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The Truth About Treating Low Back Pain

There is overwhelming medical evidence that many diagnostic tests, treatments and surgeries for low back pain are ineffective and waste many billions of dollars a year in the U.S. alone. Yet treatment appears not only to be continuing but seems to be growing and becoming more aggressive. The aggressive treatment of low back pain has become epidemic.

Medical studies on the problem of low back pain were widely reported in the mainstream media in 2007 and 2008. The Wall Street Journal, New York Times and other national publications like Time magazine reported on the Journal of the American Medical Association (JAMA) study that said Americans, “were spending more money than ever to treat spine problems, but their backs were not getting any better.”

The study documented common mistakes doctors make when treating back pain, including:

  • Ordering excessive X-rays , MRIs and CT scans
  • Performing invasive surgery too soon
  • Failing to educate patients about surgical alternatives
  • Failing to address underlying mental health issues

Also released in 2007 was The State of Health Care Quality report published by the National Committee for Quality Assurance (NCQA). It stated, “back injuries often undergo aggressive treatment when less costly and less complicated therapy may yield similar or better results.”

The NCQA report said that the vast majority of patients with low back pain have no identifiable cause of their symptoms and that less than 1% of X-rays provide useful information regarding the diagnosis of low back pain. Similarly, MRI and CT scanning usually fail to shed light on the causes of low back pain, except when there are red flags such as trauma or indicators for specific diseases. The authors stated that, “Needless tests and procedures that provide no real benefit to the patient can’t do anything but harm.”

The JAMA study also noted the widespread use of needless testing and found that 25% of the patients covered by private health insurance had an inappropriate imaging study, costing, in the aggregate, billions of dollars each year.

There is a wealth of medical evidence that most back and neck pain should be treated sparingly. An editorial in Spine Journal suggested that more than 200 treatments for chronic back pain are currently available in the clinical marketplace and that many of those “do not have a definitive track record in scientific studies.”

The authors of the JAMA study concluded: “If we keep our diagnostic and treatment efforts within well-proven limits, and emphasize the importance of activity and self-care, we suspect we would see better outcomes.”

Yet the total number of some spine treatments — e.g., spinal fusion surgery, spinal injections and the prescription of opiates — has skyrocketed in recent years, according to medical researchers.

There are many potential reasons for this spurt in back treatments, including the heavy commercialization and direct consumer marketing of treatments both old and new. It is hard to read a newspaper, watch TV or surf the Internet without seeing a commercial pop up for the latest treatment for low back pain.

Obviously, there is a lack of definitive evidence regarding many popular treatments, which allows them free rein in the marketplace before the risks and benefits can be scientifically studied and documented.

The JAMA study stated that 60% or more of initial back surgeries have successful outcomes. I am pretty good at math, so that means 40% DO NOT!  The study’s authors estimated that the 40% equates to 80,000 “failed back surgeries” a year.

The researchers also observed that the surgical success rate drops to 30% after the second surgery, 15% after a third and 5% after a fourth. The authors believed that many patients were under the care of physicians, “who are unfamiliar with the conditions leading to back surgery, the types of back surgery available and the best approaches to diagnosis and management.”

The annual medical cost to American businesses because of low back pain was estimated to be $90 billion in 2008.  This does not include the cost of related workers' comp or disability benefits, which also are in the billions, nor indirect costs such as lost productivity.

The medical studies have confirmed what I have known and studied for the past 33 years: Much of the money spent on healthcare — approximately one-third — is wasted on medically unnecessary and potentially harmful procedures.

What has changed in the treatment of low back pain since the release of the studies in 2008?

My bet: Not so much.

In fact, some medical researchers have stated the situation has gotten worse, not better, and that they have not been able to keep up with all the latest trends and back treatments available today.