The increased expenditures were expected, said the authors of a study in the Feb. 13 issue of the Journal of the American Medical Association, but the lack of results weren't.

"This calls into question whether we're providing treatments to people who aren't going to benefit," said study author Brook Martin, a research scientist in the department of orthopedics and sports medicine at the University of Washington, in Seattle. "This calls for a need for more effectiveness studies and looking at which patients would benefit from treatments and diagnostic tests."

"Spine problems are the most common reason why people of middle age have pain and disability, and we need to continue to search for better solutions because, although we have come up with newer techniques of treatments, we still have a large percentage of the of population with spine problems who are still disabled," added Dr. Andrew Sherman, head of medical rehabilitation at the Spine Institute at the University of Miami Miller School of Medicine.

That said, Sherman continued, "just because [the study authors] did not find improvement over the entire group doesn't mean that many individuals are not deriving benefit from treatment. There are many individual patients who do see improvements."

According to background information in the article, 26 percent of U.S. adults in 2002 reported lower back pain, and 14 percent reported neck pain during the previous three months.

Low back pain alone accounted for about 2 percent of all doctor's office visits, exceeded only by routine exams, hypertension and diabetes. At the same time, there have been increases in the rates of imaging, injections, use of opiates and surgery all related to spine pain.

But have these expenditures resulted in any actual improvements for the patient?

The authors sought to answer this question using data from the Medical Expenditure Panel Survey, which sampled individuals around the nation aged 17 and older from 1997 to 2005.

In 1997, 23,045 individuals were sampled, including 3,139 who reported spine problems. At this time, medical costs for those with spine problems was $4,695 compared with just $2,731 for those without spine problems.

In 2005, the survey included 22,258 respondents, including 3,187 with self-reported spine problems. Medical expenditures for those with spine problems was now $6,096 versus $3,516 for those without back and neck problems.

During that period, expenditures increased 65 percent from 1997 to 2005 for those with spine problems, which was more than for overall health expenditures during the same time period. There was only a small increase in the estimated number of U.S. adults with spine problems.

The estimated proportion of people with self-reported physical disabilities resulting from spine problems also increased, from 20.7 percent to 24.7 percent.

Most of the cost difference came from outpatient and inpatient services, with a smaller proportion accounted for by prescription medicines. However, the percentage of expenditures related to prescription medications went up more rapidly than expenses for other services.

"That includes a 423 percent increase in expenditures related to narcotic analgesics over that time," Martin said.

In addition, "there's been a steady stream of new devices and surgical techniques and imaging methods being used over time," he pointed out. "There's also been a moderate increase in people with back problems."

The annual expenditures for spine problems are comparable to the amount spent annually on arthritis, diabetes and cancer. All of those figures are dwarfed by the enormous sums spent in this country on heart disease and stroke.

SOURCES: Brook Martin, M.P.H., research scientist, department of orthopedics and sports medicine, University of Washington, Seattle; Andrew Sherman, M.D., assistant professor, and head, medical rehabilitation, Spine Institute, University of Miami Miller School of Medicine; Feb. 13, 2008, Journal of the American Medical Association

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