More People Are Undergoing Surgery and Taking Opiates to Treat Back Pain
More upstate New Yorkers with back pain are undergoing surgery and taking prescription medication such as opiate painkillers even though noninvasive treatments such as simple exercises and over-the-counter drugs usually work, according to a new Univera Healthcare report.
“We need to change our thinking when it comes to back pain,” said Richard Vienne, D.O., Univera Healthcare vice president and chief medical officer. “If patients receive the wrong care at the wrong time, it could actually lead to worse outcomes.”
In their lifetimes, more than 80 percent of upstate New York adults will experience low back pain, nearly two-thirds will experience neck pain, and some will endure chronic suffering.
According to the Univera Healthcare report, Spine care in upstate New York:
- In 2013, 626,000 upstate New York adults ages 18 and older received back and/or neck pain care that added nearly $1 billion to total, direct health care costs in the region. About 36 percent of that amount was spent on surgery, 32.2 percent was spent on diagnostic services and physician visits, and 32.9 percent was spent on non-surgical interventions.
- Surgeries for the treatment of back pain among upstate New York adults saw a 10 percent rise in utilization from 2010 to 2013.
- There was nearly a 14 percent increase in spine patients who were prescribed a medication within the first six weeks of diagnosis from 2010 to 2013.
- In 2013, almost half of patients treated for spine pain received a prescription for medication to treat the condition within the first six weeks of diagnosis. More than half of patients who were prescribed medications received a prescription for an opiate.
Choosing Wisely, an initiative of the American Board of Internal Medicine Foundation, collected care recommendations from physician-led medical specialty societies for the purpose of improving the quality of care and encouraging physician-patient conversations about services that may be unnecessary and may cause harm. Recommendations related to spine pain include the following:
- The American Academy of Family Physicians advises spine pain patients to initially avoid imaging, due to the risks associated with radiation, the likelihood that additional and unnecessary tests and procedures without improved outcomes will follow, and also the high cost.
- The North American Spine Society does not recommend magnetic resonance imaging in the first six weeks of care for patients with nonspecific acute low back pain, nor does it recommend bed rest for more than 48 hours when treating low back pain.
- The American Academy of Physical Medicine and Rehabilitation recommends that health care providers only prescribe opiates for acute disabling low back pain after an evaluation and when other alternatives have been tried. Prescribing opiates early for acute disabling low back pain is associated with longer disability, higher surgical rates and a greater risk of later opioid use.
“The number of opioid related deaths in Erie County is growing rapidly. The Erie County Department of Health estimates that the number of opioid related overdose deaths will likely more than double in 2015 compared to 2014,” said Dr. Gale Burstein, Erie County Department of Health Commissioner. “Legitimate prescription opioid use is associated with an increased risk of long-term opioid use and possibly misuse. Clinicians should incorporate the addictive risk of opioid prescribing into prescribing decisions and patient counseling,” said Burstein.
"The concern from a public health point of view is that the backlash from over prescribing of opiates ends up limiting prescriptions being provided to patients who generally need these medications," said Daniel J. Stapleton, Public Health Director of Niagara County. "That results in extending the severe pain those patients are experiencing. It also contributes to patients obtaining other forms of illegal and dangerous drugs to relieve their pain symptoms, when they can't receive opiate prescriptions."
“We are aware of the issues related to increased opiate use and abuse in both Orleans and Genesee counties,” stated Paul Pettit, Public Health Director for both Orleans and Genesee County Health Departments. “It is important for those who are experiencing back pain to talk with their primary care providers about minimal treatment which may include rest, physical therapy and over-the-counter medications and to follow their advice. It is also important for individuals who are prescribed regulated medications to remember to take them as prescribed and to dispose of them properly once no longer needed. Check with local pharmacies and law enforcement agencies on the proper disposal of medications.”
“This nation is experiencing an unprecedented opioid epidemic with roots in the overprescribing of prescription pain killers," said Christine Schuyler, Chautauqua County Director of Health & Human Services. "It's critically important that those suffering from back pain take part in physical therapy and lifestyle changes."
Recommendations for patients with low back pain:
If you have low back pain, the research Univera Healthcare compiled in its report advises staying active, limiting bed rest, using pillows between or beneath the knees when you sleep, applying heat for pain management, taking over-the-counter medications when needed, consulting your primary care provider or alternative non-surgical treatments provider (such as physical therapy and chiropractic care) if needed and remaining relaxed to avoid worsening pain.
To view the report “The facts about spine care in upstate New York, 2013”
To view an accompanying infographic