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National Trends in Health Care for Back Pain

What's the general direction of back care these days? What changes or trends have been seen in the United States over the last 10 years? These are the questions answered by this report. Researchers compared the results of two surveys taken in 1987 and again in 1997. The surveys were used to find national estimates of use and cost of health services for back pain.

Patients were asked to keep a medical diary. Health care for nonspecific back pain was recorded. Nonspecific back pain means the exact cause is unknown. All visits to doctors, chiropractors, physical therapists, or other health care providers were listed. Tests, drugs, and visits to the emergency room were also recorded. Number of days in bed due to back pain was counted.

The authors found a 10 percent rise in visits to medical doctors between 1987 and 1997. At the same time, visits to physical therapists increased four percent. Visits to chiropractors went down by 10 percent. The use of drugs for pain control stayed about the same.

The number of patients seeking treatment for nonspecific back pain was 6.5 million in 1987 and 7.4 million in 1997. Patients in 1997 were older and better educated. They were also more likely to be injured while under worker's compensation.

The authors suggest some reasons why there's been a shift away from chiropractic treatment and toward doctor visits and physical therapy visits. Perhaps patients think these are better ways to treat nonspecific back pain. Maybe health insurance is a factor. If the insurance pays for a doctor visit but not chiropractic care, then the patient goes to a medical doctor. There's also some question about how accurate the patients are in keeping their diaries. Patients may have forgotten to record some visits or the use of some drugs.

The authors conclude that rates of health care use for nonspecific back pain are actually rising. This is in spite of efforts to decrease the cost of care. Future studies to find ways to reduce painful symptoms and improve function at the same time is still the goal.

References: Michael Feuerstein, PhD, MPH, et al. National Trends in Nonoperative Care for Nonspecific Back Pain. In The Spine Journal. January/February 2004. Vol. 4. No. 1. Pp. 56-63.

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