More pain than gain in treating backache

The total cost of treating back pain in the United States has risen 65% in the last decade, but after all the pricey treatments, many people are still left with an aching back and an increasingly empty wallet, U.S. researchers said Tuesday.

They said treating spine problems in the United States costs $85.9 billion a year, rivaling the economic burden of treating cancer, which costs $89 billion.

Higher spending on prescription drugs, more advanced diagnostic tests and more frequent outpatient visits helped drive the increases, as well as greater patient demand for treatment and more use of spinal fusion surgery and instruments, researchers said.

Yet, for all of the spending, they found people with spine problems actually felt worse.

“Healthcare expenditures for people with spinal problems have increased substantially -- 65% since 1997. Within that, we found pharmaceutical expenditures have increased 171%,” said Brook Martin of the University of Washington in Seattle, whose study appears in the Journal of the American Medical Assn.

“If we are spending that much money on spine problems, we would expect to see improvements in the health of the population,” Martin said in a telephone interview.

“What this study shows is we are not seeing commensurate improvements among people with spine problems.”

Martin and colleagues analyzed data from 1997 to 2005 from a nationally representative survey of patient health expenditures and health status.

They found that in 1997 people with spine problems on average spent $4,695 a year, adjusted for inflation, compared with the average $2,731 spent for people without back problems.

The average health cost for spine patients in 2005 rose to $6,096, compared with $3,516 for people without those problems.

The proportion of spine patients reporting physical, social and work limitations rose to 24.7% in 2005 from 20.7% in 1997.

“What we’re seeing is that although costs have gone up, outcomes have not changed, which is really discouraging,” said Dr. Orly Avitzur, a neurologist from Tarrytown, N.Y., and an advisor to Consumer Reports, which recently named back surgery on its top-10 list of “Medical Gotchas.”

The research follows a number of recent studies showing that some patients who skip surgery for back pain fare just as well over time as those who have the surgery.

“It’s best to be conservative and take a wait-and-see approach, especially in the initial stages of low back pain,” Avitzur said in a telephone interview.

Dr. Paul Rubery, a spine surgeon at the University of Rochester Medical Center in New York, said that higher drug spending and increased use of diagnostic tests such as MRI accounted for a lot of the increased costs.

He said the study emphasized the need for treatments with proven benefits.

Dr. Richard Fessler, a professor of neurosurgery at Northwestern University in Chicago, challenged the study’s findings and methodology. “I think their conclusions are unwarranted and very misleading,” he said.

Fessler, in an e-mail, said the study did not mention several large recent clinical trials that showed certain patients undergoing spinal surgery had improved significantly.

Martin said his work was not an indictment of any one approach to treating back pain. “This study is a broad view of trends overall,” he said.

“Really, the goal should be to match the right treatment to the right patient who will benefit from it. I think that is sometimes where we fall short,” Martin said.