Most people who have back pain get better without surgery, prescription opioid drugs or expensive imaging tests. But researchers at Beth Israel Deaconess Medical Center in Boston say many back pain patients receive those treatments despite strong evidence showing they don't help and often do harm. The findings appeared in the July 29, 2013 issue of JAMA Internal Medicine.

Lead author John N. Mafi, MD, a fellow in the division of general medicine and primary care at Beth Israel Deaconess Medical Center, says established clinical guidelines call for conservative back pain treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen or acetaminophen (Tylenol) and physical therapy. Diagnostic imaging, opioid painkillers and aggressive therapies (such as surgery) aren't recommended for most patients.

"Previous research showed a significant increase in use of [inappropriate] treatments, but those studies were 10 years old or limited to specific populations. We wanted to study current trends in back pain care across the country," he explains.

The study authors hypothesized that because several new guidelines were released during the last 10 years, the use of recommended treatments would increase and the use of non-recommended treatments would decrease.

To find out, Dr. Mafi and colleagues used two large national databases to examine nearly 24,000 spine-related doctor visits from 1999 through 2010 – a representative sampling of about 440 million actual visits during that period. More than half the patients were women, many in their late 40s and early 50s.

During the 12-year period, researchers found a substantial increase in treatments that run counter to current guidelines. For instance, although use of approved medications like NSAIDs and acetaminophen declined from almost 37 percent to just less than 25 percent, prescriptions for opioid painkillers – which are generally not recommended – increased from 19 percent to 29 percent.

"[Opioids] are not a proven therapy and have great potential for harm. They should never be a first line treatment and should only be used after proven therapies have failed," Dr. Mafi says.

He adds that women as well as blacks, Hispanics and patients of other ethnicities were less likely than whites to receive opioid painkillers, probably due to cultural and racial disparities in pain management that have been noted in other studies.

"That's the irony," he says. "Some doctors have unconscious biases, based on gender and ethnicity, when assessing patient pain. Usually that's a disservice to patients, but in this case, it's not."