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    $86 Billion Spent on Back, Neck Pain

    Despite Nation's Dramatic Increase in Spending, Little Improvement Seen in Patients

    The Cost of Treating Back Pain continued...

    Martin tells WebMD that the 65% inflation-adjusted increase in total costs among adults with spine problems was higher than the increase in health costs overall.

    "We are spending as much on spine problems as we do for cancer and arthritis," he says. "The only disease category that dwarfs these is heart disease and stroke. If we are spending more on diagnosis and treatment, we should expect to see health status changes that are commensurate with that investment. But that is not what we are seeing."

    Steep Rise in Drug Costs

    Some of the largest increases have been in expenditures related to drug treatments, Martin says.

    Overall, pharmaceutical expenditures related to back and neck pain increased by 188% between 1997 and 2005, but cost associated with prescription narcotics rose by a whopping 423%.

    University of Washington Medical Center clinician Richard Deyo, MD, MPH, tells WebMD that increasing use of the newer narcotics such as the drugs Vicodin and OxyContin is largely responsible for the increase, even though their use for chronic pain is controversial.

    He says patients need to recognize that the drugs have many potential side effects, including drowsiness, persistent constipation, and sexual dysfunction.

    Deyo co-directs the University of Washington Center for Cost and Outcomes Research, and he was a co-author of the study.

    "We still don't know much about their long-term efficacy and safety for chronic back pain," he says. "Patients need to understand that if they take these (opioid) medications long term, after a few months it will be difficult to stop. And there is pretty good evidence that long-term use may actually increase sensitivity to pain."

    Too Much Surgery?

    Surgery, especially spinal fusion surgery or disc replacement surgery, is also a growing and somewhat controversial treatment for patients with chronic back pain without sciatica.

    "An aggressive arm of the surgical community believes that these patients benefit from surgery, but this is an area where the evidence is at best murky and confusing," Deyo says.

    Orthopedic surgeon Paul Rubery, MD, agrees that the benefits of surgery are questionable in this group of patients.

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