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Back and Neck Pain

What Chronic Back Pain Treatment in the U.S. Looks Like

Author| Ben Bobrow, MD

If you live in the U.S. and have chronic back pain, you have plenty of company.

Eight out of 10 Americans experience low back pain or neck at some point in their lives.1

Back and neck pain are some of the top complaints for which people seek medical care. The vast majority (over 95%) of patients who come to the Emergency Department complaining of back and neck pain get discharged with a diagnosis of muscle strain and over 60% of these patients receive some kind of opioid pain medication during that visit.

Sometimes people have some kind of event—such as bending, lifting or sitting for extended periods of time—to which they attribute their pain and sometimes people's pain comes on spontaneously.

There are wide variations in care, a fact that suggests there is professional uncertainty about the optimal approach. Many experts believe the problem has been "overmedicalized," and we may be over treating lots of people with pills and surgeries. For example, advanced imaging studies such as MRIs, while very sensitive tests, often detect incidental things like herniated disks and other abnormalities are very common among people without symptoms and not the actual cause of pain. Besides their added cost, incidental findings on MRIs can lead to overdiagnosis, anxiety for patients, reliance on medical care, a conviction about the existence of disease and unnecessary procedures and surgeries.

Many patients with chronic back and neck pain have no anatomical abnormalities that obviously explain their symptoms. Brain MRI studies suggest that when people suffer with pain, over time, central nervous system changes occur in how we perceive and respond to pain may perpetuate the perception of pain, even in the absence of ongoing tissue injury.


References

  1. Carey TS, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker DR. The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project. N Engl J Med. 1995;333(14):913–917.