Millions of Americans suffer from back pain, which may lead to time away from work, depression, anxiety, sleep disorders, and numerous other mental consequences.

Most guidelines for treating chronic back pain recommend analgesics, rest, and physical therapy.

Narcotics, referrals to specialists, expensive scanning procedures, and surgery are only recommended for difficult cases.

But a new study published in JAMA Internal Medicine reported that such conservative measures are not always followed.

The investigators reviewed more than 23,000 outpatient visits for back pain during a 12-year period, and found that the use of anti-inflammatory drugs and aspirin dropped by 50 percent, while MRI and CT scan use increased by more than 50 percent.

Referrals to specialists increased by more than 100 percent.

Back pain generally improves with conservative treatment, and it is essential for doctors to educate their patients to help them avoid unneeded procedures and other treatments that may have a negative impact on their psychological health.