Is this right?

Had a patient today who I have been working up for back and neck pain.  She has been on high doses of narcotics for many years (something called Opana-always a red flag to a neurosurgeon).  This woman is rail thin, has no neurological deficits and essentially normal MRI scans.  Her heavy doses have been routinely prescribed by her PMD while she has never done a day of PT or real pain management-she also has not worked in more than 4 years...am I missing something here?
Another patient same day-obese, injured lifting at work, maintained with just narcotics and "rest" for 15 months-exam normal, MRIs normal-only seeing a chiropractor who she swears does wonders...but not miracle enough to return to gainful employment and stop drawing workman's compensation.

Sojourner Truth suffered from serious back pain

The estimated annual cost of workplace low back injury in the US is between $50-100 BILLION!!! These account for 1/4 of all claims.  Studies show if out of work just 6 months, there is a 50% chance of return to full time work.  After 1 years that number drops to 25% and after 2 years nearly 0%. (Bureau of Labor Statistics)
I don't mean to pick on these two women, rather to use them to illustrate how our system is broken-

• Too many physicians find it easier to just give narcotics than deal with the challenge of a more comprehensive approach
• With increasing time constraints, it is simpler to complete paperwork (even if annoying) than to confront the patient
• Maintaining the status quo is less trouble than challenging the patient to lose weight, start exercising, and retrain.

I would never want to penalize an employee truly injured at 

work but within the realm of low back injury, the "state of the state" needs significant improvement.

How far have our treatments come?