Epidemiology of Spine Care: The Back Pain Dilemma

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Prevalence of LBP

Despite the vast amount of research devoted to LBP, the epidemiology of this condition is not well understood, and the overall prevalence of LBP in the United States is unclear. There are several techniques for estimating the prevalence of spine problems, including survey techniques as well as the use of medical billing claims data. Each method has its strengths and weaknesses. Retrospective surveys obtain information directly from affected individuals but may be subject to recall bias.

The use of interventional spine procedures

Interventional spine procedures have been used for many decades for a variety of spinal disorders and range from percutaneous injections to surgery. For a variety of reasons, there has been a recent proliferation in the number of techniques available for use and marked increases in the use rates for many of the procedures. Percutaneous interventions include epidural steroid injections (ESIs) via several different approaches, facet/zygapophysial joint (z-joint) procedures, spinal cord

Epidural steroid injections

Although ESIs for the treatment of lumbosacral radicular pain were first introduced in the early 1950s,22 there has been a lot of interest recently in the use of these injections as an alternative to more invasive surgical procedures for treating spinal pain. Since the introduction pf ESIs, many investigators have examined them for the treatment of lumbosacral radiculopathy as well as axial (nonradicular) spinal pain syndromes.23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 Although most studies

Understanding the increase in use

One of the more optimistic explanations available for the disproportionately escalating rate of ESI use could be improvements in health care delivery, including more effective management of spinal pain in the general population. If these improvements are occurring, improvements in measures of health or disability or a decrease in rates of surgical intervention for specific spine problems might be expected. The available data do not seem to indicate that this is the case. Paradoxically, measures

Z-joint Injections and RFN

There are fewer epidemiologic data examining the use of z-joint intraarticular steroid injections and RFN (ie, radiofrequency ablation of the z-joint medial branch nerve) than there are for ESIs. There is good evidence to indicate that z-joints are potential sources of back pain.63, 64, 65, 66 Injection of these joints with corticosteroids, as is performed for many peripheral joints, is believed to have the potential to transiently relieve pain. In addition, these joints are innervated by the

Discussion

Individuals with LBP are receiving an increasing number of interventional treatments for pain without any available evidence to support a substantial overall improvement in functional status. This situation presents a challenging dilemma for health care providers. There is a vast and ever-expanding array of potential treatment options for LBP, many of which have some evidence of efficacy in select patients but none of which has offered long-term benefit for most patients with LBP. There are

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References (106)

  • N. Bogduk

    Evidence-informed management of chronic low back pain with facet injections and radiofrequency neurotomy

    Spine J

    (2008)
  • C.W. Slipman et al.

    A critical review of the evidence for the use of zygapophysial injections and radiofrequency denervation in the treatment of low back pain

    Spine J

    (2003)
  • K.J. Pauza et al.

    A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain

    Spine J

    (2004)
  • S.S. Weiner et al.

    Prevention and management of chronic back pain

    Best Pract Res Clin Rheumatol

    (2010)
  • A.S. Wallace et al.

    Comfortably numb? Exploring satisfaction with chronic back pain visits

    Spine J

    (2009)
  • Y. Rhee et al.

    Narcotic drug use among patients with lower back pain in employer health plans: a retrospective analysis of risk factors and health care services

    Clin Ther

    (2007)
  • R.I. Newman et al.

    Multidisciplinary treatment of chronic pain: long-term follow-up of low-back pain patients

    Pain

    (1978)
  • R.A. Deyo et al.

    Low back pain

    N Engl J Med

    (2001)
  • G. Anderson

    The epidemiology of spinal disorders

  • R.A. Deyo et al.

    Overtreating chronic back pain: time to back off?

    J Am Board Fam Med

    (2009)
  • B.I. Martin et al.

    Expenditures and health status among adults with back and neck problems

    JAMA

    (2008)
  • D.K. Weiner et al.

    Low back pain in older adults: are we utilizing healthcare resources wisely?

    Pain Med

    (2006)
  • L.J. Paulozzi et al.

    Increasing deaths from opioid analgesics in the United States

    Pharmacoepidemiol Drug Saf

    (2006)
  • R.A. Deyo et al.

    Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002

    Spine

    (2006)
  • J.K. Freburger et al.

    The rising prevalence of chronic low back pain

    Arch Intern Med

    (2009)
  • J.N. Weinstein et al.

    Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort

    JAMA

    (2006)
  • J.N. Weinstein et al.

    Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts

    J Bone Joint Surg Am

    (2009)
  • C.R. Martin et al.

    The surgical management of degenerative lumbar spondylolisthesis: a systematic review

    Spine (Phila Pa 1976)

    (2007)
  • J.N. Weinstein et al.

    Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis

    N Engl J Med

    (2007)
  • S.J. Atlas et al.

    Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the Maine lumbar spine study

    Spine (Phila Pa 1976)

    (2005)
  • R. Chou et al.

    Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline

    Spine (Phila Pa 1976)

    (2009)
  • R.A. Deyo

    Back surgery–who needs it?

    N Engl J Med

    (2007)
  • N.J. Birkmeyer et al.

    Medical versus surgical treatment for low back pain: evidence and clinical practice

    Eff Clin Pract

    (1999)
  • S.K. Mirza et al.

    Systematic review of randomized trials comparing lumbar fusion surgery to nonoperative care for treatment of chronic back pain

    Spine (Phila Pa 1976)

    (2007)
  • M.C. Wang et al.

    Complications and mortality associated with cervical spine surgery for degenerative disease in the United States

    Spine (Phila Pa 1976)

    (2007)
  • J.A. Lievre et al.

    L’injection transsacree. [Etude clinique and radiologigue]

    Bull Soc Med Paris

    (1957)
  • S. Carrette et al.

    Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus

    N Engl J Med

    (1997)
  • P.J. Nelemans et al.

    Injection therapy for subacute and chronic benign low back pain

    Spine

    (2001)
  • M. Fukusaki et al.

    Symptoms of spinal stenosis do not improve after epidural steroid injection

    Clin J Pain

    (1998)
  • G.R. Butterman

    Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized study

    J Bone Joint Surg Am

    (2004)
  • K.D. Riew et al.

    The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain

    J Bone Joint Surg Am

    (2000)
  • S.M. Weinstein et al.

    Lumbar epidural steroid injections

    Spine J

    (2003)
  • C. Rivest et al.

    Effects of epidural steroid injection on pain due to lumbar spinal stenosis or herniated disks: a prospective study

    Arthritis Care Res

    (1998)
  • J.P. Valat et al.

    Epidural corticosteroid injections for sciatica: a randomized, double blind, controlled clinical trial

    Ann Rheum Dis

    (2003)
  • V.B. Vad et al.

    Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study

    Spine

    (2002)
  • N.K. Arden et al.

    A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study

    Rheumatology (Oxford)

    (2005)
  • K.P. Botwin et al.

    Fluoroscopically guided lumbar transforaminal epidural steroid injections in degenerative lumbar stenosis: an outcome study

    Am J Phys Med Rehabil

    (2002)
  • B.L. Rydevik et al.

    Spine epidural steroids for patients with lumbar spinal stenosis

    Spine

    (1997)
  • P.A. Banaszkiwicz et al.

    The role of caudal epidural injections in the management of low back pain

    Bull Hosp Jt Dis

    (2003)
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