07/31/2013 02:54 pm ET

Back Pain Treatment Straying From Clinical Recommendations, Study Finds


More doctors need to follow guidelines for treating their patients' back pain, according to a new study in JAMA Internal Medicine.

Clinical recommendations for treating back pain have long been to take acetaminophen or NSAIDs and to undergo physical therapy. Beth Israel Deaconess Medical Center researchers noted that these methods usually result in alleviated pain within three months.

However, these researchers found that not only did use of the over-the-counter pain relievers decrease over the past 10 years, but the use of other, potentially unnecessary methods increased.

The researchers reviewed data from 23,918 spine-related outpatient doctor visits that took place between 1999 and 2010. They found that more patients were being prescribed narcotics for their pain -- going from 19.3 percent in 1999-2000 to 29.1 percent in 2009-2010 -- and more patients were also undergoing advanced imaging techniques (including MRI or CT scans) -- going from 7.2 percent in 1999-2000 to 11.3 percent in 2009-2010.

Plus, the researchers found that the use of NSAIDs and acetaminophen decreased from 1999-2000 to 2009-2010, from 36.9 percent to 24.5 percent. However, they didn't find any differences in the number of referrals to physical therapy between those time frames (staying steady at 20 percent).

"Despite numerous published clinical guidelines, management of back pain has relied increasingly on guideline discordant care," the researchers wrote in the study. "Improvements in the management of spine-related disease represent an area of potential cost savings for the health care system with the potential for improving the quality of care."

In a related commentary published online in the same journal, Donald E. Casey, Jr., M.D., of New York University School of Medicine, explained that there are several possible reasons for this divergence from the official clinical guidelines for treatment of back pain. One could be that patients want fast results; another possible reason is that imaging centers are widely available, making it easier to get advanced imaging. Another explanation is the "perception that specialists are experts and, hence, more qualified to treat these patients and provide the best care," while yet another is price insensitivity on the part of both doctors and patients.