Comparative Effectiveness Studies Raise Questions About Popular Back Pain Treatment

New studies on treating back pain from a fractured spine could call more attention to the type of comparative effectiveness research health policy experts and President Barack Obama have embraced in their quest to increase quality of care while lowering costs. 

The New York Times: "Two new studies cast serious doubt on a widely used and expensive treatment for painful fractures in the spine. The treatment, vertebroplasty, injects an acrylic cement into bones in the spinal column to ease the pain from cracks caused by osteoporosis, the bone-thinning disorder common in older people. Doctors began performing it in this country in the 1990s, patients swore by it — some reporting immediate relief from terrible pain — and it soon caught on, without any rigorous trials to determine whether it really worked. The new studies are exactly the kind of research that health policy experts and President Obama have been calling for, to find out if the nation is spending its health care dollars wisely, on treatments that work. A bill passed by Congress this year provides $1.1 billion for such so-called comparative effectiveness research."

The New York Times reports: "The studies of vertebroplasty, being published Thursday in The New England Journal of Medicine, found it no better than a placebo. But it remains to be seen whether the findings will change medical practice, because they defy the common wisdom and challenge a popular treatment that many patients and doctors consider the only hope for a very painful condition. .. Last year, about 73,000 Americans had the treatment, which costs $2,500 to $3,000, as well as $1,000 to $2,000 for an M.R.I. scan" (Grady, 8/5).

NPR: "One of the key issues for a health care overhaul is how to pay only for necessary care — and how to identify which procedures and treatments are most advantageous to patients ... A second study from Australia of 78 people, in which half got the no-cement procedure and the other half got the cement injection, also showed no significant advantage to the cement fix. The head of the North American Spine Society says the broken vertebrae studies show that both the placebo and cement procedures work. But some interpret the findings differently: 'What it said to me is that essentially this is a treatment with no effect, and it probably shouldn't be done any more,' says James Weinstein, an orthopedic surgeon who directs the Dartmouth Institute for Health Policy and Clinical Practice."

"Many have questioned the effectiveness of various other back pain procedures. For example, long after surgeries for slipped disks had become common practice, it was determined that the surgery has only a slight advantage over rest and rehabilitation. Spinal fusion also remains controversial. In many cases, the passing of time alone can heal the back" (Silberner, 8/5).

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