Patient care could be enhanced and the healthcare system could see significant cost savings if healthcare professionals followed published clinical guidelines to manage and treat back pain, according to researchers at Beth Israel Deaconess Medical Center in Boston.
“Back pain treatment is costly and frequently includes overuse of treatments that are not supported by clinical guidelines, and that dont impact outcomes,” lead author John N. Mafi, MD, a fellow in the Division of General Medicine and Primary Care at BIDMC, said in a news release. “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 healthcare system.”
Americans spend about $86 billion each year on back or neck pain-related health issues, and it is predicted costs will continue to grow as chronic back pain increases, the authors wrote in the study, which was published in the July 29 issue of JAMA Internal Medicine.
Published guidelines for routine back pain advise use of nonsteroidal anti-inflammatory drugs or acetaminophen and physical therapy. Past research has shown back pain usually resolves within three months of these treatments. The guidelines, which have been consistent since the 1990s, suggest imaging, advanced treatments, prescription of a narcotic or referral to a specialist, presumably for consideration of a procedure, are generally unnecessary. However, if acute neurological compromise or other warning signs such as past history of malignancy are connected with the back pain, further steps can be taken to investigate.
Using data from the National Ambulatory Medicare Care and National Hospital Ambulatory Care surveys between 1999 and 2010, the researchers identified 23,918 visits for spine problems, representing 73 million visits. They found the use of acetaminophen and NSAIDs, which are recommended in the clinical guidelines, decreased from 36.9% in 1999-2000 to 24.5% in 2009-10. For the same years, use of narcotics increased from 19.3% to 29.1%, the article showed.
“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 (presumably for procedures or surgery), and the use of narcotics,” Mafi said in the release. “We also have observed a decline in the use of first-line medications such as NSAIDs or acetaminophen, but no change in referrals to physical therapy.”
The authors cite a meta-analysis that concluded narcotics offer minimal benefit to relieve acute back pain and have no proven efficacy in treating chronic back pain. The data also revealed 43% of the patients had concurrent substance abuse disorders. Researchers believe the increase in narcotic prescriptions is connected with the rise of narcotic overdose deaths, which they said is creating a public health crisis.
The steady increase of physicians requests for advanced diagnostic imaging also has become a concern. Exposure to ionizing radiation can lead to later health complications such as cancer, Mafi said, adding a study that linked regions with higher MRI use found an increase in back surgeries.
Study abstract: http://archinte.jamanetwork.com/article.aspx?articleid=1722522.