November 2009
S M T W T F S
« Oct    
1234567
891011121314
15161718192021
22232425262728
2930  
ChiroPulse

Medicine and the Overtreatment of Back Pain

I just read a fascinating article from the January edition of the Journal of the American Board of Family Medicine, as it documents the massive increase in costs for medical management of chronic back pain, while no significant increases in patient outcomes or disability rates have been observed, and increases in post-intervention complications (including death) are on the rise.

This article documents:

  • a 629% increase for epidural steroid injections

  • a 423% increase in expenditures for opioids for back pain

  • a 307% increase in the number of lumbar magnetic resonance images

  • a 231% increase in facet joint injections

  • a 220% increase in spinal fusion surgery rates

  • Manufacturers aggressively promote new drugs and devices for the treatment of back pain, yet there is evidence of misleading advertising, kickbacks to physicians, and major investments by surgeons in the products they are promoting.

  • Prescription opioid use is steadily increasing, especially for musculoskeletal conditions. Emergency department reports of opioid overdose parallel the numbers of prescriptions. Deaths related to prescription opioids are greater than the combined total involving cocaine and heroin. Ironically, “Opioid use may paradoxically increase sensitivity to pain.”

  • New and improved spinal fusion techniques and devices, such as implants, increase the risk of nerve injury, blood loss, overall complications, operative time, and repeat surgery, but do not result in improved disability or reoperation rates.

  • Increases in the rates of imaging, opioid prescriptions, injections, and fusion surgery might be justified if there were substantial improvements in patient outcomes; unfortunately, they are not. In fact, statistics indicate that disability from musculoskeletal disorders is rising, not falling. “Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain.”

At the same time that medicine has ramped up costs (gobbling up the Medicare pie), a long line of studies have shown the clear superiority of chiropractic management for low back pain. Please review the most in-depth study, published in May of 2007 which compared medical and chiropractic management for LBP in a managed care group:

Clinical and cost utilization, based on 70,274 member-months, over a 7-year period, demonstrated:

  • decreases of 60.2% in-hospital admissions

  • 59.0% less hospital days

  • 62.0% less outpatient surgeries and procedures, and

  • 83% less pharmaceutical costs

when patients were seen by a chiropractor, instead of seeing a conventional medical IPA doctor.

It’s time to end Medical Mis-Management of Low Back Pain !

Thanks to Dan Murphy, D.C. for emphasizing these points!

2 and 2 is? [Humor Alert!]

The news media has been having a LOT of fun reporting on the Congressional Health Care Overhaul lately, so I will too.

Chiropractic’s *scientific critics* state we don’t have the kind of statistics they (grin) rely on, so we shouldn’t toot our own horn like they do. Hmmm? Well, let’s take a closer look at them. Here’s some amazing scienticic statistics about modern medicine:

1. The total number of iatrogenic deaths caused by conventional medicine is an astounding 783,936 deaths per year at a cost of $282 billion dollars. That is a mind-boggling 2147 people killed every day. That’s as if 7 jumbo jet planes crashed every day. That’s a 9-11 incident, happening every other day…FOREVER. God help us all. [1]

2. A report by the British Medical Journal correlated a strike by medical doctors with lower death rates during the strike. Hmmm?

3. Recent surveys suggest that “45% Of Doctors (MDs) Would Consider Quitting If Congress Passes Health Care Overhaul.” [3]

So, if we put that all those facts together, supporting Congress’s new Health Care Plan could reduce the medical population by up to 45%, thus significantly reducing the incidence of medically-induced iatrogenic illness and death, and all the money that would save could help to pay for the new Plan.

And, perhaps with some of those savings, they might consider adding conservative chiropractic care as another cost-saving option. [4, 5]

REFERENCES

1. http://www.chiro.org/LINKS/FULL/Death_By_Medicine.html

2. http://tinyurl.com/lzdq7a

3. http://www.investors.com/NewsAndAnalysis/Article.aspx?id=506199

4. http://www.chiro.org/LINKS/Cost_Effectiveness.shtml

5. http://www.chiro.org/LINKS/Safety.shtml

Patient Satisfaction With Chiropractic

Patient Satisfaction Surveys going back to the late 1980s show that patients with neck or low back pain, headaches, and a variety of other physical complaints rate their satisfaction with chiropractic care much higher than they do conventional care provided by physical therapists or medical doctors.

Now let’s discuss the amazing results chiropractic can provide for pain relief. A 2005 study, from the prestigious medical journal Archives of Physical Medicine and Rehabilitation, titled Chronic Pain in Persons With Neuromuscular Disease interviewed patients on the pain relief they derived from a variety of procedures and medicines.

Pain relief was rated on a 1 to 10 scale (where 1 = none, and 10 = the highest relief). The highest rated score was for chiropractic manipulation (7.33), rating higher than Nerve Blocks (6.75) and Opioid Analgesics (6.37). There you have it…chiropractic is better than drugs, not to mention the fact that drugs wear off, while chiropractic correction has been shown to sustain for prolonged periods.

