Back Pain Relief Elusive: More Therapy Is Not Helping
Americans are spending more money trying to ease back and
neck pain, but new research suggests those extra dollars are not buying more
relief.
The increased expenditures were expected, say the authors
of a study in the Journal of the American Medical
Association (JAMA), but the lack of results were not.
"This calls into question whether we're providing
treatments to people who are not going to benefit," says study author Brook
Martin, a research scientist in the department of orthopedics and sports
medicine at the University of Washington, in Seattle.
"This calls for a need for more effectiveness studies and
looking at which patients would benefit from treatments and diagnostic tests,"
he says.
Dr. Andrew Sherman, at the Spine Institute at the
University of Miami, says, "Spine problems are the most common reason why people
of middle age have pain and disability.
"We need to continue to search for better solutions
because, although we have come up with newer techniques of treatments, we still
have a large percentage of the population with spine problems who are still
disabled," he says.
Dr. Sherman adds, "Just because [the study authors] did not
find improvement over the entire group doesn't mean that many individuals are
not deriving benefit from treatment. There are many individual patients who do
see improvements."
According to the article, 26 percent of US adults in 2002
reported lower back pain, and 14 percent reported neck pain during the previous
three months.
Low back pain alone accounted for about 2 percent of all
physician's office visits, exceeded only by routine exams, hypertension, and
diabetes.
At the same time, there have been increases in the rates of
imaging, injections, use of opiates, and surgery all related to spine pain.
But have these expenditures resulted in any actual
improvements for the patient?
The authors sought to answer this question using data from
the Medical Expenditure Panel Survey, which sampled individuals around the
nation ages 17 and older from 1997 to 2005.
In 1997, 23,045 individuals were sampled, including 3,139
who reported spine problems. At this time, medical costs for those with spine
problems was $4,695 compared with just $2,731 for those without spine problems.
In 2005, the survey included 22,258 respondents, including
3,187 with self-reported spine problems. Medical expenditures for those with
spine problems was now $6,096 versus $3,516 for those without back and neck
problems.
During that period, expenditures increased 65 percent from
1997 to 2005 for those with spine problems, which was more than for overall
health expenditures during the same time period. There was only a small increase
in the estimated number of US adults with spine problems.
The estimated proportion of people with self-reported physical disabilities
resulting from spine problems also increased, from 20.7 percent to 24.7 percent.
Most of the cost difference came from outpatient and
inpatient services, with a smaller proportion accounted for by prescription
medicines. However, the percentage of expenditures related to prescription
medications went up more rapidly than expenses for other services.
"That includes a 423 percent increase in expenditures
related to narcotic analgesics over that time," says Martin. "There's been a
steady stream of new devices and surgical techniques and imaging methods being
used over time. There's also been a moderate increase in people with back
problems."
The annual expenditures for spine problems are comparable
to the amount spent annually on arthritis, diabetes, and cancer. All of those
figures are dwarfed by the enormous sums spent in this country on heart disease
and stroke.
Always consult your physician for more information.