I am the first one to admit that treating patients with low back pain is not for sissies. There is no great way to sub-classify patients with low back pain and it is difficult to predict which intervention is going to be best for a given patient. However, there are some general recommendations which just about every up-to-date treatment guideline recommends. These are things like stay active, no need for imaging in most cases and avoid opioids.
Despite the solid evidence behind these recommendations, a recent study out of Harvard showed that primary care physicians are getting worse at treating patients with low back pain. Over a 11 (1999-2010) year period the study found a 106% increase in referrals to other physicians, 57% increase in advanced imaging, a 51% increase in the use of narcotics and a 0% increase in physical therapy referrals (20%).
It would be frustrating to see no improvement over 12 years, but this significant movement in the wrong direction is a hard pill to swallow. I wonder what it will take to change the medical culture in our society.
Apparently a 90 billion dollar a year price tag is not enough.