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In this issue of JAMA Internal Medicine, Mafi and colleagues1 effectively describe national trends in the management of neck and back pain between 1999 and 2010. Using a large representative sample of patient encounters associated with International Classification of Diseases, Ninth Revision (ICD-9) codes for the chief symptoms of acute back and neck pain extracted from the National Hospital Ambulatory Medical Care Survey, the authors describe patterns of care that seem discordant with well-established clinical practice guidelines for these conditions. Whereas these guidelines promote use of nonopioid analgesics, avoidance of imaging tests, use of physical therapy–based exercises, and primary care for this population,2 the results of this analysis demonstrate recent significant decreases for these recommendations. So, in the words of Saturday Night Live character DeAndre Cole played by Kenan Thompson, “What’s up with that?”
Casey DE. Why Don’t Physicians (and Patients) Consistently Follow Clinical Practice Guidelines?Comment on “Worsening Trends in the Management and Treatment of Back Pain”. JAMA Intern Med. 2013;173(17):1581–1583. doi:10.1001/jamainternmed.2013.7672