Is the opioid crisis the other white coat syndrome?

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Is the opioid crisis the new white coat syndrome? White coat syndrome occurs when a patient has their blood pressure taken and it is temporarily high requiring an additional reading. The Opioid crisis has been created when big pharma manipulated the medical system into believing that managing pain is the same as understanding why someone hurts. Opioid addiction has unfortunately been caused by a misuse of a pain relieving product that was addictive by a profession that has a poor understanding of why people hurt. Stay away from people who wear white coats who use knives is a constant refrain our patients hear from me after they experienced a surgery of dubious benefit.   The problem with tradition and dogma, is the belief that our current model of evaluation of the painful part, advanced testing, drugs and then surgical consults is a good and cost effective model.  Most of the treatment charts we have recommend conservative care first, medical testing second if improvement has not occurred within a reasonable time frame and then referral to a surgeon if the evidence indicates that this may be appropriate.  Most people who are referred after the failure with conservative care may get worse with the higher end specialists who may do injections or surgeries.  Is following this sort of clinical path really good for our patients?   The truth is, a percentage of people who end up with the surgery or the intervention are worse off.  The other truth is, some of these patients decide or in the case of workers compensation, have it decided for them to go to these specialists first.  It has been said that who you see first for a problem can determine your cost, and experience with the condition.   This is especially true in the American healthcare system. It is also true that if you see your primary doctor first for a painful condition, first they will try a medication, and then they will likely send you for either pain management, therapy to the painful part or an orthopedic surgeon and maybe if you are lucky a chiropractor. Have you ever heard a physician  say "we can do surgery, but there are no guarantees"? This often used refrain is scarier than most people realize, as you are under anesthesia while someone is doing something that can be of little or know value, or worse, their solution may leave you with a permanent injury. If you choose the medical route for a painful condition, the current evidence suggests you are more likely to have higher costs, medications that have side effects and higher risks. Who should educated healthcare consumers see first? While it is true that many medical procedures improve thousands of lives, others such as meniscus surgeries according to the New England Journal of Medicine  and impingement surgeries may be of little or no value according to the British Medical Journal, or worse, may leave you with another worsening physical problem in that region. Medical providers have as little as three hours of training in the evaluation and treatment of the musculoskeletal system.   The chiropractic profession has about the same when it comes to prescriptive medications.  With this minimal training, medical providers are currently poorly equipped to evaluate and properly treat musculoskeletal pain and will typically refer these problems out to either physical therapists, pain management specialists or an orthopedic.  The problem is, the mechanism behind the pain, unless it was due to trauma may actually come from a different part of the body.  When you do not improve with either a drug, or a therapy to the painful part, your doctor is trained to order a test such as an MRI to determine what is wrong.  Some doctors will order an MRI first to diagnose the condition which may be unwise since these sensitive tests tell you the condition of a joint or an area, but cannot tell you why the person is in pain most of the time without a good examination and other data. The problem begins with a doctors evaluation. Without holistically (evaluating everything and doing a deep history), evaluating the patient, your doctor is likely to never understand why your neck, or shoulder, or hip or foot is aching.   It is common for most doctors to call a painful joint bursitis or tendonitis, and then suggest therapies to the area.  This begins a journey of specialists, therapies and other interventions that are not curative, because this type of examination will get the diagnosis wrong, and the therapy will then be useless or even harmful.  A symptom of this type of misdiagnosis is that the area of pain improves, but something else now hurts in another body area or part. This is why it is important for healthcare consumers to take an active role in their care and be willing to question their doctors treatment decisions. Recently, a patient visited us who had an interesting history which included neck surgery that needed to be done twice.  She was young, and had three children.  Several years ago, she woke up with a stiff neck and had some numbness.   After some tests and an MRI, the doctor said she needed neck surgery.  After complications from healing ensued and a second neck surgery, she developed chronic hip pain. She was told by her doctor that the problem was in the labrum of both hips and she had already had surgery in one hip with mediocre results including a difficult rehabilitation program.  