New guidelines for lower back pain; The hard-to-swallow truth.

  • Share:
  • facebook
  • linkedin
  • twitter
Chiropractors as per Bottom Line Personal and Consumer Reports seem to have the best reputation regarding the treatment of back pain, while medical physicians seem to have the worst. The recent headlines over the past year regarding Opioids have not helped the medical cause either, since the problem of pain and the treatment of this often mechanically based condition somehow became linked to swallowing pills.  The recent explosion of costs for now treating the Opioid addictions that resulted from the relatively innocent patients who were desperate and in pain looking for someone to help has now come to haunt the medical profession.  Most people who visit their doctors for back pain have learned to expect a pill, even though a growing chorus of patients are bypassing their regular doctor already and going to someone who is in their eyes more effective; they no longer buy the pill idea.  It was only a matter of time until the cocktail of an anti-inflammatory and a muscle relaxant or valium for back pain no longer is acceptable medicine and that day was February 14th, 2017. Most other medical methods including surgeries and injections also have been shown to be questionable when patients are followed up months to years after they had the procedure. The new mantra from the American College of Physicians in a study released on February 14th is that for low back pain, avoid drugs, and use natural methods to resolve it.  This is a very powerful message from a group that primary care physicians are heavily influenced by.   It is bad news for the drug manufacturers who make these products.   It provides clarity for the average patient as to where to get relief. Is your primary doctor and your insurance company going to finally embrace the providers who are most likely to help someone like you without prejudice? The truth has always been that back pain is a mechanical problem in most cases.  The American Chiropractic Society in their news release references the new report from the American College of physicians which has been years in the making. Whether the problem is acute or chronic, back problems need to be addressed using preferably methods that include manipulation, exercises, and muscle work such as myofascial release treatment or other methods.  According to the new guidelines, "prescription opioids should be a last resort for those suffering from low back pain, as the risk of addiction and overdose may outweigh the benefits."

Two problems now arise;

1. Since the evidence leans more toward those who do manipulation, exercises, acupuncture, and muscle work to relieve or resolve back problems naturally, who will do this best and which approach should you as a patient use.  The easy answer is to look at who Bottom Line Personal and Consumer Reports recommended and found to have the best overall patient satisfaction; chiropractic. 2. Back pain is the symptom, and often the reason for your pain lies elsewhere in the body. Can just applying treatments such as manipulation, exercise, acupuncture, etc. be a good scientifically valid approach, or do we need to better evaluate our patients first so the right methods can be used to help you feel better. As a side note, United Healthcare may not consider a thorough evaluation important since they are no longer reimbursing chiropractors for their initial evaluation or x rays when needed, creating yet another hurdle for patients, and chiropractors alike who wish to maintain the quality of their results and their thoroughness of care.  Great results with back pain that are consistent require a great examination, which helps your doctor figure out why you hurt and will determine if the care is appropriate or even effective. Lower back pain can be caused by the following:
  • Foot problems
  • Gait irregularities
  • Upper back malfunction
  • Arthritic hip joints or stiff joint capsules
  • Shoulder joint problems.
  • Cancer or organ system involvement (rare)
  • Lifting improperly.
  • A herniated disc.
  • Tight legs.
  • A poorly functioning core.
  • A combination of all of these issues.
  • C section and other abdominal scars.
  • Inherited mechanical traits.

Considering that back pain is caused by many mechanical problems in areas that affect, but do not necessarily include the lower back, how can we as healthcare providers treat back pain and not betray the public trust. It is also quite likely that the patient has secondary symptoms in the neck, knees, and other areas and that these are part of the same problem which has more to do with how the body as a whole functions, rather than a problem of back pain.

The current record on back pain treatment is mediocre at best, with chiropractors having the best track record as a provider group, probably due to an intervention is known as manipulation which improves how we move and function, but also may be due to their holistic outlook on why we hurt.   Healthcare providers need to reexamine treatment and evaluation tracts that are merely guidelines for what to do when a patient does not respond to care.  Often these tracts result in MRIs and then surgical consults or more invasive and possibly dangerous interventions that can be avoided if we do a better job evaluating, and understanding the problem and then using the best tool(s) to treat with.  The cost rises markedly as soon as a patient gets an MRI and begins to visit more invasive specialists. Treatment protocols are tools, not the magic solution. As most carpenters know, your tools in the right hands used wisely help you get the job done faster and more efficiently; healthcare providers need to embody this idea when working up a patient and recommending a treatment protocol that is merely a tool.

Individualizing care to the patient, who is unique and has unique body mechanics is likely to offer the best outcomes.   A growing number of providers are now using active evaluation and treat - test - treat protocols.  According to Stephen Pearle, D.C., C.C.S.P. who is a dean at the Bridgeport College of Chiropractic, Treat - Test - Treat is the only method that has been proven to be scientifically valid.   It is similar to years ago when your math teacher had you perform long division to show your work.   Treat (the protocol), test (did the protocol improve function using a functional test) - Treat (another protocol) - Test (do we see further improvement).   You get the idea. Using the electronic medical record, we can document how things continued to stay functional and build on it using our protocols, exercises, and other methods while showing objectively your level of improvement.  Ultimately, while improvement is not always linear, you should see continued improvement and find yourself doing many of the activities that prior would have again left you in pain.

What ultimately is our takeaway from these new guidelines and who should be evaluating us for back problems?  All roads lead to the chiropractor. 

Take this simple test: How is your back doing?  Can you do a simple squat or do you fall over?  Can you stand up on one leg or do you fall over.  Imbalance or a lack of core stability means it's time to find a good chiropractor.  The reason why your core is working poorly is not an exercise problem necessarily.   Sometimes it takes a trained set of eyes to help you figure it out.   If you are wondering if you can just exercise it away, try a Pilates class first.   If you want to perform better at Pilates with a better functioning core that is no longer aching, first see your chiropractor.