Study finds ways to reduce cost of treating back pain

ATLANTA (CNN) -- Changing the medical treatments for lower back pain -- less bed rest, for example -- can reduce expenditures for one of the most costly and widespread ailments in the United States, according to a study reported Thursday.

Lower back pain may affect half of all Americans at least part of the time, scientists have estimated, with costs projected to $100 billion annually -- half of which goes for direct medical care with much of it considered ineffective.

The study found that many health care practitioners continue more traditional procedures rather than following newer, less expensive recommendations. Among them: minimal bed rest for patients, a speedier return to everyday activities, less surgery and fewer diagnostic tests with x- rays and magnetic resonance imaging (MRI).

"Our goal was to facilitate improvements in care for back pain in large organizations, focusing on problems they themselves identified," said Dr. Richard A. Deyo, the lead author of the study. He is a professor of medicine at the University of Washington, Seattle.

The study, reported in the September issue of the Journal of General Internal Medicine, included HMOs, an academic medical center, a chiropractic college and large hospital-based practices, a spokesman said.

Twenty-seven percent of 22 health-care organizations participating in the research "made major progress toward attaining their chosen goals over the one-year study period, and most of the remaining organizations saw modest improvement," said the spokesman.

"One organization decreased diagnostic x-rays by 30 percent, another increased the use of patient education materials by 100 percent and a third reduced prescriptions for bed rest by 81 percent," he said.

The attention on reducing services and costs follows other studies suggesting that treatment for low-back pain does not much matter to the well-being of patients.

In a 1998 study supported by the U.S. Agency for Healthcare Policy and Research, a comparison of treatments for low-back pain found no significant differences in outcomes among 321 patients between ages 19 and 65.

Those patients were treated by chiropractic spinal manipulation, a popular form of physical therapy called the McKenzie method (which emphasizes stretching, physical therapy and self-help) or simply by being given an educational booklet and not otherwise treated; there was no appreciable difference in therapeutic outcomes, the researchers said.

Lower back pain, once experienced, becomes a part of life for almost half of the people affected, another study reported. For many, the pain is intermittently disabling.

This study was the North Carolina Back Pain Project, led by Dr. Timothy S. Carey of the University of North Carolina at Chapel Hill and supported by federal funding.

"Repeated visits and procedures do not appear to improve patients' long- term well-being, but they clearly account for substantial health care costs," a project summary said. "Finally, back pain prognosis does not differ based on the type of provider initially seen or the level of practitioner confidence."

In the journal Archives of Family Medicine, Carey and associates reported in 1998 that a survey of 189 physicians and chiropractors revealed that chiropractors had significantly stronger self-confidence scores than physicians in treating patients' lower back pain.

However, the level of practitioner confidence did not predict patient outcomes, according to the researchers. The study included interviewing patients by telephone for up to six months after their initial visit to a practitioner.

To prevent back pain, officials of the American Medical Association recommend regular exercise to keep back muscles strong and flexible. They also said maintaining a healthy body weight and good posture when standing or sitting is helpful.

Also, they suggested that when lifting an object it should be kept near the body, in order to avoid twisting, bending forward or reaching.

The AMA officials said lower back pain is caused by injuries, the effects of aging or a wide range of other factors.

Deciding when to seek medical help is often difficult. AMA officials have issued these guidelines: Severe pain or other symptoms persisting more than "a few days" or keeping you from everyday activities; trouble controlling bowels or bladder; numbness in the groin or rectal area or weakness or numbness in the legs -- any of these symptoms should prompt visit with your physician.

For discomfort less severe, AMA officials recommend acetaminophen, aspirin or ibuprofen. Within the first 48 hours of symptoms, applying a cold pack may help. After 48 hours, try a heating pad or a hot shower to relieve symptoms.

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American Academy of Orthopedic Surgeons
American Medical Association
U.S. Department of Health and Human Services' Agency for Healthcare

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