Clinical practices in the management of new-onset, uncomplicated, low backworkers' compensation disability claims

Recent consensus guidelines delineate what appears to the the most successf ul and cost-effective management of low back pain (LBP) and some recent stu dies have suggested that better outcomes occur with the least aggressive fo rms of medical intervention. The purpose of this study was to describe how practitioners manage new-onset, uncomplicated low baa workers' compensation (WC) disability cases. A sample of cases was randomly selected from a larg e insurance carrier's national data source. An effort was made to select on ly uncomplicated cases, which would be expected to have relatively minimal need for medical intervention. There was an apparent overuse of diagnostic and treatment modalities. Diagnostic imaging was overutilized, not only in terms of the number of studies done (65% had plain films, 22% had magnetic resonance imaging scans) but also in the time frame in which they were perf ormed (38% had plain films on the first clinic visit). Ninety percent recei ved at least one medication, and 38% received more than one prescription fo r opioid analgesics. Expensive non-steroidal anti-inflammatory drugs were p rescribed more often than acetaminophen (61% versus 6%, respectively). Sixt y-two percent received physical therapy that often included modalities with as yet unproven efficacy. Overutilization of either diagnostic or treatmen t procedures increases the likelihood of iatrogenic complications, is not c ost-effective, and may adversely impact clinical and occupational outcomes.