Significant increases were also seen in the number of CT and MRI scans, even though studies show they don't help people with routine back pain get better care and, in the case of CT, expose them to radiation, which can increase risk of future cancers.

Equally concerning to the study authors was a 106 percent increase in referrals to surgeons and other specialists, leading to costly spine procedures that are rarely effective and potentially life-threatening.

"MRI or CT scans and surgery have not been shown to clinically improve back pain or quality of life, yet we still do them for multiple reasons," Dr. Mafi says.

"Patient demands and expectations are definitely part of it,” he points out. “We live in an era where patients have more say and autonomy in managing their health care, and they sometimes expect instant solutions. And we do have instant solutions for some things that really work, but not for back pain."

Dr. Mafi notes that other factors may also be at play. “In a fee-for-service system, doctors are financially rewarded for ordering a lot of tests and procedures. By changing the incentive structure we may be able to influence physician behavior; clearly guidelines don't do it. But ultimately, it will have to be a multidisciplinary approach – getting the word out to patients and doctors to stop this culture of over-treating," he says.

Overtreatment isn't just bad for patients; it's also bad for the bottom line. Back pain is one of the top reasons people see a doctor and accounts for nearly $86 billion in health care expenditures each year – not to mention an additional $20 billion annually in lost productivity costs.

"A lot of the money spent on back pain is wasted because fancier, more expensive procedures aren't necessarily effective," Dr. Mafi says. "The biggest message for patients with new-onset back pain is that it will likely resolve on its own with Tylenol in two or three months. Folks have to understand that sometimes patience and time are superior to the fanciest technologies."

Roger Chou, MD, an associate professor in the department of medicine and medical informatics & clinical epidemiology and an internist at Oregon Health & Science University in Portland, directed the development of the American Pain Society/American College of Physicians clinical guidelines for the management of low back pain referred to in the study.

"Unfortunately, the results of this study are not that surprising,” he says. “We have been seeing persistent trends towards increased use of MRI as well as surgery and opioids over the last 10 to 20 years, despite guidelines recommending a more selective and judicious approach. The increase in use of opioids is especially troubling, given the alarming increase in accidental overdose deaths associated with opioid use, and the fact that low back pain is the most common reason for prescribing opioids despite data showing that benefits are limited."

Dr. Chou lauds efforts to limit opioid prescriptions and instead "incorporate exercise, cognitive behavioral therapies and other treatments that we think are more effective." He says efforts are also underway to reduce unnecessary use of expensive MRIs and "the frequently unnecessary surgeries and other procedures that result from them."