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$86 Billion Spent on Back, Neck Pain

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

Steep Rise in Drug Costs continued...

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.

Rubery directs the Spine Center at New York's University of Rochester Medical Center.

He tells WebMD that some of the blame for the rising cost of back and neck treatment belongs to the patient.

"Patients often want the drugs they see on TV or the one their uncle is on, even if an older and cheaper drug will work just as well," he says. "And these days, most patients demand MRIs, even when there is little medical indication. If patients were willing to accept time-tested treatments and take more responsibility for their health, costs would come way down."


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