Study: Patients treated unnecessarily for back pain

WASHINGTON - "Why did they cut you?" The shocking question came from a respected spine surgeon tracked down by Keith Swenson, who was still in severe pain after an earlier back operation.

He didn't know what to believe. Two other surgeons had urged more operations, different ones. Swenson, who's from Howard Lake, Minn., is far from alone.

Even though only a fraction of people with back pain are good candidates for surgery, complicated spine operations are on the rise.

By one recent estimate, Americans are spending a staggering $86 billion a year in care for aching backs, from MRIs to pain pills to nerve blocks to acupuncture. That research found little evidence that the population got better as the bill soared over the past decade.

"The way medicine is so Star-Treky these days, they believe something can be done," said Dr. Charles Rosen, a spine surgeon at the University of California, Irvine.

The reality is that time often is the best antidote. Most people will experience back pain at some point, but up to 90 percent will heal on their own within weeks. In fact, for run-of-the-mill cases, doctors aren't even supposed to do an X-ray or MRI unless the pain lingers for a month to six weeks.

Yet a study last year found nearly one in three aching Medicare patients get some kind of back scan within that first month.

Why is that a problem? Those scans can be misleading. By middle age, most people who don't even have pain nonetheless have degeneration of their disks, those doughnut-looking shock absorbers between vertebrae. So in someone who does have pain, pinpointing that a particular black spot or bulge on a scan is the true cause is tricky.

The right operation can help, but specialists say only about 10 percent of people with lasting pain are candidates. More than 333,000 of the simpler decompression operations - laminectomies and diskectomies that cut away part of a bone or disk to relieve nerve pressure - were performed in 2007, the latest data compiled by the American Academy of Orthopedic Surgeons. There were nearly 381,000 spinal fusions - more complex, riskier surgeries that bind vertebrae together with a bone graft and sometimes metal hardware.

There is some hopeful news - increasing evidence that more people should try pushing past the pain in aggressive exercise programs. Deyo calls them boot camps for back pain.

That's what ended Swenson's five-year pain odyssey. After a volleyball injury, scans showed he had degeneration in seven disks but one bulged in a way that doctors thought explained the pain radiating down both legs. They cut away part of that spot; it didn't help. Neither did multiple pain-blocking options.

"Exercise is medicine, but it has to be the right exercise," said Dave Carpenter, president of Physicians Neck & Back Clinics in Minneapolis, where Swenson finally turned.

Swenson, now 51, said he was so debilitated that it took several months to improve, plus two years of "maintenance" conditioning. Today, he's running a thriving gardening business near Minneapolis that ships peonies nationwide.