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Comment & Response
March 2014

Assessment and Management of Back Pain

Author Affiliations
  • 1Division of Pain Medicine, Department of Anesthesiology, Stanford University, Redwood City, California
  • 2Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
JAMA Intern Med. 2014;174(3):479. doi:10.1001/jamainternmed.2013.13695

To the Editor In stark contrast to recommendations set by clinical guidelines, Mafi and colleagues1 recently highlighted a disturbing trend of increased narcotic use and decreased nonsteroidal anti-inflammatory drug use in the management of back pain using the nationally representative National Hospital Ambulatory Medical Care Survey (NHAMCS) data set. We found similar trends in our investigations of the 1997-2009 NHAMCS data set, in addition to troubling sex, race and ethnicity, and health care access disparities in opioid prescriptions.2,3 In light of these disparities, we think an important next step is to assess whether the imaging, physical therapy, and physician referrals rates that Maif and colleagues1 analyzed also showed sex, race, ethnicity, and health care access biases.

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