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Avoiding the Back Pain Overtreatment Trap

Dr. Anand Blog Article

November 1st, 2017

When it comes to the way we experience the aches and pains of life in today's modern, fast-paced and digitally-connected world, the notion of dealing with any amount of pain for any length of time can seem downright barbaric. We have medicines! We have modern surgical innovations! We have myriad "gadgets" that promise relief or your money back! Right? Especially when it comes to back pain, you'll find few other physical ails that are more universal to the human race, and as a result, seemingly limitless treatment options to address it. But how much is too much?

Avoiding the Back Pain Overtreatment Trap

A recent study that surveyed more than 2,000 physicians, published in the multidisciplinary medical journal PLOS One, found that for a variety of medical concerns in the United States, overtreatment is commonplace. This sample population of doctors indicated that more than 20 percent of overall medical care was unnecessary – which included nearly 25 percent percent of diagnostic tests, 22 percent of prescription medications and more than 11 percent of procedures. When you've got thousands of health care providers indicating that more treatment is not the best way to go, you know you've got a problem.

Although I'm a spine surgeon and thus a provider of some of these treatment options, I am a physician first. It is my honor and obligation to apply measures required to treat those who are injured, but to avoid overtreatment. Of course, this obligation also requires that I work within the knowledge that I'm not treating a stack of bones. I am caring for a living, breathing human whose pain may also potentially be wrapped up in lifestyle, family and economic concerns. Balancing this knowledge is crucial for all physicians, but our patients have some responsibilities, too. Figuring out, together, how to manage back painwhile not jumping the gun on unnecessary treatment is art and science, and it requires partnership.

I am a physician who believes that more treatment does not necessarily translate to better outcomes for patients. In America, because there is so much access to health care services, diagnostic testing and treatment options, we sometimes hold on to the notion that we should try them all. If you're battling back pain, the first order of business is to find a physician specialist whom you can trust. He or she should be someone who listens to your concerns and takes all aspects into consideration before making recommendations. I have had countless patients come to me after visiting another provider who seemed "quick to recommend surgery" or other invasive treatments. Trust your gut. If a provider's recommendations don't feel quite right to you, get a second opinion. A physician worth his or her license won't sweat it because he or she knows that a patient's confidence in a provider's recommendations only translates to a more favorable outcome long term.

Now here's where things can get a bit dicey. What if a provider recommends a back pain treatment option that doesn't fit with what the patient thinks he or she needs or has requested? For example, a patient who has been battling back pain for six months visits a specialist with a specific remedy or treatment course already in mind after some internet research and conversations with loved ones. Upon evaluation, the provider suggests first that weight loss is one non-medication, non-surgical treatment option that may provide significant relief. What happens if the patient is repelled by the recommendation because he or she was expecting simply to receive a prescription for medication to mask the pain and then be on their way?

Now, I don't mean to suggest here that no one needs medication, diagnostic examination or treatment (non-surgical or surgical) to address their back pain concerns. On the contrary, there are spinal conditions that will require all of the above in order to provide the greatest chances for relief. But I can tell you from experience that sometimes lifestyle modifications – weight loss, exercises that focus on the core muscles to strengthen the spine, smoking cessation and time – are just what the doctor ordered. And they don't place anyone at risk of overtreatment because they don't require a prescription or a scalpel.

Whether it's back pain or another condition entirely, sometimes the strongest prescription for a cure is patience – with yourself and your providers. Overtreatment can be a trap that's tough to get out of. Collectively avoiding it from the get-go will be our best bet toward reversing the trend.


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