The Price of Pain

Nonetheless, Deyo isn't advocating an end to surgery and other treatments. "It's a matter of being more judicious about what we do, not stopping what we do," he says. "We all have a bias for action. Both doctors and patients hate the idea of just wait and see, or try something that doesn't seem very dramatic. But it's often the best bet."

"It's not so clear that a lot of the things we're doing are helping that much," says Deyo. "Most of the time you can take care of it yourself. It will get better. The odds are in your favor. Time is in your favor."

Aside from allowing time to heal, the best treatments may be the least dramatic: exercise more and lose weight. "They're harder to do than getting an injection or an operation or taking a pain pill," says Deyo. "People want something more than that, and lifestyle change is hard for all of us." But it's worth trying. "The take-home message is that some of these basics that we tend to ignore or overlook are probably the most important things," says Deyo.

This is not to say that all the expenditures on back pain treatments are for naught. The percentage of the population seeking treatment for back pain increased from 20.7 percent in 1997 to 24 percent in 2005—which may mean better access to treatment rather than a greater incidence of back pain, or ineffective treatments, says Dr. Alan Hilibrand, a professor of orthopedic surgery at Jefferson Medical College and a spokesman for the American Academy of Orthopaedic Surgeons. "Hopefully, people are having better access to the care they need."

Educating doctors about alternative treatments—even when a patient may be clamoring for high-tech intervention—may be another key to reducing costs and relieving pain. "They [patients] can't order drugs and tests for themselves. Somebody has to be offering them," says Dr. Michael Haak, a spine specialist and orthopedic surgeon at Northwestern University's Feinberg School of Medicine. "You need to encourage [doctors and patients] to be aware of all the alternatives."

Deyo is all too aware of those alternatives, both professionally and privately. He has had back problems himself. "I don't know how I got mine, like most people," he says. Now 58, he started feeling the pain in his mid-40s (and still occasionally gets twinges). He knew better than to demand MRIs and surgery. Instead he took ibuprofen and let it heal on its own. "Most people will have recurrences of back pain," he says. "Most of the time it's something you can take care of yourself, and you'll get better eventually."

© 2008