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National trends in nonoperative care for nonspecific back pain
Spine J. 2004 Jan-Feb;4(1):56-63.
National trends in nonoperative care for nonspecific back
pain.
Feuerstein M, Marcus SC, Huang GD.
Department of Medical and Clinical Psychology, Uniformed
Services University of the Health Sciences, 4301 Jones
Bridge Road, 20814, Bethesda, MD, USA
Few empirical data are available that document changes in
population-based rates for the evaluation and treatment of
nonspecific back pain.To determine the extent of change in
the pattern of outpatient evaluation and treatment of
nonspecific low back pain in the United States between 1987
and 1997.The 1987 National Medical Expenditure Survey and
the 1997 Medical Expenditure Panel Survey, two nationally
representative surveys with similar sampling methods and
questions, were used.Noninstitutionalized adults in the
United States.Changes in rates of any health service for
nonspecific back pain and occurrence of provider-specific
care and types of services provided. Changes in the
prescription of specific medication classes (ie,
nonsteroidal anti-inflammatory drugs [NSAIDs], muscle
relaxants, nonnarcotic and narcotic analgesics) were also
investigated.Overall rate for outpatient treatment for
nonspecific back pain in the US population was relatively
stable over the decade (4.48% in 1987, 4.53% in 1997,
p=.85). Among those receiving care, the proportion receiving
physician care increased from 64% in 1987 to 74% in 1997
(p<.001), whereas those obtaining care from physical
therapists increased from 5% to 9% during the same time
period (p<.01). The proportion of respondents receiving
NSAIDs, muscle relaxants, nonnarcotic analgesics and
narcotic analgesics remained stable. However, the mean
number of patient visits in which these medications were
prescribed increased from 2.0 to 3.9 over the decade
(p<.001). The proportion of individuals receiving
chiropractic care (p<.01) and X- rays (p<.001) were lower in
1997 than 1987.The national pattern of health care for
nonspecific low back pain observed in the present study
serves as a basis for future investigations into the
management of this major public health problem. Findings
suggest that perhaps a duplication of care is partly
responsible for the high degree of health care utilization
in this population.
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