Traditionally, treating back pain has been built off of the notion that “less is more”. Nonsteroidal anti-inflammatory drugs (NSAIDs)—ibuprofen, aspirin or acetaminophen and physical therapy are all recommended treatments from the guidelines set by the American College of Physicians.
The guidelines do not promote early imaging or “other aggressive treatments, except in rare cases”, with the knowledge that the majority of patients experiencing new back pain tend to get better within three months.
According to John Mafi, a chief medical resident at Beth Israel Deaconess Medical Center, narcotic medications—such as Percocet or Vicodin—have “no proven efficacy in improving chronic back pain”.
Yet, it appears that physicians are increasingly prescribing narcotic drugs to patients with back pain. Findings published in the Journal of the American Medical Association Network publication showed that:
- The recommendation for using NSAIDs or acetaminophen per visit decreased from almost 37% in 1999 to about 24.5% in 2010.
- Narcotic drug use increased from about 19% in 1999 to about 29% in 2010.
- Physician referrals increased from about 7% in 1999 to 14% in 2010.
- Scans, such as computed tomography (CT) or magnetic resonance images (MRIs), rose from about 7% to about 11% during that same period.
- Physical therapy remained unchanged at about 20%; X-rays remained unchanged at about 17%.
What is the reasoning behind doctors using these treatment methods?
“Patients expect doctors to have some kind of magic cure, and so doctors want to offer them something,” Bruce Landon, a professor of health care policy and medicine at Harvard Medical School says. “Often it’s easier to offer them something rather than explaining why more aggressive treatments and testing won’t make them better in the long run.”
What do you think? Have you seen a doctor for a treatment for your back pain?