Rise in U.S. spinal surgeries sparks call for non-invasive back pain approach
Oct. 31, 2013 — The American Chiropractic Association (ACA), in response to a recent government report and articles questioning the rise in spinal fusion surgeries in the United States, has urged patients and health-care providers to consider the benefits of a more conservative approach to back pain.
"Research supports the use of more conservative treatments as a
first-line defence against pain. This sensible approach not only reduces
health care costs but also may help some patients avoid riskier
treatments altogether," said ACA president Dr. Keith Overland.
Overland's comments follow the release in October of a report from the
U.S. Department of Health and Human Services Office of the Inspector
General (OIG) showing that hospitals that purchased spinal devices from
physician-owned distributors (POD) had higher rates of spinal surgeries
than the rate of hospitals overall. The report noted that many hospitals
rely on the surgeon's preference when making purchasing decisions, and
in some cases those surgeons have a financial stake in the companies
selected. OIG findings show that using a POD did not reduce costs and
those hospitals that did generally saw an increase in the number of
surgeries performed — indicating clinical decision may have been
affected by the business relationship.
A related article
published on Oct. 27 in The Washington Post reports the number of spinal
fusion surgery in the United States has risen six-fold in the past 20
years, from 56,000 in 1994 to 465,000 in 2011. The Post analyzed 125,000
patient records in Florida and found that half the rise in spinal
surgery cases in that state involved patients whose diagnoses would not
normally make them candidates for the procedure. The article added that
Medicare estimates more than $200 million was spent improperly on spinal
fusions in 2011 because a conservative course of treatment had not been
Medical guidelines for back pain recommend the use
of conservative treatments. An article published in the Journal of the
American Medical Association (JAMA) in April 2013 encourages patients
with back pain to first try conservative treatments — exercises,
physical therapy, chiropractic or acupuncture — and resort to surgery
only when less invasive options fail.
A study published earlier
this year in the JAMA Internal Medicine confirms that many physicians
don't follow guidelines and instead refer back pain patients to surgery
or write prescriptions for powerful pain killers. The latter is part of
an epidemic problem of prescription drug abuse in the United States,
according to the ACA. The number of prescriptions filled for opioid pain
killers — some of the most powerful medications available — has
increased by nearly 50 percent in the past 10 years to 257
million. Unintentional overdose deaths involving opioids now outnumber
cocaine and heroin deaths combined.
"It's important today for
patients facing spine surgery to do their due diligence and ensure no
stone is left unturned. There are effective, more conservative
treatments that help many patients each year avoid surgery, lessen
reliance on addictive pain killers,and get back to their normal lives
and activities," said Dr. Overland.