Getting what you pay for in back pain relief

“Back pain is so common that almost anyone can hang out a shingle, claim to have a cure, and make a living,” Richard A. Deyo writes in “Watch Your Back! How the Back Pain Industry Is Costing Us More and Giving Us Less — and What You Can Do to Inform and Empower Yourself in Seeking Treatment.”

You don't have to read much more than his supersized subtitle to understand where Deyo, a physician and a professor at Oregon Health and Science University, is headed in this book.

About two-thirds of Americans suffer back pain at some point, he writes, and treating it is big business. In 2005 — the last year of his research team's decadelong study of back treatment — the cost of treating back pain was estimated at $86 billion, about 9 percent of the nation's total health care bill.

But Deyo doesn't think back patients are getting their money's worth.

It's not that people don't feel better after seeing a doctor — quite often they do, though quite often the pain returns later. But Deyo says that in many cases there is little evidence that expensive drugs or surgeries have had much or anything to do with healing.

At one point, he cites a series of published claims: Epidural blocks lessened the back pain for 80 percent of patients. Mobilization and manipulation also helped 80 percent. Microcurrent therapy? Eighty-two percent, after 10 treatments. YMCA exercise class: Eighty percent. Surgery? Seventy to 80 percent.

“See a pattern?” he writes. “It looks like 70 to 80 percent of people with back pain get better no matter what you do!”

This doesn't seem to reflect effective treatment, he writes: “It looks suspiciously like natural healing.”

That's just one point in a book that examines spinal imaging, cognitive behavioral therapy, acupuncture, steroid injections, physical therapy and dozens of other tools and treatments. He also encourages policy changes for government health care planners, including requiring head-to-head comparisons of competing treatments, with publication of the results.

The heart of his prescription for better care is a more active patient role, with patients making sure they know all options, risks and — this is the tough one — final costs before making a choice for back treatment.

It may not permanently end back pain — Deyo, who has back pain himself, thinks it's something most of us have to learn to manage — but at least it could stop wasting some of the money.