Wednesday, December 18, 2013
You think you are safe if you follow your doctors orders but are you? There seems to be a large growing problem with prescription medicine abuse that seems to have the policy holders in the U.S. concerned at this time. Since the 1990's prescriptions for narcotics has increased 300% in the U.S.
Monday, September 16, 2013
Spinal Manipulation for the treatment of back and neck complaints has been well documented. I think it has been researched to death but the government continues to shell out money for lower back pain research. By the way a recent study (Lancet 2013, JAMA 2013) have demonstrated that lower back pain is the number one disabling condition in the World today. What does this mean well it means more people miss days at work for back pain than any other single condition. So I guess we can not study lower back pain enough. The largest chiropractic study ever is currently underway. With funding from the House Armed Services Committee the Palmer College of Chiropractic, RAND Institute and the Samueli Institute are conducted a 3 phased study called ACTS (Assessment of Chiropractic Treatment). ACTS I is currently underway and it is comparing medical care vs. medical care plus chiropractic care for the treatment of enlisted military personnel. ACTS II is looking at chiropractic care and how it effects reflex and reaction time with military Special Forces. ACT III will look at strength, balance, and long term outcomes of lower back pain in enlisted military personnel and if they are eligible to be deployed. The results of this study will probably not be released for about 5 years though. Another recent study (Spine, April 2013) demonstrated that spinal manipulation group of patients showed a faster and quicker reduction on symptoms than those patients given a NSAID. Another recently released study demonstrated that the type of practioner that you first see determines you likelihood of having lower back surgery. This study showed that for the same diagnosis if you went to a chiropractor first you had a 1.5% chance of lower back surgery. If you went to an orthopedic surgeon first you chances of surgery were 42.7%. I also have been fortunate enough to be involved in a research project. The University of Pittsburgh School of Health and Rehabilitation Services is the sponsor of this research entitled Foundations of Evidence Informed Practice (EIP). This research project is for chiropractors only and my part will start in Jan 2014. It is an attempt to have the average chiropractor practioner develop better evidence based practice in his or her daily chiropractic practice. I am excited to be part of this research project with over 1500 Doctors appling to be part of it and they only excepted 325.
Thursday, August 15, 2013
Many patients have asked what exercises do I need to do to keep my back pain from returning? Current research indicates that lower back pain has a very high rate of reoccurrence about 60-80% within a two year period. Doing daily core exercises can lower this rate to under 30%.
Wednesday, July 24, 2013
Evidenced based healthcare is the new buzz word in healthcare. What it means is that you are treated according to the latest researched evidence for that condition. Basically it is trying to give you the most "bang for your buck." Many conditions have been researched to find the best "evidence based" treatment approach. Well what about back pain? What does the evidence show? First off we have found out the number one disabling condition the WORLD today is lower back pain. More people miss more work or are laid up due to back pain than due to any other single condition followed by major depression and then other musculoskeletal disorders. So what has the research "proved" is the best treatment? You may be surprised to find that spinal manipulation (which is mostly performed by chiropractors) has one of the highest levels of research associated with successful treatment of lower back pain. The research also demonstrated that NSAID (non steroid anti-inflammatory drugs), such as aspirin, Advil, Aleve, Tylenol are effective. These medicines, in research, have been shown to do as well as the stronger medications like Vicodin, Flexeril, and those types of medications which have potentially severe side effects. The third recommendation for the treatment of back pain was exercise. These are the three most "evidence based" treatments for lower back pain. (Rand 1992, AHCPR 1994,) Those with questionable research were epidural steroid injections and lower back surgery. A recent study has demonstrated that if you saw a chiropractor as your first doctor for lower back pain you had a 1.5% chance of lower back surgery. If you saw a surgeon as the first person that you saw for your lower back pain you had a 42.7% chance of surgery (Spine December 12, 2012). The average cost of a chiropractic treatment program is about $552 (Health Affairs, 2013: 32 (1): 45-52) and the average cost of lower back surgery is around $50,000. $50,000 for a treatment that is not very effective. So the research suggests that you try NSAID and if that does not help you condition you should consider seeing a chiropractor. Several studies also indicate that lower back pain has a very high rate of reoccurrence 60-80% within a two year period. Exercises can lower that reoccurrence to below 30%. We treat our patients using the latest evidence based guidelines. We use spinal manipulation coupled with exercise therapy and we have had very good success. It is now time for the rest of the U.S. to catch up to this treatment. Here is a link to an algorithm for the treatment of back pain. http://www.tihcij.com/Articles/Algorithms-for-the-Chiropractic-Management-of-Acute-and-Chronic-Spine-Related-Pain.aspx?id=0000381