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Medicine and the Overtreatment of Back Pain

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Medicine and the Overtreatment of Back Pain

The Chiro.Org Blog

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

Medical Mis-Management of Low Back Pain

About the Author:

I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been, and remains, my favorite hobby.


  1. Scott November 3, 2009 at 11:59 pm

    We need to get this out to the masses, you can’t argue when you see numbers like that. Too bad chiropractors don’t have a better PR machine.

  2. Frank November 4, 2009 at 1:09 am

    We do, Scott…and it’s right here!

    But it only works if you share what you see here.

  3. Richard Rogovin, DC November 4, 2009 at 10:43 am

    The general public does not know these things. All we can do is educate educate and educate. I would like to add some of these facts to my website.

  4. karl November 4, 2009 at 4:05 pm

    this article again reveals how difficult/challenging the neuromusculoskeletal system is to treat/rehab. there’s no one answer/ “silver bullet”. but having said that, conservative care should be the first choice option in most cases of NMS conditions. this is why i feel it’s important to be heard. the chiropractic profession should become a more collective force/presence. part of our strategy should be presenting the facts and not smear other practitioners. COST is and always will be a primary issue. that’s our strong point. that’s why the physical therapists are in my opinion are becoming dominate players in the physical medicine arena. they are replicating our model. we need to “fight” as professionals. smearing the other practitioners is a trap. they will use it against you. be heard but be heard with facts.

  5. Frank November 4, 2009 at 4:40 pm

    Hi Karl

    Do you consider this posting a smear? I hope not. The Cost-Effectiveness of Chiropractic page contains many of these studies.

    The people who need to see these studies are Insurance Companies. If they realize how much they can save, they will do their part to preferentially direct patients towards us. Here’s how that could work:

    Several years ago I called to verify insurance coverage for a new patient.

    The adjuster rattled on that the coverage was 300 deductable and 75% copay for medical services.

    I said, that’s nice, but I’m a chiropractor.

    She said “OH! Well for chiropractic the deductable is only 200, and we pay 85%!

    I believe this is just the tip of the iceberg. The beginning of a tusanami of change.

  6. karl November 5, 2009 at 11:18 pm

    hey frank…….no i didn’t think the article was a smear at all. i probably wasn’t clear. i just would like to see more chiropractors use info like this without becoming over the top/evil like….. smearing other practitioners. reason is, first i believe it’s the wrong approach; secondly and maybe even more importantly the blowback if you will can be bad news. keep up the good work it’s very much appreciated. i hope i’m being alittle clearer.

  7. Dr. Kevin Smith November 7, 2009 at 11:55 am

    Great article. If permissible, I’d like to use the information for a hand out for my patients.

  8. Frank November 7, 2009 at 2:17 pm

    Hi Kevin

    We’re happy for doctors to utilize our materials for patient education. We would appreciate you footnoting us as your source. Have a great weekend!

  9. Marco J. La Starza, D.C. November 7, 2009 at 9:45 pm

    It seems like everyone who has LBP has tried injections and heavy meds by the time they get to me?

  10. Chiropractic Books November 10, 2009 at 4:20 pm

    Some of those percentage increases are frightening numbers. Thanks for getting the word out!

    Dr Doug
    Chiropractic Books

  11. Dr. Kevin Smith November 13, 2009 at 9:08 am

    Dr. Frank,

    Thank you. And I would be more than happy to include the footnote!

    Have a terrific weekend!


  12. Scott Garber November 18, 2009 at 11:21 pm

    I am all about informed choice and the least invasive way first. It is very sad when I receive a new patient who has gone the route of pills, surgery, and more pills. Information like this is great to be able to educate people before they make a choice. Thanks Frank.

  13. Dr. Kevin Smith November 20, 2009 at 11:32 am

    Dr. Garber brings up a very good point. It’s better that we are able to get out into the public and educate them about their treatment options (a TRUE informed consent). It’s not smear if all you’re doing is presenting the truth.

  14. Scott November 23, 2009 at 9:53 pm

    I am not an advocate of smear. I think long term all it does is confuse the public. With the internet and sites like this the public is now more educated then ever. They are NOT stupid and are starting to see the truth. All we need to do is show them data, statistics, and not have to put down or bash other systems.

  15. Scott November 23, 2009 at 9:56 pm

    Oh, and thanks Dr. Dan Murphy for your time and research. Thanks again Frank for making this information available to learn and share.

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