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BackPage Online, August 2018

doi: 10.1097/01.BACK.0000544134.78737.d6
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Burnout a Problem for Patients as Well as Doctors

When people hear about rising levels of discontent and burnout among doctors, they often fail to think about the ramifications for patients and members of the general public. Burnout often leads to ineffective care, a loss of relationships with patients, and an increase in the probability of serious medical errors. Here is a link to an excellent overview of the implications of burnout from Karen Kahn at the NPQ nonprofit quarterly:

https://nonprofitquarterly.org/2018/06/04/money-drives-nonprofit-health-clinician-burnout-follows-patient-care-falls/

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Why Do Prices for Spine Care Vary So Dramatically?

Anyone who is familiar with the spine field knows how difficult it is to determine the “real” price of any particular service—diagnostic or therapeutic. The price of an MRI might vary by hundreds of dollars between hospitals. The cost of fusion surgery can vary by tens of thousands of dollars. Zach Cooper and colleagues recently conducted a study of hospital prices and health spending for people covered by private insurance. Their conclusion? “Prices vary substantially across regions, across hospitals within regions, and even within hospitals.” And those prices reflect a variety of influences. Hospital market structure makes a difference. Hospitals that have a monopoly on services in any given area charge higher prices that hospitals that don't. Hospitals often charge lower prices in competitive markets with multiple insurers. And mergers between hospitals in the same vicinity appear to lead to increased prices—perhaps due to decreased competition for customers. Here is a link to the full report:

http://www.healthcarepricingproject.org/sites/default/files/20180507_variationmanuscript_0.pdf

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Do Platelet-Rich Plasma Injections Help Patients With Chronic Back Pain Attributed to the Disc?

There is growing interest in platelet-rich plasma injections as a treatment for low back pain attributed to discogenic sources. And there is an increasing volume of research, although it is fundamentally inconclusive—mostly small case series and cohort studies that cannot prove cause-and-effect.

Furthermore, discogenic pain itself is a nebulous concept, with varying definitions. And there are no validated diagnostic tests that can distinguish discogenic pain from other hypothetical pain sources. So given these uncertainties, readers should be skeptical about both the efficacy and safety of platelet-rich plasma injections. Here is a link to a useful preliminary review of the evidence in this area that discusses some of the clinical trials to date:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911760/

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