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Little gained for billions spent on back pain.

As treatment bill soars, more in US deemed afflicted

by Tara Parker-Pope ( New York Times News Service )

NEW YORK - Americans are spending more money than ever to treat spine problems, but their backs are not getting any better.

Those are the findings of a report in the Journal of the American Medical Association, which found that spending on spine treatments in the United States totaled nearly $86 billion in 2005, a rise of 65 percent from 1997, after adjusting for inflation. Even so, the proportion of people with impaired function because of spine problems increased during the period, even after controlling for an aging population.

"You'd think if you're putting a lot of money into a problem, you'd see some improvements in health status," said Brook I. Martin, research scientist at the Department of Orthopedics and Sports Medicine at the University of Washington and lead author on the study, published today. "We're putting a lot of money into this problem, and it's a big investment in healthcare expenditures, but we're not seeing health status commensurate with those investments."

The report is the latest to suggest that the nation is losing its battle against back pain and that many popular treatments may be ineffective or overused. Researchers have produced conflicting data about the effectiveness of spinal surgery for back pain, although one major clinical trial, known by the acronym Sport, found that spinal surgery patients did better than patients receiving more conservative care, which included medications or physical therapy. However, some doctors have questioned whether surgeries, injections, and narcotic pain medications are being used appropriately. </block> <block><![CDATA[ "I think the truth is we have perhaps oversold what we have to offer," said Richard A. Deyo, a physician at Oregon Health & Science University in Portland and a coauthor of the report. "All the imaging we do, all the drug treatments, all the injections, all the operations have some benefit for some patients. But I think in each of those situations we've begun using those tests or treatments more widely than science would really support."

To study spending trends on spinal care, the researchers examined annual household survey data from the Agency for Healthcare Research and Quality, which were collected from about 23,000 people a year from 1997 to 2005. Pharmacy and medical record data were included and were used to estimate national spending and treatment practices.

The researchers found that people with spine problems spent about $6,096 each on medical care in 2005, compared with $3,516 in medical spending by those without spine problems.

The biggest surge in spending has been for drugs. In 2005, Americans spent an estimated $20 billion on drug treatments for back and neck problems, an increase of 171 percent from 1997. The biggest jump was for narcotic pain relievers like OxyContin and other drugs, which increased more than 400 percent.

The researchers estimated that in 1997, about 21 percent of the adult population suffered from crippling back or neck problems. By 2005, that number grew to about 26 percent, taking into account an aging population.

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