Time to Align Coverage with Evidence for Treatment of Back Pain

Daniel C. Cherkin, Richard A. Deyo, Harley Goldberg

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Despite improved knowledge about the benefits and harms of treatments for chronic back pain in the past several decades, there is a large and consequential mismatch between treatments found safe and effective and those routinely covered by health insurance. As a result, care for back pain has, if anything, deteriorated in recent decades—expenses are higher, harms are greater, and use of ineffective treatments is more common. Deficiencies in health care delivery processes and payment models are centrally involved in the failure to improve care for back pain. A key step for accelerating progress is changing insurance coverage policies to facilitate use of the safest and most helpful approaches while discouraging riskier and less effective treatments. Relatively simple changes in reimbursement policies may minimize harm and improve quality of life for many patients with chronic back and similar pain syndromes. Such changes might also reduce health care expenditures because the costs of treatments currently covered by insurance and their associated harms may well outweigh the costs of the relatively safe and effective treatments recommended by current guidelines but poorly covered by insurance. There is no justification for continuing the status quo—patients and clinicians deserve better.

Original languageEnglish (US)
Pages (from-to)1910-1912
Number of pages3
JournalJournal of general internal medicine
Issue number9
StatePublished - Sep 15 2019


  • back pain
  • evidence-based medicine
  • health insurance
  • reimbursement

ASJC Scopus subject areas

  • Internal Medicine


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