Most Doctors Neglect Back Pain Guidelines, Leading To Rise In Narcotic Prescriptions

A study published in JAMA Internal Medicine looked at a database of nearly 24,000 back pain-related medical visits from 1999 and 2010 and found that doctors aren't following the proper treatment guidelines.

It is unknown, however, if doctors are intentionally ignoring the guidelines, or if they simply aren't aware. The treatments for back and neck pain, which were categorized together when reviewing the 24,000 participant cases, are supposed to be mild pain killers, such as aspirin or acetaminophens like Tylenol. So then why are doctors turning to extreme medical treatments like CT scans, MRI scans, and addictive pain killers?

Researchers found that within a 10-year span, the use of mild painkillers and acetaminophen dropped from 37 percent in 1999 to 2000 to 24.5 percent in 2009 to 2010. Given this, what was being used to treat pain and neck pain? The use of narcotics, known for their addictive qualities, had a spike of 19 to 29 percent in that same time frame. The use of physical therapy, which is in accordance to the guidelines, remained at a constant 20 percent, but referrals to other doctors doubled from seven percent to 14 percent.

According to the Centers for Disease Control and Prevention, out of the 38,329 drug overdose deaths in the United States, 60 percent of them were pharmaceutical-related (22,134). In 2007, prescription abuse cost the U.S. about $55.7 billion.

Back and neck pain are not uncommon ailments, and doctors see patients about them frequently. According to WebMD, back pain affects 80 percent of Americans at some point in the lifetime, which can come in the form of lower, middle, or upper back pain, or a typically more painful lower back pain combined with Sciatica. Sciatica is a form of pain, weakness, numbness, or tingling in the leg, frequently caused by injury or pressure to the sciatic nerve, which runs from the lower back down to the buttocks and into the lower limb.

"Despite numerous published national guidelines, management of routine back pain increasingly has relied on advanced diagnostic imaging, referrals to other physicians, and use of narcotics, with a concomitant decrease in NSAID (non-steroidal anti-inflammatory drugs) or acetaminophen use," said Dr. John Mafi, lead author from Harvard Medical School.

Those with poor physical fitness or who are overweight are most likely to suffer back pain. back pain often arrives at around the age of 30 to 40, can be hereditary, or can be caused by certain types of arthritis or cancer. Cases of disease or cancer were not included in the observational study, in order to keep the back pain as common and mild as possible for comparison purposes.



"There no longer is any kind of rest, ice, or seeing if your body can heal on its own anymore. You are immediately sent to a specialist, for MORE tests, invasive procedures, and absolutely no regard for the human body as a whole anymore," Dawn Gonzalez, a patient advocate for the Arachnoiditis Society for Awareness and Prevention (ASAP), wrote in an e-mail to National Pain Report. Gonzalez's spine was severely injured by epidural steroid injections (ESI) for back pain and is outspokenly against ESI and other drastic back pain treatment measures.

The question remains; why would doctors ignore guidelines that advise taking a Tylenol and resting, and continue to increase recommendations of pain medications, CT scans, and MRIs in the last decade? Although the study doesn't quite delve deep enough to answer the inner workings of doctors' methodologies, Mafi provides insight.

"The problem is that it really takes a lot of patience to manage back pain," he told HealthDay. "To make matters more complicated, the existing treatments don't cure back pain but only treat its symptoms. Patients want a cure, and doctors want to be able to give them a cure."

What is this quick fix doing to patients though? The use of CT scans and MRIs rose from about seven percent to 11 percent, while X-rays remained a consistent 17 percent from 1999 to 2010. CT scans and MRIs are used for diagnostic reasons to see into the body without actually cutting the body open, but some doctors warn that there has been too much unnecessary radiation exposure from the CT scans to patients lately.

"There's a huge potential for cost savings to improve the quality of care and reduce unnecessary procedures that can lead to patient harm," Mafi said.

MRIs are expensive and can cost anywhere from $500 to well into the thousands, depending upon the number of scans and if injectable contrast dye is used, which allows radiologists to improve visibility of muscles, ligaments, and other organs.

However, it might be worth it to undergo an expensive scan, especially since CT scans emit radiation. Despite the fact that the study revealed an increase in doctor referrals, health boards monitor doctors to ensure they aren't providing favors for other specialty doctors, such as radiologists. The increase in the past 10 years of MRI uses may just be precautionary measures used by the doctors, especially since the first commercial MRI scanner was used in 1980, making it a fairly young but useful technology.

"It depends what trauma or injury the patient has experience, but MRIs are a safe and important non-invasive diagnostic tool that don't use ionizing radiation, while X-rays and CT scans use high dosages of radiation," said David Olson, a radiologic technologist with nearly 15 years of X-ray and MRI experience. "Being able to see what's inside the body is important if the patient is experiencing pain, and MRIs can provide a 3-D image for the doctor to see what's really going on."

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