Wednesday, February 13, 2008

Back and Neck Pain is a Money Drain

Several sources including MSNBC, the NY times and Forbes are reporting findings from a study published in JAMA that shows despite the cost of treating back and neck pain rising 65% over the past decade (a whopping $85.9 billion a year which is almost as much as we spend to treat cancer), people aren't getting any better.
Use of expensive drugs (Celebrex), diagnostic tests (MRI's) and expensive surgeries (spinal fusion) are cited as the reasons for the cost increase. Yet these treatments don't seem to help any. The study looked at national survey of what people spend and how healthy they are. Despite the increase in spending on spinal problems, people with back and neck problems who reported physical, social and work limitations rose to 24.7 percent in 2005 from 20.7 percent in 1997.
Bottom Line: The bad news is that most of our current treatments for back and neck pain aren't that great. The good news is that most of these conditions resolve on their own. Before spending lots of money on medications, surgery and expensive tests; try good old fashion rest, heat and cheaper drugs like Tylenol and and Ibuprofen/Alleve.

More info: With the exception of one recent study (SPORT) which suggest spinal surgery might be more effective than conservative treatment, most reports show that when it comes to spinal pain, all treatments seem to work about equally effectively and don't help a great deal. An article on low back pain that I ask my students to read comes from American Family Physician that states:

"Acute low back pain with or without sciatica usually is self-limited and has no serious underlying pathology. For most patients, reassurance, pain medications, and advice to stay active are sufficient"

There are certain "red flag" coniditions associated with back pain that might require more agressive testing or treatment which include:

Age > 50 years, fevers/chills, recent infection, wound near spine, history of significant trauma, unrelenting night pain or pain at rest, worsening muscle weakness or nerve damage, difficulty urinating, fecal incontinence, unexplained weight loss, cancer or strong suspicion for current cancer, osteoporosis, depressed immune system from medications like oral steroids, and IV drug use.

However, absence of these conditions usually means not much more needs to be done. Most back or neck pain resolves in 4-6 weeks. If things don't get better, then more testing, referrals, etc. may be indicated.

One of the disturbing things about the report is that when it came to prescriptions, one of the biggest increases was with the drug Oxycontin. This is a narcotic medication that is extremely addicitive and can be quite dangerous. In general, it is not recommended in the treatment of chronic back and neck pain.

Also, general health and ergonomics are major contributors to spinal pain and are often overlooked. Many patients with back pain get substantial improvement from weight loss. Though weight loss is difficult for many, even a 5-10% decrease in body weight can lead to imrovements in back pain (in addition to overall health). Both back and neck pain can also be caused by poor seating, posture, and other work related conditions like driving for long periods of time. Simple adjustments of the works space are very cheap and often quite effective.

1 comment:

david said...

I never thought I would be one to suffer from back pain, even when I saw my dad suffer as he got older I didn't think it would be that painful. Now 45 I regret saying any of that, I get out of bed every morning birth chronic back pain, going to try and take some of your remedies on board.