Overtreating chronic back pain: time to back off?
Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. Some of these have become widely used for indications that are not well validated, leading to uncertainty about efficacy and safety, increasing complication rates, and marketing abuses. Recent studies document a 629% increase in Medicare expenditures 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 among Medicare beneficiaries; and a 220% increase in spinal fusion surgery rates. The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain.
Deyo
Richard A
RA
Department of Medicine, Oregon Health and Science University, Portland, OR, USA. deyor@ohsu.edu
Mirza
Sohail K
SK
Turner
Judith A
JA
Martin
Brook I
BI
D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy* / Q000601:surgery; D005791:Patient Care / Q000379:methods*; D013124:Spinal Injuries; D013997:Time Factors
D000701:Analgesics, Opioid