Study: Doctors not following back pain guidelines

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Doctors have increasingly ignored clinical guidelines for the treatment of routine back pain by prescribing powerful and addictive narcotics instead of other recommended painkillers, according to a new study.

Researchers at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston based their conclusion on an examination of about 24,000 cases of spine problems in national databases from 1999 to 2010. Their findings appeared online this week in JAMA Internal Medicine.

"Well-established guidelines for routine back pain stress conservative management, including use of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen and physical therapy," wrote lead author Dr. John Mafi and his colleagues. Under established treatment guidelines, routine back pain will usually improve within three months, they wrote.

Despite these guidelines, researchers found that doctors were doing much the opposite.

Although physical therapy referrals remained steady during the study period, prescriptions for narcotic painkillers jumped 51 percent. That was offset by a drop in prescriptions for non-opiate drugs.

The study's authors noted that an analysis in 2007 found that narcotics provided little or no benefit in cases of acute back pain and that they had also failed to prove effective in cases of chronic back pain. The jump in narcotic prescriptions therefore raised "significant concerns," they wrote, and may be linked to a larger national crisis involving prescription drug deaths.

Researchers also identified "an inappropriate increase" in the use of "low value" diagnostic imaging that could increase patients' future cancer risk because of exposure to ionizing radiation.

Although medical guidelines recommended that doctors avoid early imaging except in rare cases, researchers found that the use of computed tomography or magnetic resonance imaging had increased by 57 percent.

Researchers say that such scans have proved to be of little benefit to patients who lack "red-flag symptoms" and that overuse of the technology has been identified in previous studies as well.

"In 2007, a projected 1,200 additional future cancers were created by the 2.2 million lumbar CTs performed in the United States," the authors wrote in Monday's study.

Nationally, back and neck problems are responsible for more than 10 percent of all visits to primary care physicians and account for $86 billion in health care spending every year.

The study authors said spending on these conditions had increased more rapidly than overall health expenditures from 1997 to 2005.

"With health care costs soaring, improvements in the management of back pain represent an area of potential cost savings for the health care system while also improving the quality of care," the authors concluded.