Spine surgery anyone??

Being a research lover, this interesting project came across my desk a few days ago.  It was a real eye opener!  I couldn't help but put it into my website blog so my members and patients might get some good information from it.  This information was obtained from Medicare expenditures.  As everyone knows chronic back pain is among the most common of patient complaints.  Being so very common, it has spawned a rapidly and expanding range of tests and treatments.  Some of these have become widely used for indications that are not well validated, leading to uncertainty about safety, increasing complication rates, and (naturally) marketing abuses. 

Increases in Medicare expenditures:

1. 629% increase for epidural steroid injections

2. 423% increase for expenditures for opioids for back pain

3. 307% increase in the number of lumbar MRIs

4. 231% increase in facet joint injections

5. 220% increase in spinal fusion surgery rates

These authors state: "The prevalence and impact of back pain have led to an expanding array of tests and treatments, including injections, surgical procedures, implantable devices, and medications.  Each is valuable for some patients, but use may be expanding beyond scientifically validated indications, driven by professional concern, patient advocacy, marketing, and the media."  Although approximately 25% of US adults reported back pain during the past 3 months, this percentage has not changed for decades.  Added to that fact is expanded testing and treatment for back pain have not improved outcomes, but have increased complications, including deaths.  The use of MRI imaging, according to the American College of Physicians and the American Pain Society, is not recommended in cases of nonspecific low back pain. 

Opioid use in patients for noncancer pain sometimes lasts for decades.  These patients have persistent high levels of pain and poor quality of life.  The authors even state "opioid use may paradoxically increase sensitivity to pain."  Chronic use of opioids may also cause hypogonadism, reduced testosterone levels, diminished libido, and erectile dysfunction. 

The research project also admitted that spinal injections may offer temporary relief of pain, but European and American guidelines based on systematic reviews, conclude they do not reduce the rate of subsequent surgery.  "Facet joint injections with corticosteroids seem no more effective than saline injections." 

Spine fusion surgery is limited when treating degenerative discs with back pain with no sciatica, yet they have increased 220% from 1990 to 2001 in the US.  "Higher spine surgery rates are sometimes associated with worse outcomes."  In fact, in a 1999 study published in the Journal of Bone and Joint Surgery, the best outcomes occurred where surgery rates were lowest, and the worst results occurred in areas where surgery rates were highest. 

These authors didn't even footnote the number of studies that show that spinal adjusting is highly effective, safe, cost effective, and results in long-termed stable outcomes in the treatment of chronic low back pain. 

http://www.jabfm.org/cgi/content/full/22/1/62 for the article.  It's quite fascinating!!