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Doctors Ignoring Guidelines on Treating Back Pain

Update Date: Jul 30, 2013 09:30 AM EDT

When it comes to treating patients, doctors have sets of guidelines designed to help them assess different types of situations. Although these guidelines are only recommended, following them could make catching certain conditions easier. According to a new study conducted by researchers from Beth Israel Deaconess Medical Center in Massachusetts and Harvard Medical School, an increasingly larger number of doctors have been ignoring these guidelines when it comes to treating back pain.

In this study, the research team reviewed nearly 24,000 cases taken from the national databases. These cases were mostly related to spinal issues and were recorded from 1999 to 2010. Based on the study, the guidelines surrounding back pain treatment include using nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen and physical therapy. These treatment options are considered to be conservative and help with pain management. Despite this route, the study found that more doctors seem to ignore them.

The researchers reported that although doctors continued to refer patients to physical therapy at around the same rate, prescriptions for narcotic painkillers soared by 51 percent. Due to the increase of these prescriptions, the researchers also noted a decrease in prescriptions for non-opiate drugs. The researchers stated that the increased rate of narcotic drug prescription is alarming and could be problematic. They cited a 2007 study that concluded that narcotics did not help patients with acute back pain and chronic back pain in some situations.

"Although we lack adequate data to make firm recommendations on narcotic medications, which may be indicated in certain instances, such increases in narcotic prescriptions may be contributing to a current crisis in pubic health: The rapid increase in narcotic overdose deaths parallels a reported 300 percent increase in the U.S. sales of prescription narcotics since the 1990s," lead author, Dr. John Mafi and colleagues wrote in their study.

Furthermore, the researchers found that doctors were utilizing low value diagnostic imaging tests, which would expose the patients to unnecessary radiation. The guidelines recommend doctors to avoid imaging or other forms of aggressive treatments early on. However, the researchers found that doctors used computed tomography (CT) or magnetic resonance imaging (MRI) 57 percent more frequently.

"In 2007, a projected 1,200 additional future cancers were created by the 2.2 million lumbar CTs performed in the United Stated," the authors warned.

The researchers hope that their discovery could influence medical professionals to remember to stick to the guidelines that were set to increase quality of care and lower risks.

The study was published in JAMA Internal Medicine

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