Is your back pain being overtreated?

A Disease Management post on 2/13/2018.   Topics: 

back pain

If you’re one of the approximately 80% of Americans living with chronic back pain, you may be at risk of being overtreated or undergoing more aggressive treatment too soon. Both in the U.S. and abroad, the guidelines for the diagnosis and treatment of back pain start with more conservative approaches, including:

  • non-steroidal anti-inflammatory medications (NSAIDs) or acetaminophen to manage pain
  • physical therapy
  • losing weight if you’re overweight
  • applying ice and/or heat

Experts advise against primary care physicians routinely sending patients for imaging tests such as MRI or CT scans, immediately referring patients to specialists for injections or surgery, and prescribing narcotic pain relivers. Researchers have found that most routine back pain improves with conservative treatment and that getting more aggressive types of treatment sooner does not change the long-term outcome and may even limit your future treatment options.

But studies have found that, faced with patients who request referrals or more aggressive types of treatments, doctors often skip conservative treatments and follow a more aggressive treatment path. One study found that:

  • use of acetaminophen and NSAIDs declined by just over 50%
  • opiate prescriptions increased 51%
  • CT and MRI scans for back pain rose 57%
  • referrals to specialists increased 106%

Who’s at risk for chronic back pain?

While anyone can experience this type of pain, it’s more common for some groups of people, including:

  • people older than 50
  • “weekend warriors”, who are more likely to injure their backs by exercising strenuously after being inactive the remainder of the week
  • people who are overweight or obese
  • pregnant women (in most cases this type of back pain goes away after delivery)
  • people whose jobs require heavy lifting, pushing, or pulling
  • people with family members who have been diagnosed with a type of arthritis in the back called ankylosing spondylitis
  • smokers

 In addition, some studies have found that people living with depression or anxiety appear to have a greater risk of back pain.

 How to guard against overtreatment and manage your pain

Although living with back pain can be extremely frustrating and can even limit your ability to take part in activities at work and home, specialists advise that it’s important to first try conservative treatments. A health advisor can provide you with up-to-date, evidence-based information about the range of back pain treatment options and connect you with the appropriate specialists, including physical therapists. If your primary care physician recommends a more aggressive treatment approach first, you should seek a second opinion.

In addition to the recommended, gold standard treatments of non-narcotic pain relievers, the application of ice or heat, and physical therapy, your doctor may also suggest topical pain relievers or therapeutic massage as first steps in the treatment process. And while the pain may make you want to stop moving, doctors recommend remaining as active as possible. More than a day or two of bedrest can lead to deconditioning of the muscles that support the spine.

There are cases, however, when back pain may be a symptom of a serious underlying condition that requires immediate, more aggressive treatment. If you experience any of the following symptoms, you should see your doctor as soon as possible:

  • progressive weakness in your leg
  • loss of bladder or bowel control
  • fever with increasing back pain
  • pain that starts after you injure your back, which could be caused by a spinal injury
  • back pain accompanied by severe, continuous abdominal pain
  • back pain with unexplained weight loss
  • back or neck pain with numbness in the arms or legs

 


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