Potentially low-value services for low back pain decreased from 2011 to 2019
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Published results showed a decrease in the use of potentially low-value services among patients with low back pain, with reductions in the use of surgery, opioids and imaging from 2011 to 2019.
Using administrative claims data from the HealthCore Integrated Research Environment, researchers identified 2,196,761 patients who had repeated claims for low back pain (LBP) at least 8 weeks apart from 2011 to 2019. Researchers considered utilization of services considered potentially low value by the International Association for the Study of Pain, including ED visits, liberal use of diagnostic imaging, opioids, spinal injections and surgery, as the primary outcomes. Researchers also examined all-cause inpatient stays, defined as hospitalizations for at least 1 night, and described inflation-adjusted per-patient-per-month allowed costs over time.
Results showed the use of inpatient services decreased from 12.4% to 9.3% from 2011 to 2019. Researchers also found a decrease in surgery use from 4.5% to 3.3%, use of opioids among patients from 24.9% to 19.4% and use of imaging from 73.6% to 59.9% during the same period, while use of epidural injections remained similar. Total per-patient-per-month costs decreased from $1,216 to $1,101 and inpatient per-patient-per-month costs decreased from $454 to $355 from 2011 to 2019, according to results. Researchers noted surgery, opioids and imaging had notable decreases in costs.
“The study was limited by possible miscoding, unknown use of services and medications billed outside of insurance, and unknown pain severity,” the authors wrote. “Trends in the use of potentially low-value services for LBP among commercially insured patients with LBP appear to be moving in a desirable direction.”
Perspective
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Low back pain remains a costly, debilitating problem for many adults in the United States. As this study outlines, it is the third most common and costly medical problem for which adults are treated. As the natural history of back pain and its multiple causes are better understood, a reduction in the use of unnecessary diagnostic tests and treatments has occurred. This study supports earlier studies that have demonstrated a downward trend in the use of low-value services, such as sophisticated imaging, epidural steroid injections, surgery and opiate use over the last decade. Other, less invasive treatments, such as physical therapy, acupuncture, yoga and Pilates, have proven to be of great value and can be used long term with little, if any, side effects or detriment.
As one would expect, with more detailed history taking and physical examination, and a better understanding of the anatomy which causes back pain, patients who truly require invasive treatments are more appropriately evaluated and dealt with and return to full function and unrestricted life as a result. As we continue to improve our understanding of the spine and pain, we expect similar trends to continue, reducing health care costs, unnecessary procedures and prescription of opiates.
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