Pain in the Back

Back pain is a common problem, accounting for >10% of visits to primary care practitioners. However, despite it's ubiquity, back pain is often not treated in accordance with established guidelines. These guidelines stress conservative treatment with non-steroidal anti-inflammatory drugs or acetaminophen, combined with physical therapy. A study published in JAMA examining patient records from 1999 to 2010 found that use of these drugs decreased 50% in this period, combined with 50% increase in narcotic prescriptions. The authors note that narcotics have no proven efficacy in treating chronic back pain and 43% of these patients have concurrent substance abuse disorders. Overall US sales of prescription narcotics increased 300% in the same period, leading to more overdose deaths than cocaine and heroin combined.