New research published in the Journal of the American Medical Association (JAMA) indicates that physicians are increasingly treating back pain with narcotics.
Recent studies show that more than 10 percent of visits to primary care physicians are related to back or neck pain. The research also uncovered the disturbing trend of doctors prescribing arguably unnecessary prescriptions for narcotics. This despite newly published clinical treatment guidelines recommending first-line treatment for back pain with non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen.
The authors of the research used nationally representative data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to assess trends in treatment, including diagnostic imaging, physical therapy, referrals to other physicians, and medication use, in outpatient visits for neck and back pain. The study covered January 1, 1999, to December 26, 2010. Patients who presented fever, neurologic symptoms, or were diagnosed with cancer were excluded from the sample.
During the time frame studied, 23,918 physician visits related to neck and back pain were identified. Between the beginning and the end of the study period, use of NSAIDs or acetaminophen per visit decreased from 36.9 percent to 24.5 percent, while use of narcotics per visit increased from 19.3 percent to 29.1 percent—an increase of more than 50 percent. In addition, use of muscle relaxants and benzodiazepines per visit increased from 19.6 percent to 23.7 percent, and use of neuropathic agents per visit increased from 3.4 percent to 7.9 percent.
Patients with back and neck pain also received more screenings after visiting their physicians. The number of expensive computed tomograms or magnetic resonance images increased from 7.2 percent at the beginning of the study to 11.3 percent by the end of the study.
The results fly in the face of current guidelines and are especially troubling in light of a significant increase in the number of deaths caused by opioid painkillers. The researchers stated that the growing use of narcotics instead of recommended treatment for neck and back pain was not only possibly detrimental to patient safety and health; it also contributed unnecessarily to health care spending. The researchers also pointed out that spending for treatment of these orthopedic conditions increased at a faster rate than overall health expenditures from 1997 to 2005.
With the soaring cost of health care an ongoing social and political issue, 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, said the researchers.