A study published in the July issue of Spine reaffirmed several earlier studies concluding, “Both orthopedic surgeons’ and family physicians’ knowledge of treating lower back pain is deficient”. When given a survey testing knowledge of simple lower back pain management orthopedists average score was 44.3 out of 100.
At our office we only recommend care based on evidence based guidelines. Given the above study’s conclusions you may want to consult your San Francisco Chiropractor before seeking the advice of a medical physician.
The Wall Street Journal just printed a great article on how much overtreatment happens in the US. Most interesting to me was the paragraphs on back pain, but what also caught my was that American’s spend $1 billion on unnecessary antibiotics.
“For all the misery it causes, 80% to 90% of back pain resolves with only “conservative measures” (which include anti-inflammatory drugs, rest, heat, physical therapy and chiropractic treatments). “Sometimes it take days to weeks, sometimes it takes weeks to months, but pain lasts more than three months in only about 10% of cases,” says Michael J. Yaszemski, chief of orthopedic spine surgery at the Mayo Clinic in Rochester, Minn.”
“Whether to operate even in those remaining cases is controversial, he says. With acute lumbar disc herniation, studies have found that two and five years later, there’s little difference between patients who had surgery and those who did not. But surgery can sometimes provide relief faster.” I would add that surgery also comes with some possible severe side effects including death and blindness.
The UK’s National Institute for Clinical Excellence in May released guidelines for treating lower back pain.
The first recommendation is to promote self-management. This means to suggest to patients with LBP to exercise and try to continuing doing ones normal activity, as much as possible. The next one is pain medication – first acetaminophen (unfortunately this has also been proven to increase the risk of cardiovascular events). The final recommendation is exercise or manual therapy (i.e. spinal manipulation) or acupuncture.
Another interesting feature is what the guidelines proscribe. All of the following are treatments/diagnostic tests that are NOT allowed (because they either don’t work or aren’t needed):
Medical/Surgical treatments
SSRIs for pain management
Facet injections
Radiofrequency facet joint denervation
IDET (Intradiscal Electrothermal Annuloplasty)
PIRFT (Percutaneous Intradiscal Radiofrequency Thermocoagulation)
Diagnostic tests:
Plain film x-ray under any circumstances
MRI to be offered only to rule out red flags or for surgical referral.
People always call our office and ask if they should see their doctor first before consulting me. Unfortunately it is very likely that your health care provider will ignore these and all other guidelines and do what they have always done, even if the scientific evidence indicate it is not effective.
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