The results suggest that some treatments with the strongest evidence of benefit for patients with low back pain-such as therapeutic exercise and antidepressants-are less often used.

In a random telephone survey, Dr. Timothy S. Carey and colleagues of University of North Carolina, Chapel Hill, identified 732 adults with chronic low back pain. The respondents were asked in detail about what back pain treatments they used.

Treatments Used Don't Match the Research Evidence
The respondents saw a wide range of physicians and other health professionals-the average patient made 21 visits to nearly three different health care providers per year. Medications were very widely used, with narcotics used by 61 percent of patients and muscle relaxants by 31 percent. Over the past year, more than one-third of patients had undergone advanced imaging procedures, like CT and MRI scans.

The patients also used many treatments for which there is little or no research evidence of effectiveness. These included physical treatments like traction, corsets or braces, or electrical nerve stimulators.

At the same time, use of research-proven treatments was relatively low. Less than half of patients had a prescription for exercise, and only 30 percent had seen a physical therapist in the past year. Just three percent of patients had gone through a structured rehabilitation program-one of the few treatments with moderately strong evidence of effectiveness.

As in previous studies of back pain, many patients had symptoms of depression. However, few of these patients were taking antidepressant medications or seeing a mental health professional.

"Chronic low back pain is disabling, expensive, and becoming increasingly common," Dr. Carey and colleagues write. The past 15 years have seen substantial progress in research to evaluate the effectiveness of various treatments for back pain. However, the treatments chosen vary depending on a lot of factors, including patient preferences and which professionals the patient sees.

The new results suggest that most patients with chronic low back pain see more than one health professional and receive a number of different tests and treatments. The researchers voice special concern about the overuse of narcotics and other medications and the underuse of exercise, antidepressants, and other proven treatments. "Concerted efforts by professional groups, insurers, and health policy makers are needed to substantially change treatment patterns...for this common and disabling illness," Dr. Carey and colleagues conclude.

About Spine
Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. According to the latest ISI Science Citation Impact Factor, Spine ranks highest among general orthopaedic journals and subspecialty titles. Visit the journal website at www.spinejournal.com.

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