Watch Your Back! How the Back Pain Industry is Costing Us More and Giving Us Less - And What You Can Do to Inform and Empower Yourself in Seeking Treatment

[Excerpt] This book considers what we know about treatments for back pain and asks a number of critical questions. Are some of the most popular treatments really effective? Do they “cure” or even improve the problems they claim to address? If some back pain treatments are ineffective or even harmful, why do patients clamor for them and doctors provide them? Who benefits from the vast back pain industry that’s developed over the past thirty years? Is it patients? Or the doctors, hospitals, and man­ufacturers that produce the technology of back pain therapy? What does all this say about our medical system? Or our efforts to enhance quality, improve safety, and reduce health care costs? How can patients maneuver to help themselves rather than help the medical industry? Will efforts to measure patient satisfaction help deliver safer and more effective treatments or encourage the opposite? In answering these questions, this book does more than describe and analyze the back business. It also explores the complex ways that doctors interact with patients, drug companies, and medical device makers. The results can inadvertently lead to treatments that are inef­fective or even harmful

Report of the NIH Task Force on Research Standards for Chronic Low Back Pain

Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients’ lives. Such cLBP is often termed non-specific, and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. The NIH Pain Consortium therefore charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimal data set to describe research participants (drawing heavily on the PROMIS methodology); reporting “responder analyses” in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect the RTF recommendations will become a dynamic document, and undergo continual improvement.Perspective: A Task Force was convened by the NIH Pain Consortium, with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimal dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes

Associations Between Relative Value Units and Patient-Reported Back Pain and Disability

Objective: To describe associations between health care utilization measures and patient-reported outcomes (PROs). Method: Primary data were collected from patients ≥65 years with low back pain visits from 2011 to 2013. Six PROs of pain and functionality were collected 12 and 24 months after the index visits and total and spine-specific relative value units (RVUs) from electronic health records were tabulated over 1 year. We calculated correlation coefficients between RVUs and 12- and 24-month PROs and conducted linear regressions with each 12- and 24-month PRO as the outcome variables and RVUs as predictors of interest. Results: We observed very weak correlations between worse PROs at 12 and 24 months and greater 12-month utilization. In regression analyses, we observed slight associations between greater utilization and worse 12- and 24-month PROs. Discussion: We found that 12-month health care utilization is not strongly associated with PROs at 12 or 24 months