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Trends in treatment of back pain frequently go against guidelines

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Researchers who studied more than 10 years of back pain management found patients are frequently prescribed unnecessary treatments or referred to specialists, which are not recommended by national guidelines.

“Back pain treatment is costly and frequently includes overuse of treatments that are not supported by clinical guidelines, and that don’t impact outcomes,” John N. Mafi, MD, a fellow in the Division of General Medicine and Primary Care at BIDMC. “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.”

Mafi and colleagues analyzed 23,918 spine surgery visits between 1999 and 2010 from National Ambulatory Medical Care and National Hospital Ambulatory Care surveys. They looked at factors such as non-steroidal anti-inflammatory drugs (NSAIDs), changes in how diagnostic imaging was used, and referral for physical therapy, according to a press release.

“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 and the use of narcotics,” Mafi said.

Narcotic use increased from 19.3% to 29.1% during the study period, while NSAID and acetaminophen use decreased from 36.9% to 24.5% during the same period. Physician referrals also increased during that time, from 7.2% to 11.3%, according to the abstract.

Reference:

Mafi JN. JAMA Intern Med. 2013;doi:10.1001/jamainternmed.2013.8992.

Disclosure: Mafi received a National Research Service Award training grant from US Health Services and Research Administration for his work on this study. One of the authors (Davis) was supported by a Harvard Catalyst National Institutes of Health research award.