Medically speaking, we’re treating lower back pain all wrong according to an opinion piece in Medpage today.
The evidence is stunning when you look at the approaches to lower back pain and other spinal conditions, yet the healthcare systems have responded slowly.
In December 2019, I attended a National Academies of Sciences workshop on the role of non-pharmacological approaches to pain management. ” While some researchers believed more research is needed, several said they believed that we have enough research to conclude that clinicians must immediately implement the information we already have and that payors must reform as well which would result in a change to the culture of treating back problems allowing patients to visit the right healthcare practitioners at the right time.
Chiropractors have the best reputation for successfully treating problems in the lower back. They are the right clinicians at the right time. Unfortunately, patients often are prevented from seeing them first due to insurance networks, biased workers comp carriers, doctors who will not refer until they run tests that are often costly and unnecessary such as an MRI, and hospital systems that hire very few chiropractors due to limitations in Medicare coverage. Few chiropractors in NJ will treat Medicaid patients due to low reimbursements.
The researchers are right, and so is Dr. Goertz, the system needs to stop medicalizing back pain and many other spinal conditions and follow the research; the problem is movement. The research shows this.
Chiropractors and other non-pharmacological approaches such as physical therapy have the research to show they help back problems better and more safely than medical interventions which while sometimes needed, are often used when the patient was not given the option of chiropractic care or physical therapy.
Why choose chiropractic first?
- Take a thorough history of your problem.
- Perform a thorough functional exam, looking at neurological and orthopedic tests and assessing body build, structures, and how you move.
- Treat on the first visit as long as there are no treatment concerns.
- May take x rays
- Use multiple approaches that include manipulation of the spine and extremities, myofascial release, or other soft tissue approaches, and give you exercise instruction to strengthen that area(s) in question.
- May recommend foot orthotics to correct an imbalance from the ground up.
Why is a holistic approach important?
Lower back pain is the symptom, yet the problem can come from the feet, the hips, the upper body, or a combination thereof.
By looking at only the area of complaint, you will likely miss the cause of the pain itself. It is quite common to see acute lower back pain resulting from restricted joints and tight fascia in the rib cage.
This is why a thorough history is important and why the doctor must dig for facts or clues before the evaluation.
Also observing the patient is very important. There are often subtle clues behind how the patient stands. Diagnosing lower or even upper back pain, neck pain, and even knee and shoulder pain is about looking at the person, and understanding what is affecting the painful part.
Check out the article in MedPage Today. It is timely and is a call to action to fix our system, to stop incentivizing treatments that are of high cost and low quality, and to break down the barriers to appropriate care for the patients that need it. In this case, make it easy to see a chiropractor.
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We’re Treating Low Back Pain All Wrong — Let’s reexamine the current approach to treatment
by Christine Goertz, DC, PhD April 14, 2023
In December 2019, I attended a National Academies of Sciences workshop on the role of non-pharmacological approaches opens in a new tab or window to pain management. At the end of the meeting, as expected, panelists concluded that more research was needed. However, to my surprise, several scientists also called for immediate action on the approach to treating low back pain. They called for clinicians to implement the evidence we already have into clinical practice; for policymakers to enact payment reform that would support such implementation; for all of us to commit to making the cultural changes needed to ensure that patients have access to the right care from the right provider at the right time.
Where did this response come from? It stemmed from the fact that low back pain has been over-medicalized, making a very bad problem worse, and the need for realigned incentives that encourage clinicians to follow current evidence and treatment recommendations.