Worsening Trends in the Management and Treatment of Back Pain

doi:10.1001/jamainternmed.2013.8992

Table 3

Adjusted^a Proportions of Utilization Stratified by Chief Complaint of Acute versus Chronic Back Pain over Time

Year (sample n acute) [sample n chronic]	1999–2000 (n=1,232) [n=572]	2001–2002 (n=1,360) [n=725]	2003–2004 (n=1,246) [n=831]	2005–2006 (n=1,276) [n=816]	2007–2008 (n=1,292) [n=979]	2009–2010 (n=1,112) [n=700]	P-value
Medications
Narcotics
Acute	19	19	25	29	28	28	<.001

Chronic	22	25	26	26	48	37	<.001

Tramadol
Acute	3.2	2.1	1.0	1.8	3.1	3.6	.39

Chronic	2.9	4.4	1.8	4.6	3.9	4.7	.23

Neuropathic
Acute	1.6	3.3	2.1	2.9	5.0	4.3	.02

Chronic	5.7	6.6	4.9	5.4	18	9.4	.001

Benzo/Relaxant
Acute	20	22	29	27	28	28	.003

Chronic	14	20	20	18	24	21	.12

NS AIDs/APAP
Acute	41	38	43	34	34	31	.001

Chronic	30	20	27	17	19	16	<.001

Referrals
Physical Therapy
Acute	18	12	14	16	13	18	.58

Chronic	9.7	3.9	16	9.5	6.4	10	.99

Other Physician^b
Acute	6.8	11	13	11	16	11	.07

Chronic	3.0	5.8	5.3	7.3	12	13	<.001

Imaging
X-Ray
Acute	22	17	18	20	20	17	.52

Chronic	7.4	6.7	4.3	8.6	6.8	9.6	.22

CT/MRI
Acute	6.7	6.5	5.3	10	12	11	.001

Chronic	4.5	6.2	3.4	6.1	6.7	7.6	.16

^aLogistic regression models adjusted for age, sex, race/ethnicity, region, insurance type, visit year, whether the provider was the PCP, and whether the visit was located in a metropolitan area.

^bInteraction with time was significant (p=.01).