found that:
  • The rate of narcotic prescriptions increased from 19% of back pain visits in 1999 to about 29% in 2010;
  • The use of CT scans or MRIs increased from 7% in 1999 to 11% in 2010; and
  • The rate of physician referrals for back pain increased from 7% in 1999 to 14% in 2010.

Meanwhile, the rate of physicians prescribing non-steroidal anti-inflammatory drugs (NSAIDs)—such as Advil, Motrin, and Aleve—declined from 37% in 1999 to about 24% in 2010. These drugs are often recommended as a first line of treatment along with physical therapy, according to American College of Physicians guidelines.

In addition, physical therapy referral remained relatively unchanged over the study period, occurring in about 20% of patient visits.

Findings suggest physicians are not following guidelines

The takeaway from guidelines for back pain treatment is that "less is more," study co-author John Mafi said. Moreover, narcotic medications "have no proven efficacy in improving chronic back pain," he added.

  • Are you 'Choosing Wisely'? More than a dozen medical societies have joined forces to create master lists of unnecessarily procedures and discourage overtesting. Check out the lists (part one and part two) and see what our experts have to say about the included imaging tests and cardiovascular procedures.

"Patients expect doctors to have some kind of magic cure, and so doctors want to offer them something," study co-author Bruce Landon says, adding that often doctors find it "easier to offer them something rather than explaining why more aggressive treatments and testing won't make them better in the long run."

Back pain accounts for more than 10% of primary care physician visits and about $86 billion in health care spending annually, not including lost productivity, according to Landon. "With health care costs soaring, improvements in the management of back pain represent an area of potential cost savings for the health care system while also improving the quality of care," the study says (Morin, "Science Now," Los Angeles Times, 7/29 ; Tarken, Fox News, 7/30; Hellmich, USA Today, 7/29).


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