She now had pain in the other hip and did not want another surgery. This is not an atypical scenario, which may have been avoided with a holistic exam, history and more appropriate understanding of why her neck originally hurt. Many stomach symptoms, or breathing symptoms also involve the musculoskeletal system, yet, without the proper training, you are likely to have an expensive test which offers little benefit, yet, you and your insurer are charged handsomely for a test that does not help diagnose or treat the problem.  You may be given a medication to relieve the symptom which is often inappropriate or worse, may cause other symptoms. 95% of those who believe they are having a heart attack actually are not and are told they have muscle spasm. Other than triage, these patients are sent home and continue visiting their healthcare providers who are poorly trained at understanding why they were in pain. When someone in pain becomes chronic, they are often sent for pain management which means opioids or other drugs, procedures designed to deaden nerve pain by burning nerves, but there is little understanding from these healthcare providers behind the mechanisms that caused the pain.  People are often sent for physical therapy that may never end because it is done on the painful part, rather than the parts producing the pain in another part of the body.  Patients who have swelling in an ankle or leg are sent for numerous tests, when a proper musculoskeletal workup may have found that they had foot and gait problem. Can we blame those in the white coats for getting it wrong?  As healthcare consumers, we must be able to determine who we should see first.  We must also understand that medical primary care providers, while very knowledgeable may not be the best portal of entry provider to see first for a painful condition.   We can blame the system for not requiring medical providers to learn more about musculoskeletal conditions when they receive their required continuing education. What about chiropractic? Chiropractors have been trained in evaluation and treatment of the musculoskeletal system and are primary care portal of entry providers for these types of conditions.  They also have many hours in internal medicine diagnosis that allows them to recognize and refer these cases to the appropriate medical providers when needed.  Some doctors of chiropractic are trained to offer nutritional advice and nutraceuticals which can be used to help people resolve many conditions that often people have been taught they needed a medical provider for.  The chiropractic holistic drug free approach for musculoskeletal pain has high patient satisfaction rates as per Consumer Reports and many other sources that the general public depends on. Most notably, the primary care approach of chiropractic for musculoskeletal pain is lower in overall cost as was recently discussed by Optum Healthcare and many chiropractors are able to treat a conditions including plantar fasciitis, back pain, knee pain, shoulder pain, neck pain and hip pain. Chiropractic approaches care from a health perspective rather than a disease perspective that is used under the medical industrial complex.  As a healthcare consumer, you will notice that the chiropractic approach is very pro activity, fitness and healthy living. The medical approach requires that there be a diagnosis of a disease for the doctor to recommend a medication for a problem and many of their approaches require expensive tests and therapies to the part.  Chiropractic in its approach looks at function, mechanisms of movement and will begin a trial of care that improves most patients, eliminating tests and medications that are expensive and may have harmful side effects. As we know now, the opioid crisis was a result of doctors embracing the next big thing in pain management, and the pharmaceutical industry lobbying the FDA to change verbiage to allow its usage for long term use.  Many of these patient did not realize that their problem was mechanical, and required a mechanical solution which is best found in chiropractic offices.  The problem was also compounded by insurance companies making it cheaper to take opioids and other medications than to appropriately treat a physical problem with a chiropractor or a therapist. For the average person, the medical industrial complex which consists of hospitals, doctors, insurance carriers and equipment providers have a greater interest in generating income than helping the public long term. Chiropractors believe the body is self regulating and are looking for what causes the problem.  Philosophically, most patients want their problem cured at a reasonable cost.  Without insurance, the only providers most people can afford to visit is either their chiropractor or their primary doctor.  Most medical specialists are highly priced, as well as the facilities they work in.   Visiting your primary doctor first for a musculoskeletal problem is likely to end up with either a referral to an expensive medical specialists who has surgical training, a therapist who will work the part that is painful or sometimes to a chiropractor.   The  good news is, the chiropractor often can resolve many musculoskeletal complaints in just a few visits, without drugs, referrals or surgery. Chiropractic should be your first choice for painful conditions such as neck pain, back pain, sciatic pain, disc problems, hip pain, knee pain, arm pain and even rotator cuff problems.   Their holistic drug free cost effective approach is supported by science, and the profession has the highest patient satisfaction in the industry.  As a healthcare consumer, who you choose can determine your experience with the diagnosis and treatment of an injury or a chronic pain problem.   While it may require a few visits, in the long term, your body will thank you.