Doctors Ignoring Evidence for Back Pain Treatment
Medical doctors are increasingly ignoring the recommended guidelines for treating back pain, a new study from the Journal of American Medical Association finds.
Researchers from the Beth Israel Deaconess Medical Center in Boston examined records for 23,918 doctor visits related to back pain between 1999 and 2000. They discovered that medical doctors are actually getting worse at employing evidence-based treatments.
Current guidelines from the American Medical Association recommend that acute back pain be treated first with conservative, active treatments like chiropractic care and exercise rehabilitation. Over-the-counter non-steroidal anti-inflammatory drugs can be used to ease short-term pain, rather than narcotics like Oxycontin which can actually make matters worse, according to recent research.
However researchers found that physicians are overprescribing narcotics and overusing expensive testing.
During the study period, prescriptions for narcotics grew from 19.3% to 29.1%, reflecting a national trend of growing opioid use. Lead researcher, Dr. John Mafi, explained that during the 1990s medical doctors were widely accused of ignoring patients' pain. While some of the criticism was valid, many physicians overreacted by doling out more serious painkillers. Now around 43% of patients with back pain show signs of substance abuse disorders, Mafi and his colleagues found.
Doctors are also relying too heavily on imaging techniques no longer deemed necessary for every type of spinal pain. Use of MRI and CT scans grew from 7.2% to 11.3% during the study period, despite research demonstrating such scans are not always useful for many cases of back and neck pain. Although these scans do not harm the patient, they typically don't find anything wrong, and can cost around $1,000 per a scan.
That may be why patients under standard medical care tend have more medical costs associated with their back pain treatment compared to chiropractic patients, according to a recent study. Chiropractic patients can also expect to receive evidence-based treatments like exercise therapy and spinal adjustments. A study of military personnel with back pain earlier this year found that those treated by a chiropractor had better results compared to patients treated with standard medical care alone.
Mafi JN, et al. Worsening trends in the management and treatment of back pain. JAMA 2013; doi:10.1001/jamainternmed.2013.8992.