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Related Concept Videos

Analgesia and Pain Management01:25

Analgesia and Pain Management

Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...

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Operational and Intervention Effects of Targeted Tuina in Lumbar Intervertebral Disc Degeneration Model Rabbits
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Overtreating chronic back pain: time to back off?

Richard A Deyo1, Sohail K Mirza, Judith A Turner

  • 1Department of Medicine, Oregon Health and Science University, Portland, OR, USA. deyor@ohsu.edu

Journal of the American Board of Family Medicine : JABFM
|January 7, 2009
PubMed
Summary
This summary is machine-generated.

Chronic back pain treatments are increasing, but patient outcomes haven't improved. A better understanding of pain, rigorous trials, and improved regulatory oversight are needed for effective chronic pain management.

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Area of Science:

  • Pain Medicine
  • Health Services Research

Background:

  • Chronic back pain is a widespread patient complaint with significant impact.
  • A proliferation of tests and treatments exists, some lacking validated indications.
  • This has led to concerns regarding efficacy, safety, complication rates, and marketing practices.

Purpose of the Study:

  • To examine trends in medical expenditures and procedures for chronic back pain.
  • To assess whether increased healthcare utilization correlates with improved patient outcomes.
  • To propose recommendations for improving the management of chronic back pain.

Main Methods:

  • Analysis of Medicare expenditure data for epidural steroid injections, opioids, lumbar magnetic resonance imaging, and spinal fusion surgery.
  • Review of available studies on population-level patient outcomes and disability rates related to chronic back pain treatments.

Main Results:

  • Medicare expenditures for epidural steroid injections increased by 629%.
  • Expenditures for opioids for back pain rose by 423%.
  • Lumbar MRI utilization increased by 307%, and spinal fusion surgery rates by 220%.
  • These increases have not corresponded with population-level improvements in patient outcomes or disability rates.

Conclusions:

  • The current approach to chronic back pain management is not yielding improved population-level outcomes despite increased utilization of interventions.
  • There is a critical need for enhanced understanding of pain mechanisms.
  • Recommendations include more rigorous independent trials, stronger regulatory oversight for pain treatments, and adoption of a chronic disease management model.