Too Much Too Soon? Over-treating Back Pain
As a patient, have you ever been surprised or disappointed by the treatment recommendations your physician has given you? While we all want to know what's wrong and how to make it right as quickly as possible, the reality is it's not always that easy. Most cases of back pain are effectively treated with ice, rest rehabilitation or gentle exercise, over-the-counter pain relievers and TIME. But if you're suffering from chronic pain, such a simplistic treatment recommendation might be unsettling, making you feel like your physician doesn't care, is avoiding the problem or that he or she doesn't know what to do.
The truth is that your symptoms and circumstances are unique, and your course of treatment should be too. But that often isn't the case. In fact, research from Harvard University has found that patients with back pain are increasingly prescribed narcotics, extensive tests and surgeries rather than first undergoing more conservative therapies.
According to the study, the trend of over-diagnosis and overtreatment is getting worse. Researchers analyzed data from 1999 through 2010 on nearly 24,000 doctors' visits for back pain to see if patients were cared for according to established, evidence-based guidelines. What they found:
- Tylenol and non-steroid anti-inflammatory drug (NSAID) use declined by more than 50%
- Prescriptions for narcotic opiates increased by 51%
- CT and MRI scans increased by 57%
- Referrals to specialists increased by 106%
- Use of physical therapy remained steady at about 20%
While the study shows that doctors may be treating patients aggressively too quickly, it also shows that patients themselves are impatient and requesting that more extreme measures be taken instead of starting off with milder methods. For me, the real takeaway from the study is that treatment should be tailored to individuals and their unique circumstances instead of following formulas. One size treatment doesn't always fit all and what may be best for someone else might not work for you. A variety of factors should be considered every step of the way. Advanced imaging procedures, drugs and referrals to other physicians should be recommended only in the most severe of cases; those that don't respond to conservative treatment methods or those with other symptoms that seriously affect the patient's quality of life. And surgery should only be suggested if the patient has first tried other non-operative approaches, and they haven't worked.
The study also brings to light the concept of 'medical necessity,' a term often used to determine what your insurance company or state federal medical programs cover in relationship to the medical care you receive. According to the American Medical Association, medical necessity means:
"Health care services or products that a prudent physician would provide to a patient for the purpose of preventing, diagnosing, treating or rehabilitating an illness, injury, disease or its associated symptoms, impairments or functional limitations in a manner that is: (1) in accordance with generally accepted standards of medical practice; (2) clinically appropriate in terms of type, frequency, extent, site and duration; and (3) not primarily for the convenience of the patient, physician or other health care provider."
Medical necessity guidelines are in place in order to reduce inappropriate and wasteful tests and treatments, which have the potential to save on healthcare costs and improve the quality of your medical care. While in your best interest, it can be confusing. Before agreeing to undergo examinations, or committing to costly prescriptions or procedures, be sure to ask your doctor and your insurance provider about your plan coverage, and do not be afraid to ask questions.
I encourage you, whether patient or caregiver, to empower yourself with knowledge so you can play an active role in your health, and always seek options and answers by asking "Why? What is the expected outcome of this treatment? How long will it take? Do we really need to do this? What happens if we wait? and What are my alternatives?" If you feel that your physician isn't listening or willing to answer your questions, find a doctor you feel comfortable with who will engage you in conversation and help educate you. We really are here to help.