Medicine and the Overtreatment of Back Pain
SOURCE: J Am Board Fam Med. 2009 (Jan); 22 (1): 62-68
Commentary by Dan Murphy, D.C.
I just read a fascinating article in the January edition of the Journal of the American Board of Family Medicine, as it documents the massive increase in costs for medical management of chronic back pain, with no comparable improvements in patient outcomes, or decreases in disability rates. Worse yet, significant increases in post-intervention complications (including death) also appear to be on the rise.
This article documents:
- a 629% increase for epidural steroid injections
- a 423% increase in expenditures for opioids for back pain
- a 307% increase in the number of lumbar magnetic resonance images
- a 231% increase in facet joint injections
- a 220% increase in spinal fusion surgery rates
- Manufacturers aggressively promote new drugs and devices for the treatment of back pain, yet there is evidence of misleading advertising, kickbacks to physicians, and major investments by surgeons in the products they are promoting.
- Prescription opioid use is steadily increasing, especially for musculoskeletal conditions. Emergency department reports of opioid overdose parallel the numbers of prescriptions. Deaths related to prescription opioids are greater than the combined total involving cocaine and heroin. Ironically, “Opioid use may paradoxically increase sensitivity to pain.”
- New and improved spinal fusion techniques and devices, such as implants, increase the risk of nerve injury, blood loss, overall complications, operative time, and repeat surgery, but do not result in improved disability or reoperation rates.
- Increases in the rates of imaging, opioid prescriptions, injections, and fusion surgery might be justified if there were substantial improvements in patient outcomes; unfortunately, they are not. In fact, statistics indicate that disability from musculoskeletal disorders is rising, not falling. “Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain.”
At the same time that medicine has ramped up costs (gobbling up the Medicare pie), a long line of studies have shown the clear superiority of chiropractic management for low back pain. Please review the most in-depth study, published in May of 2007 which compared medical and chiropractic management for LBP in a managed care group:
Clinical and cost utilization, based on 70,274 member-months, over a 7-year period, demonstrated:
- decreases of 60.2% in-hospital admissions
- 59.0% less hospital days
- 62.0% less outpatient surgeries and procedures, and
- 83% less pharmaceutical costs
when patients were seen by a chiropractor, instead of seeing a conventional medical IPA doctor.
It’s time to end the