Overtreating chronic back pain

Time to back off?

Richard (Rick) Deyo, Sohail K. Mirza, Judith A. Turner, Brook I. Martin

Research output: Contribution to journalArticle

404 Citations (Scopus)

Abstract

Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. Some of these have become widely used for indications that are not well validated, leading to uncertainty about efficacy and safety, increasing complication rates, and marketing abuses. Recent studies document a 629% increase in Medicare expenditures for epidural steroid injections; a 423% increase in expenditures for opioids for back pain; a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries; and a 220% increase in spinal fusion surgery rates. The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain.

Original languageEnglish (US)
Pages (from-to)62-68
Number of pages7
JournalJournal of the American Board of Family Medicine
Volume22
Issue number1
DOIs
StatePublished - Jan 2009

Fingerprint

Back Pain
Chronic Pain
Health Expenditures
Medicare
Marketing
Epidural Injections
Spinal Fusion
Opioid Analgesics
Uncertainty
Chronic Disease
Magnetic Resonance Spectroscopy
Steroids
Safety
Pain
Equipment and Supplies
Therapeutics
Pharmaceutical Preparations
Population

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice

Cite this

Overtreating chronic back pain : Time to back off? / Deyo, Richard (Rick); Mirza, Sohail K.; Turner, Judith A.; Martin, Brook I.

In: Journal of the American Board of Family Medicine, Vol. 22, No. 1, 01.2009, p. 62-68.

Research output: Contribution to journalArticle

Deyo, Richard (Rick) ; Mirza, Sohail K. ; Turner, Judith A. ; Martin, Brook I. / Overtreating chronic back pain : Time to back off?. In: Journal of the American Board of Family Medicine. 2009 ; Vol. 22, No. 1. pp. 62-68.
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