(HealthDay News) – Management of back pain is increasingly relying on guideline discordant care, including narcotic use, advanced imaging, and referrals to physicians, according to research published online July 29 in JAMA Internal Medicine.

John N. Mafi, MD, from Harvard Medical School in Boston, and colleagues used nationally representative data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to characterize treatment of back pain from 1999–2010. The authors assessed the use of guideline discordant indicators (imaging, narcotics, and referrals to physicians) and guideline concordant indicators (nonsteroidal anti-inflammatory drug [NSAID] or acetaminophen use and referrals to physical therapy).

The researchers identified 23,918 outpatient visits for spine problems, representing about 440 million visits. There was a significant decrease in NSAID or acetaminophen use per visit, from 36.9% in 1999–2000 to 24.5% in 2009–2010. Narcotic use increased significantly from 19.3% to 29.1% during the same period. Physician referrals increased significantly from 6.8% to 14%, while there was no change in physical therapy referrals (about 20%). During the study period, the number of radiographs was unchanged at about 17%, but computed tomograms and magnetic resonance imaging increased significantly from 7.2% to 11.3%.

“Despite numerous published clinical guidelines, management of back pain has relied increasingly on guideline discordant care,” the authors write. “Improvements in the management of spine-related disease represent an area of potential cost savings for the health care system with the potential for improving the quality of care.”

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