Using national survey data, researchers with the Harvard Medical School identified almost 24,000 outpatient visits between 1999 and 2010 where the patients' main symptom was back or neck pain. They found increases in non-recommended actions such as the use of advanced imaging, referrals to other physicians and prescriptions for narcotics.
Back and neck problems account for $86 billion a year in healthcare spending nationally. Health systems and payers have tried hard to curb inappropriate use of imaging services for routine back pain complaints. The researchers found that early use of MRI for acute back pain was associated with an eightfold increase in surgery.
The researchers also saw a decrease in recommended treatments such as physical therapy and nonsteroidal anti-inflammatory drugs or acetaminophen. They estimated that the visits identified in the surveys corresponded to 440 million actual patient visits for back and neck pain.
“With healthcare costs soaring, improvements in the management of back pain represent an area of potential cost savings for the healthcare system while also improving the quality of care,” the study authors concluded.
In an accompanying editorial, Dr. Donald Casey Jr., with the New York University School of Medicine's department of population health, suggested several reasons for the findings. These included “a historical admonition” of physicians for failing to treat patients' pain, greater availability of imaging facilities, patient demand for quick resolution, price insensitivity by both doctors and patients, and physician fear of being sued for “missing something.”
The last explanation matches a 2011 study by researchers at Children's Hospital of Philadelphia who surveyed members of the Pennsylvania Orthopedic society and determined that 19% of imaging tests were ordered for “defensive medicine” purposes.
These findings, however, run counter to the well-publicized efforts to reduce the use of expensive imaging tests in back pain treatment that have been in place at institutions such as Seattle's Virginia Mason Medical Center. Since 2004, Virginia Mason was able to lower costs and improve patient satisfaction without an increase in failure-to-diagnose lawsuits. In fact, they reported a 56% reduction in professional liability insurance premiums between 2004 and 2011.
The researchers noted that using established treatment guidelines, routine back pain usually improves within three months.
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