Spinal fusion surgery for back pain was reviewed in three articles in the Journal of the American Medical Association this week http://cot.ag/bjDgWW . The sobering conclusions were that we are spending up to 10 times more for complicated new surgical procedures and frequently getting worse outcomes and up to twice as many complications.

 

Unfortunately, this is nothing new in the history of back pain treatment. An article in Spine http://cot.ag/dASfWh analyzed the cost of the treatment of back and low back pain in the United States.  It found that the cost of care from 1997 to 2005 went up from $62 billion to $86 billion and at the same time the number of patients reporting difficulty in functioning because of their pain also went up by 25%. Spending 65% more ($34 billion) resulted in worse outcomes.

 

The article also showed that the reason that doctors thought their patients had back pain shifted from muscles and other soft tissue to the spine and nerves.  It should come as no surprise that since the number one diagnosis for back pain (nonspecific low back pain) is related to sprains and strains of muscle and other soft tissue, that ignoring muscle could only result in worse outcomes.

 

We can find reports of low back pain treatment as long ago as 1500 B.C. in Egypt. If you tune in next week I will review the history of our understanding of back pain and how our modern unsuccessful concepts developed.

~ Norman Marcus, MD
Norman Marcus Pain Institute, New York NY
 
 
“Your New York City Doctor”
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