For back pain, some treatments underused
For back pain, some treatments underused
People with back pain use a lot of medical treatments, but often not the ones with the strongest evidence of effectiveness, according to a study in the April 1 issue of Spine.
The results suggest that some treatments with the strongest evidence of benefit for patients with low back pain, such as therapeutic exercise and antidepressants, are less often used.
In a random telephone survey, Timothy S. Carey, MD, MPH, and colleagues of University of North Carolina, Chapel Hill, identified 732 adults with chronic low back pain. The respondents were asked in detail about what back pain treatments they used.
The respondents saw a wide range of physicians and other health professionals. The average patient made 21 visits to an average of nearly three health care providers per year. Medications were widely used, with narcotics used by 61% of patients, and muscle relaxants used by 31%. Over the past year, more than one-third of patients had undergone advanced imaging procedures.
The patients also used many treatments for which there is little or no research evidence of effectiveness. These included physical treatments such as traction, corsets or braces, or electrical nerve stimulators.
At the same time, use of research-proven treatments was relatively low. Less than half of patients had a prescription for exercise, and only 30% had seen a physical therapist in the past year. Just 3% of patients had gone through a structured rehabilitation program, which is one of the few treatments with moderately strong evidence of effectiveness.
As in previous studies of back pain, many patients had symptoms of depression. However, few of these patients were taking antidepressant medications or seeing a mental health professional.
"Chronic low back pain is disabling, expensive, and becoming increasingly common," Carey and colleagues write. The past 15 years have seen substantial progress in research to evaluate the effectiveness of various treatments for back pain. However, the treatments chosen vary depending on a lot of factors, including patient preferences and which professionals the patient sees.
The new results suggest that most patients with chronic low back pain see more than one health professional and receive several different tests and treatments. The researchers voice special concern about the overuse of narcotics and other medications and the underuse of exercise, antidepressants, and other proven treatments. "Concerted efforts by professional groups, insurers, and health policy makers are needed to substantially change treatment patterns...for this common and disabling illness," Carey and colleagues conclude.
People with back pain use a lot of medical treatments, but often not the ones with the strongest evidence of effectiveness, according to a study in the April 1 issue of Spine.Subscribe Now for Access
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