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Back Pain Treatment Not in Sync With Current Guidelines

Study finds increased use of opioids and nonguideline therapies (July 29)

According to a new study published in JAMA Internal Medicine, trends in back pain treatment strategies in the U.S. are “discordant” with current guidelines.

Investigators at Harvard Medical School report that opioid prescriptions and the use of nonguideline treatments increased between January 1999 and December 2010, while the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen decreased during the same period.

Using data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, the authors studied outpatient visits with a chief symptom and/or a primary diagnosis of back or neck pain, as well as those with secondary symptoms and diagnoses of back or neck pain. Assessments included imaging, narcotics, and referrals to physicians (guideline-discordant indicators). In addition, the authors looked at the use of NSAIDs or acetaminophen and referrals to physical therapy (guideline-concordant indicators).

Data were obtained from 23,918 visits for spine problems. The investigators found that narcotic use per visit increased from 19.3% in 1999–2000 to 29.1% in 2009–2010 (P < 0.001). In contrast, NSAID or acetaminophen use decreased from 36.9% to 24.5% (unadjusted P < 0.001). Physical therapy referrals remained unchanged at approximately 20%, but physician referrals increased from 6.8% to 14.0% (P < 0.001). The number of radiographs also remained stable at approximately 17%, whereas the number of computed tomograms or magnetic resonance images increased from 7.2% to 11.3% during the study period (P < 0.001).

The authors conclude that, despite numerous published guidelines, the management of back pain has relied on “guideline-discordant” care. Improvements in the management of spine-related disease represent an area of potential cost savings for the nation’s health care system, they add.

Source: JAMA Internal Medicine; July 29, 2013.

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