Researchers from the University of Washington, Seattle, found that the nation's dramatic rise in expenditures for the diagnosis and treatment of back and neck problems has not led to expected improvements in patient health.
Their study appears in the Feb. 13 issue of The Journal of the American Medical Association.
After adjustment for inflation, total estimated medical costs associated with back and neck pain increased by 65% between 1997 and 2005, to about $86 billion a year.
Yet during the same period, patients reported more disability from back and neck pain, including more depression and physical limitations.
"We did not observe improvements in health outcomes commensurate with the increasing costs over time," lead researcher Brook I. Martin, MPH, and colleagues wrote. "Spine problems may offer opportunities to reduce expenditures without associated worsening of clinical outcomes."
The Cost of Treating Back Pain
Low-back pain is one of the most common reasons for doctor visits, with one in four adults in one survey reporting low-back pain within the previous three months. Neck pain is also a common reason for doctor visits.
Over the past decade, diagnostic imaging has become common for patients with back and neck pain, and the use of narcotics, injections, and surgery has also increased dramatically.
In an effort to better understand the medical costs and benefits associated with these interventions, Martin and colleagues analyzed data from the nationally representative survey of medical expenditures from 1997 through 2005.
After adjusting for inflation, they estimated individual yearly medical expenditures among adults with back and neck problems were $4,695 in 1997 and $6,096 in 2005, compared with $2,731 and $3,516, respectively, for people without back and neck problems.
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.
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."