Back Pain often Overdiagnosed and Overtreated

The standard treatment for what doctors commonly term as “routine” back pain, surprisingly, involves conservative measures such as over-the-counter pain relievers, ice and heat application, and gentle exercise. Despite this, a significant number of unnecessary tests, prescriptions for narcotics, and referrals for surgery have been prevalent in medical practices. Dr. Bruce E. Landon, a professor of health care policy at Harvard Medical School, emphasizes that most routine back pain tends to improve on its own within three months with conservative therapy. Aggressive interventions like injections, imaging, and surgery often show little impact on long-term outcomes and may even have the potential to worsen the condition.

A recent study led by Dr. Landon and colleagues reveals a worsening trend of overdiagnosis and overtreatment. Analyzing data from nearly 24,000 outpatient visits for acute or chronic flare-up back pain between 1999 and 2010, they assessed whether patients were treated according to established evidence-based guidelines. These guidelines recommend non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen for pain relief, referral to physical therapy when appropriate, cautious use of imaging, and avoidance of narcotics and early referrals for injections or surgery.

Back pain guidelines ignored

The study published in JAMA Internal Medicine highlights an increasing trend among doctors to deviate from evidence-based guidelines for treating back pain. The data covering 1999 to 2010 showed a decline in the use of non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, while prescriptions for narcotic pain relievers, referrals to other physicians, and requests for CT or MRI scans increased. The shift toward more aggressive treatments may stem from patient demands and the convenience for doctors, who often find it easier to prescribe medications or order tests rather than spend time on patient education. The current healthcare system’s structure may contribute to this trend, as doctors are often compensated for procedures rather than counseling.

What to do for low back pain

Dr. Jeffrey N. Katz, a professor of medicine and orthopedic surgery at Harvard Medical School, recommends the following strategies for managing low back pain:

1. Cold and heat: Use ice or cold packs at the beginning of a flare-up and switch to gentle heat after 48 hours.

2. Rest: If sitting or standing causes severe pain, bed rest can be helpful for short periods (a few hours at a time, for no more than a couple of days).

3. Exercise: An exercise program can aid the healing process during an acute flare-up, prevent recurring episodes, and improve function in chronic low back pain. Work with a doctor or physical therapist to develop a suitable exercise plan.

4. Medication: Over-the-counter pain relievers, such as acetaminophen or NSAIDs like aspirin, ibuprofen, or naproxen, are usually sufficient to relieve acute low back pain. Regularly scheduled use is more effective than taking them after the pain flares up.

If these strategies prove ineffective, consult with a doctor about more advanced options for treating low back pain.