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Back pain treatment is costly and often includes overuse of imaging and referral to specialists. The total health costs for low back and neck pain increased 65% from 1997 to 2005 (from a mean of US$4795 per person to US$6096; JAMA 2008; 299:656).
To examine trends in outpatient treatment of back pain, researchers used data from federal surveys in 2-year increments between 1999 and 2010. Guideline-concordant use of NSAIDs or acetaminophen dropped from 37% to 25%, while guideline-discordant use of narcotics increased from 19% to 29%. Referrals for physical therapy remained unchanged at 20%, while referrals to other physicians for injections or surgery doubled, from 7% to 14%. Use of magnetic resonance imaging or computed tomography increased f…