You will find many more articles like this at the Patient Satisfaction With Chiropractic Page.

ADD and or ADHD

A new study just revealed that stimulant medications, specifically methylphenidate, are associated with a 6- to 7-times increased risk for sudden death in children and adolescents. UGH!

What does the FDA say about that? “Given the limitation of this study’s methodology, the FDA is unable to conclude that these data affect the overall risk and benefit profile of stimulant medications used to treat attention-deficit/hyperactivity.”

The ADD/ADHD Page is devoted to the holistic approach…chiropractic care, dietary modification (no more food colorings and preservatives!), and no more dangerous drugs!

This is just one of many pages in the Pediatrics Section .

Vaccination

Vaccination is a controversial topic with chiropractors because of our non-drug and non-surgery approach to health. The Vaccination Page attempts to present both sides of the vaccination issue.

Low Back Pain and Chiropractic

As you may know, until the late 90s, all chiropractic research was funded by our schools, or by research organizations like the FCER and the ICPA.

Even since then, the Federal Government has funneled homeopathic doses of cash towards chiropractic research. For this reason, much of early the funded research focused on low back pain.

You may want to review the Low Back Pain and Chiropractic Page, because it compiles most of those studies. It also contains free-access Chapters from author Richard C. Schafer, D.C., FICC’s books (RC is the most published chiropractic author) and some editorials about ending medical mis-management of low back pain. Enjoy!


There’s a lot more info like this in the Section

Disc Herniation and Chiropractic

Is It Safe to Adjust the Cervical Spine in the Presence of a Herniated Disc?

The Disc Herniation and Chiropractic Page answers this question as it reviews a number of articles devoted to this topic.

Do Kids Need Chiropractic?

Our Pediatrics Section contains a wide variety of materials pertaining to children’s health.

The Kids Need Chiropractic, Too! page contains many articles by the profession’s foremost pediatric specialists.

The ADD/ADHD page reviews a natural approach to case management, including nutritional recommendations.

We hope you will find this resource of great value!

The Cost-Effectiveness of Chiropractic

Chiropractic services have been included in a spectrum of managed care programs since the early 90s. Because of their focus on cost savings, retrospective analyses are made periodically to compare the costs of management across the spectrum of providers.

The Cost-Effectiveness of Chiropractic Page contains most of these studies going back to the early 1990s. The most current study demonstrated decreases of 60.2% in hospital admissions, 59.0% less hospital days spent, 62.0% less in outpatient surgeries and procedures, and 83% less pharmaceutical costs, when patients were seen by chiropractors rather than conventional medical IPA providers. WOW! It’s hard to argue with those kinds of statistics.

You will find this page of great interest.


There’s a lot more info like this in the Section

The Popularity of “Alternative Medicine”

Chiropractors had always been considered a “fringe” provider (or worse) by conventional medicine.

David M. Eisenberg’s article, Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use, published in the January 28, 1993 issue of the New England Journal of Medicine generated a shift in that opinion. This article was a rude awakening, and a genuine “eye–opener” for organized medicine, since it described an amazing shift in public opinion.

The Alternative Medicine Articles section is a collection of numerous articles that document the increasing public interest in alternative forms of patient care, including chiropractic and acupuncture.

The Safety of Chiropractic

Controversy. The Media feeds on it.

Millions of patients love their chiropractor and appreciate our unique and safe approach to recovery from pain. Significant research suggests that chiropractic is the safest approach available for relief from neck pain, back pain, headaches and other “musculo–skeletal” complaints. Lets review that research, and discuss how modern medicine has contributed to the Myth that chiropractic care is dangerous.

Read more about: The Safety of Chiropractic

Inappropriate Use of the Title “Chiropractor”

The results of this year-long prospective review suggests that the words chiropractor and chiropractic manipulation are often used inappropriately by European biomedical researchers when reporting apparent associations between cervical spine manipulation and symptoms suggestive of traumatic injury. Furthermore, in those cases reported here, the spurious use of terminology seems to have passed through the peer-review process without correction. Additionally, these findings provide further preliminary evidence, beyond that already provided by Terrett, that the inappropriate use of the title chiropractor and term chiropractic manipulation may be a significant source of over-reporting of the link between the care provided by chiropractors and injury.

Read more at ChiroZINE

End Medical Mis-Management of Low Back Pain

The medical “debate” has been going on for years…is spinal adjusting (a.k.a manipulation) effective for Low Back Pain? The original Meade study (British Medical Journal 1990) demonstrated that chiropractic was much more effective for LBP than conventional medical care. In 1995, Meade did a follow-up, again publishing in the BMJ. It demonstrated that those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals, especially for those who suffered from chronic (or long-term) low back pain!

Read more at ChiroZINE

Musculoskeletal Knowledge: How Do You Stack Up?

One of every 4 or 5 primary care visits is for a musculoskeletal problem. Yet undergraduate and graduate training for this burden of illness continues to constitute typically less than 5% of the medical curriculum. This is an area of clear concern, but also one in which sports medicine practitioners can assume leadership.

Read more at ChiroZINE