WORSENING TRENDS IN BACK PAIN MANAGEMENT

(The authors looked at 23,918 patient visits for neck or back pain over a 12 year period)

A couple key points of the study1 found rather large increases in guideline discordant care that has not been shown to improve outcomes

1) referrals to other physicians: (over 100% increase)

2) prescriptions for narcotics (nearly 50% increase)

3) use of advanced imaging such as CT/MRI (nearly 60% increase)

The authors also found a decrease or no change in care concordant with guidelines:

1) decrease in prescriptions of NSAIDs or use of OTC Acetaminophen (nearly 33% decrease)

2) no change in PT referrals

I believe the authors say it well in the final paragraph of their study:

Despite numerous published national guidelines, management

of routine back pain increasingly has relied on advanced

diagnostic imaging, referrals to other physicians, and

use of narcotics, with a concomitant decrease in NSAID or acetaminophen

use and no change in physical therapy referrals.

With health care costs soaring, improvements in back pain management represent an area of potential cost savings

for the health care system while also improving the quality of care

Ed Scott PT, DPT, OCS

1Worsening Trends in Back Pain Management and Treatment

JAMA Intern Med. 2013;173(17):1573-1581. doi:10.1001/jamainternmed.2013.8992