HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Rapid Responses: Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Deyo, R. A. Articles by Martin, B. I. Search for Related Content PubMed PubMed Citation Articles by Deyo, R. A. Articles by Martin, B. I. Social Bookmarking                      What's this?

Overtreating Chronic Back Pain: Time to Back Off?

Department of Medicine, Oregon Health and Science University, Portland (RAD)
Department of Orthopaedics (SKM, BIM), University of Washington, Seattle
Department of Psychiatry (JAT), University of Washington, Seattle

Correspondence: Corresponding author: Richard A. Deyo, MD, MPH, Family Medicine, Mail Code FM, 3181 SW Sam Jackson Park Rd., Portland, OR 97239-3098 (E-mail: deyor{at}ohsu.edu)

Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. Some of these have become widely used for indications that are not well validated, leading to uncertainty about efficacy and safety, increasing complication rates, and marketing abuses. Recent studies document a 629% increase in Medicare expenditures for epidural steroid injections; a 423% increase in expenditures for opioids for back pain; a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries; and a 220% increase in spinal fusion surgery rates. The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain.

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati

This article has been cited by other articles:

				R. A. Deyo Imaging Idolatry: The Uneasy Intersection of Patient Satisfaction, Quality of Care, and Overuse Arch Intern Med, May 25, 2009; 169(10): 921 - 923. [Full Text] [PDF]

				M. A. Bowman and A. V. Neale Optimism: A Good Theme for Family Medicine J Am Board Fam Med, January 1, 2009; 22(1): 1 - 3. [Full Text] [PDF]