Useless Care for Back Pain on the Rise

Cheryl Clark, July 30, 2013

Physicians are drifting away from evidence-based care for back pain patients and are treating them with growing rates of referrals to surgeons and other doctors and orders for "inappropriate" CT or MRI images, a study shows.

Doctors were less likely to follow established evidence-based guidelines for treating back or neck pain and prescribe anti-inflammatory drugs. Instead, they were more likely to prescribe narcotics and order expensive, inappropriate imaging tests, despite no evidence of benefit.

Usually, and absent other red flags like neurological problems or fever indicating more serious issues, back pain resolves within three months, and neither imaging, narcotics or surgery, which carry serious risks, are likely to hasten relief.

That's according to a study of 23,918 patients who sought care for spinal problems between 1999 and 2010 by researchers at Beth Israel Deaconess Medical Center in Boston.

"We were hoping that practices would get a little better, but what we found was that everything just got worse," says John Mafi, MD, the study's lead author and a fellow in Beth Israel's division of general medicine and primary care.  

"It's hard to change behavior of patients and it's hard to change behavior of physicians. We live in a society or culture that expects a quick, effective, and immediate solution. We do have good technologies for treatment for many conditions, but unfortunately, back pain is just not one of them."

Mafi adds that within the first three months of pain onset, "surgery, MRI or CT scanners and specialty visits don't tend to improve outcomes for patients with back pain, which is just one of those frustrating things we don't have a quick fix for."

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