Disc herniation, chiropractic and nerve root injections; which method offers best and safest relief for back pain suffers?
A recent study looked at the cost/benefit of the different procedures to treat disc herniation and the pain that results from it. While there was some disparaging news regarding nerve root injections due to a poorly manufactured medication, many patients are often suggest to take a nerve root injection over three sessions before having a more invasive discectomy or fusion.
Safety of course is an issue with any medical or procedure, and after a few people have had problems with the medication used for spinal injections, perhaps doctors need to first suggest a less invasive method such as chiropractic manipulation before considering an injection. While having an injection involves numbing the area using anesthesia and then bathing the nerve root, chiropractors can use a variety of methods that are non invasive and safe such as flexion distraction which is a special table clinically proven to reduce disc pain and get you the relief you are after. Flexion distraction is a safe, minimum force chiropractic / osteopathic method that is performed over a number of sessions which mechanically may help affect the disc and reduce the mechanical and lesions affecting a nerve, vs. injection which does not address the mechanical dysfunction in and around a spinal joint.
Appropriate management of why you hurt rather than just treating the disc as if it did not have an underlying cause may ultimately determine your long term results. Most people experience pain first, a doctor who usually orders tests first and then suggests treatments directed at the lesion instead of looking at you, your gait and possible mechanical reasons why you may have damaged a disc.
Disc problems are created by altered body mechanics in most cases. Did the injury occur when lifting, or bending improperly or were you doing something that did not seem to warrant all that pain? If the discs are just weak, why did it happen to you and why doesn’t everyone have disc problems? Perhaps we need to look at disc problems from a more analytical point of view.
To begin to understand why the disc went bad, you may want to read the book Cheating Mother Nature, what you need to know to beat chronic pain. The prevailing wisdom is that disc problems just happen and there is a mechanism as to why they happen if we just look at the disc itself. If we look at the body as a whole, we begin to see a different story. Most disc problems begin at the feet, with body asymmetries which are inherited at the root of most disc problems.
If you manage the back only, and not the mechanism behind the pain, the treatment may or may not relieve the problem but the problem is likely to return at a later time since we treated the symptom, rather than the cause. Many people who had lower back surgeries will tell you that they required further interventions over the year primarily because the disc problem was merely the symptom.
Injection of the nerve roots treats the symptom, as well as methods such as flexion distraction chiropractic methods, however, if we treat the problem as a gait issue (body style and walking related) also, people get far greater relief, and a greater likelihood of not having a future disc problem. Once you have experienced a lumbar disc problem, you do not want to experience it again because of the disability it can cause and the pain you will experience.
Cost is a consideration, especially with today’s Obamacare style plans.
Years ago, if you needed to go the doctor, you paid a low copayment and had whatever procedure or test the doctor wanted to order without a consideration of what the test would cost. Now, many of us are discovering the plan we have has a high deductible (meant to discourage you from using healthcare services) and doctors are now being forced to consider the medical appropriateness of a test such as an MRI that can cost $1000 to you because of your deductible, and you had not even been treated for the problem yet.
The value of what we get for our healthcare dollar is now important, since we become personally liable for the cost of the procedure. Since we are now feeling those costs personally, it is now, more than ever, important to choose the most cost effective provider for relief of pain.
A recent study from the department of chiropractic, radiology and orthopedics in Zurich Switzerland compared the costs of chiropractic manipulation in relieving lower disc problems to nerve root injections given by doctors in that country. While the study did show improvements with both methods, and costs of both methods being similar, the cost of epidural injections in Zurich, Switzerland are about $729 per injection. In NJ, where we live, each injection will likely cost you after your insurance discount in excess of $3000 per injection, or for three injections; close to $10,000 or more. When you compare this to the typical chiropractic visit regimen, the chiropractic route is much less expensive and with the right doctor, much more comprehensive.
One more consideration is that the chiropractor will likely give you exercises, muscle work and proper advice and gait management, making it a far better dollar for dollar value. While many of us have been taught over the years to trust their doctor fully, the truth is, with the musculoskeletal system, a disease centered approach that merely treats the symptoms and ignores the mechanism of injury will likely not resolve a disc problem fully, even if the pain was reduced. Sometimes, you need to trust someone who things differently.