Wednesday, July 24, 2013

Evidence based Healthcare

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.