As back pain has become an increasingly common ailment in the United States – and for chronic sufferers, one of the most debilitating – desperate patients and their doctors have propelled major advancements in the field.
New treatments range from the cheap and easy – yoga and acupuncture, for example – to expensive and invasive procedures like disk replacement surgery or injecting quick-drying cement into the back to help stabilize the spine.
Now, many spine care experts say that after years of progress, it’s time to take a step back and re-evaluate the recent so-called advancements.
The cost-effectiveness of these treatments will be a major topic of discussion in San Francisco this week when thousands of back care experts are expected to flood the city for one of the world’s largest conferences on the spine.
“Five years ago, the topics would be on all the new technology: Look at this new thing we’ve come up with, and isn’t it great? But the current environment has pushed that to the back seat,” said Dr. Charles Branch, president of the North American Spine Society, which is hosting this week’s conference. “Now it’s: Let’s take the stuff we’re doing that we think works and prove it to everybody.”
The conference will run Tuesday through Saturday at Moscone Center. Nearly 3,000 spinal care experts – including surgeons, physical therapists, chiropractors and nurses – are expected to attend.
The spine’s tough job
Roughly 4 in 5 Americans suffer some sort of back pain, doctors say, and it’s the third most common reason for people to visit their physician. Part of the reason back pain is so common is because the fairly narrow spine is expected to support a great deal of weight. That means that as Americans have gotten larger, so has the field of back care medicine.
The past 15 years have seen major advancements in spinal care, much of it expensive and invasive. Doctors seem to agree that most recent treatments are useful – the questions are how useful, and to whom are they useful.
“These patients are in a lot of pain, but at the end of the day you’ve got to be honest and make sure what you’re doing makes a difference,” said Dr. Patrick Suen, chief of regional spine surgery at Kaiser Permanente San Jose. “It’s not that I’m saying all these technologies don’t work. There probably is a use for all of them, but it’s not for everybody.”
For example, disk replacement surgery is typically done for people who have degenerative disk disease, and for whom other, less-invasive treatments haven’t been successful. But not everyone will see improvement with the procedure at all.
For others, the surgery might help for a few months, but then the pain comes back, which raises the controversial issue of cost-effectiveness. Disk replacement surgery can cost tens of thousands of dollars.
“For patients who have back problems, the compromise on their quality of life can be very severe,” said Dr. Serena Hu, an orthopedic surgeon and chief of spine service at UCSF. “Some patients, what you can give them may be worth the cost. But nobody wants to treat a patient with an expensive procedure and have it only last three months.”
Backing off surgery
For a while in the 1990s, surgery for back pain seemed like a good catch-all answer for most patients. But spine care experts, including surgeons, have since backed off that solution, and now most agree that patients need to be evaluated carefully, especially before starting invasive treatments.
In fact, most people who experience back pain won’t be helped by surgery at all, said Harley Goldberg, director of the spine care program at Kaiser Permanente San Jose. Research into dozens of areas of noninvasive treatments – including yoga, acupuncture and massage – have produced sometimes mixed results. But when he sees patients, he almost always recommends they start with basic stretching and strengthening exercises and ultimately regular workouts.
“My caution to most people with back pain is to stay simple. Exercise regularly and find a specific exercise program that works for you,” Goldberg said. “It’s only when it’s more severe, unrelenting pain that we require the more aggressive, invasive and sometimes surgical answer.”