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CNN Medical Unit: Daily Dose (What's this?)

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Get the reporting, research and analysis behind on-air stories straight from the CNN Medical Unit, led by chief medical correspondent Dr. Sanjay Gupta.

Treating that pain in the neck

Bottom Line: Patients may want to try exercising, yoga or over-the-counter pain medicines before they go to the doctor for back or neck pain

Next Daily Dose »

Billions of dollars are spent on medication, surgery and imaging, but many cases may not require doctor's care.

Overview

Back and neck problems are among the most commonly encountered issues in clinical practice. Can a remedy such as enlisting a chiropractor work? And when should a person seek treatment for back pain?

A 2002 survey of U.S. adults revealed that 26 percent had low back pain and 14 percent reported neck pain in the previous three months. According to the study, published in the Journal of the American Medical Association on February 13, 2008, Americans are spending more than $80 billion every year on back pain.

Questions and answers

Where are those billions of dollars going?

Dr. Sanjay Gupta, CNN chief medical correspondent: It's being spent on prescription pain medications, on surgery, and on MRIs and other imaging studies. This study found that we are spending as much each year to treat back pain as we spend treating cancer. That's staggering -- spending more than $80 billion on a problem that in most cases does not require a doctor's care.

Where does the pain come from, and is the money worth it?

Gupta: The neck is a huge source of pain. But most pain is concentrated in the low back. The low back is the crux of all the movement we do every day. Any time you twist, bend, walk, stand, lift, you're impacting this part of your back. When you think about the pressure we put here -- while we ride in the car for hours commuting, or when we're on airplanes, when we lift things the wrong way -- all of that takes a toll on the back. But here's what this study is telling us: Your back pain is probably not going to get better if you rush to the doctor for a pain pill prescription. It's not going to get better if you ask for imaging studies such s MRIs.

We now know that 80 to 85 percent of the time, this pain goes away within a couple or three weeks. Going to the doctor, getting a narcotic pill, or getting an MRI really doesn't seem to speed up that recovery.

What can you do about neck and back pain?

Gupta: In the long term, you really do need to think about losing weight and strengthening the big muscles that run up and down along the spine. If you strengthen those muscles, you're much more likely to be able to tolerate the wear and tear of daily life.

Chiropractors can provide a lot of relief. I have friends who use them all the time, and they provide a lot of relief in the short term.

If there is something that is lingering, continuing for a long period of time, or if you're starting to develop numbness or weakness, then it probably is time to get it checked out and even get something done about it.

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Background

ORIGINAL PRESS RELEASE

Expenditures Rising for Back and Neck Problems, But Health Outcomes Do Not Appear to Be Improving

CHICAGO - Although expenses related to back and neck problems have increased substantially in the last decade, outcomes such as functional disability and work limitations do not appear to be improving, according to a study in the February 13 issue of JAMA.

Back and neck problems are among the symptoms most commonly encountered in clinical practice. In a 2002 survey of U.S. adults, 26 percent reported low back pain and 14 percent reported neck pain in the previous three months, according to background information in the article. Rates of imaging and therapy for back and neck (spine) problems have increased substantially in the last decade, but it is not clear how this has effected expenditures or health outcomes for individuals with these problems.

Brook I. Martin, M.P.H., of the University of Washington, Seattle, and colleagues conducted a study to examine changes in expenditures and health status related to spine problems. The researchers analyzed 1997 - 2005 data from the nationally representative Medical Expenditure Panel Survey (MEPS). A total of 23,045 respondents (U.S. adults older than 17 years) were sampled in 1997, including 3,139 who reported spine problems. In 2005, the sample included 22,258 respondents, including 3,187 who reported spine problems.

The researchers found that expenditures were higher in each year for those with spine problems than for those without. In 1997,the average age- and sex-adjusted medical costs for respondents with spine problems was $4,695, compared with $2,731 among those without spine problems (inflation adjusted to 2005 dollars). In 2005, the average age- and sex-adjusted medical expenditures among respondents with spine problems was $6,096, compared with $3,516 among those without spine problems. From 1997 to 2005, these trends resulted in an estimated 65 percent inflation-adjusted increase in the total national expenditure of adults with spine problems, a more rapid increase than overall health expenditures.

Most of the difference observed in inflation-adjusted expenditures between those with and without spine problems in 2005 was accounted for by outpatient services (36 percent) and inpatient services (28 percent). Smaller proportions were accounted for by prescription medications (23 percent); emergency department visits (3 percent); and home health, dental and other expenses (10 percent).

The estimated proportion of persons with back or neck problems who self-reported physical functioning limitations increased from 20.7 percent to 24.7 percent from 1997 to 2005. Adjusted self-reported measures of mental health, physical functioning, work or school limitations, and social limitations among adults with spine problems were worse in 2005 than in 1997.

"These data suggest that spine problems are expensive, due both to large numbers of affected persons and to high costs per person. We did not observe improvements in health outcomes commensurate with the increasing costs over time. Spine problems may offer opportunities to reduce expenditures without associated worsening of clinical outcomes," the authors conclude.