Tuesday, July 30, 2013 Study: Back Pain Treatment Increasingly Ignores Clinical Guidelines Despite published guidelines that call for physical therapy or medications such as ibuprofen or acetaminophen for first-line management of most back pain, other treatments such as imaging, narcotics, and referrals to other physicians have increased, according to a study published online yesterday in JAMA Internal Medicine. Because more than 10% of visits to primary care physicians relate to back and neck pain, and the treatments recommended by guidelines generally are less costly than those being used increasingly, the financial implications in the health care market are significant. "With health care costs soaring, improvements in the management of back pain represent an area of potential cost savings for the health care system while also improving the quality of care," the study concludes. The study identified 23,918 visits to primary care physicians for spine problems. Average age of the patients increased from 49 to 53 years during the study period, January 1999 through December 2010, and 58% of the patients were female. According to the results, physical therapy referrals remained unchanged at about 20%, but physician referrals increased from 6.8% to 14%. Nonsteroidal anti-inflammatory drug or acetaminophen use per visit decreased from 36.9% to 24.5%, while narcotic use increased from 19.3% to 29.1%t. The number of radiographs remained at about 17%, but the number of computed tomograms or magnetic resonance images increased from 7.2% to 11.3% during the study period.