Doctors ignore guidelines for back pain, study finds

Share with others:


Print Email Read Later

By Monte Morin

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 spine problem cases in national databases from 1999 to 2010. Their findings are 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 John Mafi, a Boston internal medicine physician, and colleagues.

Under established treatment guidelines, routine back pain usually improves within three months. Despite those guidelines, researchers found doctors were doing much the opposite.

Although physical therapy referrals remained steady during the study period, narcotic painkiller prescriptions jumped 51 percent, offset by a drop in non-opiate drug prescriptions.

The authors noted that a 2007 analysis found narcotics providing little or no benefit for acute back pain and also ineffective for chronic back pain. The narcotic prescription increase raises "significant concerns," they wrote, and may be tied to a national prescription drug death crisis.

Researchers also identified "an inappropriate increase" in use of "low-value" diagnostic imaging that could increase patients' future cancer risk because of exposure to ionizing radiation. While medical guidelines urge doctors to avoid early imaging except in rare cases, researchers found that computed tomography or magnetic resonance imaging (CT scans and MRI) use had increased by 57 percent.

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

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 spine problem cases in national databases from 1999 to 2010. Their findings are 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 John Mafi, a Boston internal medicine physician, and colleagues.

Under established treatment guidelines, routine back pain usually improves within three months. Despite those guidelines, researchers found doctors were doing much the opposite.

Although physical therapy referrals remained steady during the study period, narcotic painkiller prescriptions jumped 51 percent, offset by a drop in non-opiate drug prescriptions.

The authors noted that a 2007 analysis found narcotics providing little or no benefit for acute back pain and also ineffective for chronic back pain. The narcotic prescription increase raises "significant concerns," they wrote, and may be tied to a national prescription drug death crisis.

Researchers also identified "an inappropriate increase" in use of "low-value" diagnostic imaging that could increase patients' future cancer risk because of exposure to ionizing radiation. While medical guidelines urge doctors to avoid early imaging except in rare cases, researchers found that computed tomography or magnetic resonance imaging (CT scans and MRI) use had increased by 57 percent.

health - science


Advertisement
Advertisement
Advertisement

You have 2 remaining free articles this month

Try unlimited digital access

If you are an existing subscriber,
link your account for free access. Start here

You’ve reached the limit of free articles this month.

To continue unlimited reading

If you are an existing subscriber,
link your account for free access. Start here