I live in a large city with several teaching hospitals around. I've been to several doctors in different clinics for my problem with back pain. Every one has a different idea of what to do. I can't help but wonder if I lived out west in a small, rural town, what kind of treatment would I get there?

You might get exactly the same treatment you've received in the more urban populated area. A recent study of trends in treating back pain came up with some surprising findings.

For example, the rate of spine surgery is much higher in western states compared to the East Coast. There's a wide range of treatment offered across the U.S. but the same is true just within individual states, too.

Overall trends show that spinal fusion has risen dramatically in the last 20 years. MRIs have made it possible to identify disc problems more readily. Along with this has come increased reliance on surgery to correct the problem.

In the U.S. the number of people with back pain is about the same as in other developed countries. The difference is that surgery is used two to five times more often here than in other countries like England or Scotland.

More studies are needed to find out what works and why. Choosing the right treatment for each patient and having the best outcome is the only way to solve the problem of overuse of surgery.