Useless Care for Back Pain on the Rise

Cheryl Clark, for HealthLeaders Media , July 30, 2013

Also, Mafi says, doctors think that ordering the imaging test "will provide the patient some psychological benefit."

3. Financial incentives
MRI machines are costly, as are back surgeries, and when the doctors own the imaging equipment, they're more likely to order an imaging test, Mafi says. "I don't think there's anything intentional, but there's an unconscious bias. And we know that regions that have more MRI machines also have more surgeries. They go hand-in-hand," he says.

In an invited commentary in the same issue of JAMA Internal Medicine, Donald Casey, MD, of New York University Langone Medical Center, suggested that doctors use consistent "checklist-based algorithms" that track patient-reported outcomes to improve how they care for these patients.

Second, Casey recommended that patients have higher out-of-pocket insurance co-payments for imaging associated with back pain.

And third, "perhaps the biggest challenge," he wrote, is all the groups, "that promote self-proclaimed intellectual property-based ownership of interventions (including complementary and alternative therapies)…" but which lack "formal and rigorous quality of evidence evaluations…" need to agree on an "objective, common framework or evaluating the value of individual and combination modalities for back pain.

"It is only by achieving greater concordance on the evaluation of the efficacy of back pain interventions that we can achieve greater concordance on our practices."

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2 comments on "Useless Care for Back Pain on the Rise"

Back Pain HC (10/11/2013 at 3:59 PM)
If you take care of your back, it's more likely to carry you through the day with few complaints.

Susan Park (8/1/2013 at 4:21 PM)
I'm having a hard time with this...I was on NSAIDS for 12 years for back pain, and just in the last 3 on pain meds. My back pain would not be cured by conventional therapy...NSAIDS, rest, physical therapy, steroidal shots....and hasn't been cured by surgery. But to even suggest that surgery not be an accepted treatment really upsets me.....I couldn't walk before I had my surgery, my condition had deteriated so badly. I can walk, albeit still with pain, so I really don't know the answer.....




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