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Writing in JAMA, researchers detail an investigation using Medicare claims data between 2002 and 2007. During that period, the overall number of lumbar stenosis operations declined slightly, while use of the most complex approach increased some 15-fold.

In examining 2007 data, the researchers found that more complex fusion operations had double the rate of major medical complications and double the 30-day mortality of decompression alone. The average hospital charge for the more complex procedure was some $80,000 — versus $24,000 for decompression.

An editorialist concludes that “conflicting economic incentives are clearly at work,” noting that a surgeon’s reimbursement for the more complex approach can be ten times that of simple decompression. Current financial incentives and market forces in medicine, he says, amount to “a formidable economic and social problem.”

High Blood Sugar Better in 1 Week! Plus She Lost 11 Pounds!

My other chiropractor couldn’t help me!

79 year old man gets relief from chronic pain in 3 treatments! Listen to this!

 Archives of Internal Medicine article (Free)

Archives of Internal Medicine commentary (Subscription required)

American College of Physicians/American Pain Society guideline on managing low back pain (Free)

General practitioners rarely follow guidelines when managing new episodes of low back pain, reports the Archives of Internal Medicine. (The analysis was conducted in Australia, but the guidelines assessed match those in the U.S.)

 Researchers examined data on some 1700 visits to GPs for new low back pain from 2005 to 2008, after national guidelines for treating musculoskeletal pain were released. Among the findings:

 Although guidelines recommend acetaminophen as a first-line analgesic, it was prescribed for only 18% of patients. NSAIDs and opioids were prescribed for 37% and 20%, respectively.

• One fourth of patients were referred for imaging, despite guidelines advising against routine referral.
• Only one fifth of patients received advice and education as recommended.

 These findings were similar to those from the period before guideline publication.

 The authors conclude: “The results indicate that in most cases, usual care is not evidence-based care and so is not likely to provide the best outcomes.”

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