The Price of Pain

High-tech imaging tests, for example, are a major money drain when it comes to treating back pain. "Patients want [imaging] and think that it will discover the answer for why they're having pain that can be fixed," says Deyo. "Doctors want it because they're afraid they'll be sued if they don't do it."

The tests are useful once a patient is committed to surgery, but before that "patients may want to think twice before they ask for them," says Deyo. "In part, we're just guilty of trying to keep hitting things with the same hammer over and over again and not taking a step back and rethinking the problem and considering whether an exercise program, more physical therapy, may be beneficial."

An ever-larger arsenal of prescription medicines is another huge factor in the cost of treatment. In the JAMA cost analysis study, expenditures for pain medicines increased about 423 percent from 1997 to 2005. During the same period the average bill for each pharmacy visit for a spine-related medication rose from $25 to $58.

The rise is due to more prescriptions being written—and to greater use of newer brand-name medications instead of generics. But Deyo believes that many patients can get "quite effective" pain relief with simple and cheap over-the-counter pain relievers such as ibuprofen and naproxen instead of expensive prescription drugs. And they can try a low-tech heating pad, too.

Having an operation to fix a back problem is costly both financially and in recovery time. But the jury is still out as to whether some of these procedures are worth it. According to a 2006 study published in JAMA, herniated disk patients who did not opt for surgery fared nearly as well after a two-year period as those who went under the knife.

Researchers said the differences in outcome between the two approaches were "small and not statistically significant." Deyo, a co-author of the 2006 report, said that risk-averse patients who prefer to avoid surgery would probably get better anyway, and risk takers who prefer surgery would probably get better faster and spend more money. It's largely "a matter of personal preference, which way you go," says Deyo.

The price tag for these procedures is hefty. Each year about 300,000 Americans have surgery for herniated disks—with hospital, anesthesia and surgery costs running around $10,000 per operation. The bill for a spinal fusion procedure is even higher, at about $60,000 per procedure for hospitalization costs in 2005. (That's more than double what it was in 2000.)