Docs disregard imaging guidelines when treating back pain

Doctors could improve treatment for back pain and eliminate waste simply by following clinical imaging and prescription guidelines for treating patients, according to a study published online in JAMA Internal Medicine.

In the study, researchers from Beth Israel Deaconess Medical Center in Boston determined that doctors are inappropriately imaging patients, as well as increasingly treating them with narcotic prescriptions rather than nonsteroidal anti-inflammatory drugs (NSAIDs).

"There is [a] discordance between the guidelines and physician use of imaging," John Mafi, M.D. the study's lead author, said in a [email protected] post. "In patients with new-onset back pain, ordering an MRI or CT scan is not indicated in most cases."

The researchers also noticed a decline in the use of NSAIDs that was at odds with clinical guidelines.

"The guidelines recommend it as a first-line treatment," Mafi said. "What we are seeing instead is a rise in narcotic prescriptions. The guidelines are cautious about narcotics and say to be cautious and recommend them only as second- or third-line therapies."

Mafi added that the researchers also size a rise in referrals to specialists, "though primary care clinicians are usually able to manage patients with routine cases of back pain themselves with minimal treatment."

In their study, the researchers analyzed data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medicare Survey. They found that the proportion of patients undergoing CT or MRI imaging for back pain increased from 7.2 to 11.3 percent between 1999 and 2010, while referrals to other physicians, such as surgeons or back specialists, increased from 6.8 to 14 percent.

In addition, the proportion of patients, who received NSAIDS declined from 36.9 to 24.5 percent, while narcotic prescriptions increased from 19.3 to 29.1 percent.

"The biggest message for the public is that for the most part, back pain will get better in time with conservative treatment," Mafi said. "So instead of rushing to get a prescription for narcotics or an MRI, have patience. If it lasts longer than a couple of months, going to physical therapy to get some core strength training may help. We are not saying MRI, CT, or referrals are always wrong; there may be circumstances where they are appropriate. But we think the rapid rise in use of these tools for back pain is a problem."

To learn more:
- read the study in JAMA Internal Medicine
- see the [email protected] post

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