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Back Pain Health Center

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Docs Order Too Many Narcotics for Back Pain: Study

Physical therapy and over-the-counter painkillers usually more appropriate, guidelines say

WebMD News from HealthDay

By Randy Dotinga

HealthDay Reporter

MONDAY, July 29 (HealthDay News) -- Many doctors ignore guidelines about the treatment of back pain and instead turn to extensive use of scans like MRIs and the most addictive types of painkillers, new research finds.

It's not clear exactly how many aren't following recommendations, nor whether they're causing harm or perhaps just not helping patients get better. Researchers also don't know if the physicians are unaware of the guidelines or simply don't want to follow them.

Still, the findings are troublesome, said study author Dr. John Mafi, chief medical resident at Beth Israel Deaconess Medical Center in Boston. While they may be appropriate in some cases, treatments like scans and powerful painkillers "are increasingly being overused, and unnecessarily so," he said. "Doctors are increasingly not following guidelines."

Back pain and neck pain (which the new study combines into one category) are very common in the United States. According to estimates, they account for more than 10 percent of all visits to primary care doctors and cost $86 billion to treat.

Established, national guidelines suggest that routine back pain be treated with physical therapy and painkillers including aspirin-like drugs and acetaminophen (Tylenol). Only rare cases are thought to need more aggressive treatment, such as imaging scans.

The study authors looked at a database of nearly 24,000 U.S. medical visits from 1999 to 2010 that were related to back pain. People with serious conditions potentially linked to their back pain -- like cancer -- were not included.

The researchers found that the use of aspirin-like painkillers and acetaminophen fell from about 37 percent in 1999-2000 to 24.5 percent in 2009-2010, while the use of narcotics -- which can be addictive -- jumped from 19 percent to 29 percent. Use of physical therapy remained steady at about 20 percent, while referrals to other physicians doubled, from nearly 7 percent to 14 percent.

Meanwhile, use of X-rays remained stable at about 17 percent, while use of CT scans and MRIs rose from about 7 percent to 11 percent. CTs and MRIs have become much more common over the past two decades, prompting some physicians to warn that they're exposing too many patients to unnecessary and dangerous levels of radiation.

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