New guidelines for doctors to evaluate lower back pain; a case of the blind leading the blind.
It is quite well known that the management of acute lower back pain is not only inconsistent but ineffective. What the public does not know is that acute lower back pain is not something you can neatly classify without looking at the rest of the body, the persons body style and their overall symmetry or asymmetry, which needs further study.
The book Cheating Mother Nature, what you need to know to beat chronic pain digs into this with the realization that the public needs transparency and needs to understand the ramifications of how they are built, which runs in families. There are hints that eventually, the medical researches will likely figure this out such as this study about the necessity of foot support (click here) and this study that indirectly links disc problems to genetics (read here).
As it stands, and as the NY Times reported a few years ago, lower back pain is an epidemic that has evaded most treatment methods (other than chiropractic, exercises and muscular techniques). Most of the public does not know this but with the new consumer driven health plans, most people will likely think twice before visiting pain management specialists for expensive injections since this will clearly hit them in the pocketbook.
Without clarity of who is most effective and what the costs are, consumers are definitely at a disadvantage with these new plans which are just more rationing in disguise, however this time the rationing is done by the consumer who will make decisions concerning their lower back first by emotion but secondarily by cost. The lowest cost provider for lower back pain may not be the best however, since a less effective provider with less effective methods may on the one hand charge less per visit but take two to three times as long to get an inferior result when compared to a provider with a better thought process.
How is the consumer to know, and are these guidelines really helpful.
Under the intention of using scientifically valid data, the new guidelines attempt to create classifications of severity. The problem is that from a purely medically diagnostic point of view, this can help the average physician with little knowledge of the musculoskeketal system diagnose better, however, without looking at why the problems exist by looking at the entire body, we are stuck in the same rut of uninformed diagnosis looking for a lesion rather than a cause of the lesion and then throwing a therapy at it based on an insufficient knowledge basis. In other words, the blind leading the blind.
A better idea is to have those professions that are most effective in the treatment and evaluation of gait and back problems teach courses that most doctors can take for their annual medical credits that teach them how to better evaluate which leads to better referrals and of course better treatment which is more effective and more cost effective as well.
Without this, people will go to their doctors, and then find an alternative such as chiropractors (more frequently happening now) or acupuncture because of the lower overall cost and reported satisfaction of treatment. Family physicians deserve to understand the musculoskeletal system better so they can do their jobs better and rather than relying on medication which masks the symptoms and does nothing to help the patient long term.
New Guidelines for Doctors Treating Low Back Pain
Evidence-based approach should improve care, experts say.
MONDAY, Oct. 1 (HealthDay News) — Experts have developed evidence-based guidelines to help doctors manage patients with acute low back pain.
Low back pain is one of the most common reasons for outpatient visits to doctors, but there is a lack of consistency in how best to handle these cases, according to the team that developed the guidelines, which were published in the October issue of the Journal of the American College of Radiology.
“The approach to the workup and management of low back pain by physicians and other practitioners is inconstant,” article co-author Dr. Scott Forseen said in a journal news release. “There is significant variability in the diagnostic workup of back pain among physicians within and between specialties.”
He and his colleagues at Emory University Hospital and Georgia Health Sciences University developed a process for how doctors should manage patients with low back pain.
During their first visit, patients should be categorized into one of three groups after a thorough medical history and physical examination: non-specific low back pain; low back pain potentially associated with compression of a nerve in the spine (radiculopathy) or abnormal narrowing of the spinal canal (spinal stenosis); or low back pain potentially associated with a specific cause.
Read more here