The study, published in JAMA Internal Medicine, found that over the 12-year period, recommendations that patients with back pain use non-steroidal anti-inflammatory drugs or acetaminophen decreased from 36.9% in 1999-2000 to 24.5% while narcotic use went from 19.3% to 29.1%.
Physician referrals, including referrals to surgeons or other physicians for procedures, increased from 6.8% to 14%. And the number of "inappropriate" CT or MRI images among patients with back pain increased from 7.2% to 11.3%.
Back pain care represents an enormous segment of the healthcare industry, with an estimated $86 million spent annually on back or neck pain issues. It's the fifth biggest reason people see a physician, and accounts for more than 10% of all appointments with primary care doctors, the researchers wrote.
Mafi blames three factors for the movement away from evidence-based care for back pain patients.
1. Patient expectations
Increasingly, patients expect that if their doctor is really listening to them, they will order the MRI and have lots of tests, with lots of referrals to other physicians, Mafi says. So physicians basically oblige their patients, even if they know it's not likely to help.
2. Ease of ordering imaging tests
"Doctors are increasingly pressed for time, and it's just easier to order the MRI, or make a referral to a back specialist then to give a nice, satisfying explanation" why the patient will have the same outcome by waiting for a few months.