Wednesday, February 13, 2008

Back Pain Spending Surge Shows No Benefit - New York Times

Back Pain Spending Surge Shows No Benefit

Americans are spending more money than ever to treat spine problems, but their backs aren't getting any better.

Those are the findings of a report in the Journal of the American Medical Association, which found that United States spending on spine treatments totaled nearly $86 billion in 2005, a rise of 65 percent from 1997, after adjusting for inflation. Even so, the proportion of people with impaired function due to spine problems actually increased during the period, even after controlling for an aging population.

"You'd think if you're putting a lot of money into a problem, you'd see some improvements in health status,'' said lead author Brook I. Martin, research scientist at the University of Washington's department of orthopedics and sports medicine. "We're putting a lot of money into this problem, and it's a big investment in health care expenditures, but we're not seeing health status commensurate with those investments.''

The report is the latest to suggest the nation is losing its battle against back pain, and that many popular treatments may be ineffective or overused. Researchers have produced conflicting data about the effectiveness of spinal fusion surgery for back pain, although one major study called Sport, for Spine Patient Outcomes Research Trial, showed that spinal surgery patients did better than patients receiving more conservative care, which included medications or physical therapy. However, some doctors have questioned whether surgical treatments, injections and narcotic pain medications are being used appropriately in many patients.

"I think the truth is we have perhaps oversold what we have to offer,'' said Dr. Richard A. Deyo, a physician at the Oregon Health & Science University in Portland and a coauthor of the report. "All the imaging we do, all the drug treatments, all the injections, all the operations have some benefit for some patients. But I think in each of those situations we've begun using those tests or treatments more widely than science would really support.''

To study spending trends in spinal care, the researchers examined annual household survey data from the Agency for Healthcare Research and Quality that was collected from about 23,000 people a year from 1997 to 2005. It included information from pharmacy and medical records and was used to estimate national spending and treatment practices.

The researchers found that people with spine problems spent about $6,096 each on medical care in 2005, compared to $3,516 in medical spending among those without spine problems.

During that time, the biggest surge in spending was for drugs. In 2005, Americans spent an estimated $20 billion on drug treatments for back and neck problems, an increase of 171 percent from 1997. The biggest jump was for narcotic pain relievers, such as OxyContin and other drugs, which increased more than 400 percent.

Outpatient treatment for back and neck problems increased 74 percent to about $31 billion during the period, while spending related to emergency room visits grew by 46 percent to $2.6 billion. Spending for surgical procedures and other inpatient costs grew by 25 percent to about $24 billion.
Despite the growth in treatment of back problems, the data show that the percentage of people with serious spine problems hasn't improved. In fact, it appears to have gotten worse.

Based on the sample, the researchers estimated that in 1997, about 21 percent of the adult population suffered from back or neck problems that limited their function. By 2005, that number grew to about 26 percent, after adjusting the numbers for age and sex.

It's not clear why more people appear to be suffering from back and neck pain. It could be that rising obesity rates are taking an added toll on the spine, researchers suggested. Or it could be that excessive treatment of back problems is leading to more problems.

"I do worry there is a combination of side effects and unnecessary treatments and labeling people as being fragile when they're really not,'' Dr. Deyo said. "The combination of those kinds of things may actually be in some cases doing more harm than good.''

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