If you get a chance, read the following article in the news today:
This doctor says MRI/CT's, X-rays, narcotics aren't needed in most cases. Hmm, sounds like a fan of our Affordable Care Act here in the US. He has some good points, but misses the target.
First, continuing with physical therapy when you have a herniated disk isn't recommended. The only way to determine if your disk is herniated is diagnostic tests.
Also, if the doc decides to not do diagnostic testing and it's later determined that the problem could have been identified sooner with testing, he/she will get sued. Most docs run tests they know aren't particularly helpful, but they do it for liability reasons. This is where Tort reform is needed.
He also says narcotics are not useful for pain management. If the pain is caused from a muscle strain, then I agree, Tylenol or Advil would probably work good. But when pain is caused from a structural defect, the medication DOES make a difference.
I would love for there to be a panel discussion where doctors are on one side and spineys are on the other so that they can see first hand what works and what doesn't.
A new study has found that many physicians are not following expert recommendations for the treatment of back pain. By not doing so, they are subjecting patients to unnecessary imaging tests, ineffective surgeries and unnecessary exposure to addictive narcotics, say the authors of the study published in JAMA Internal Medicine.
Several guidelines for back pain stress a more hands off approach, largely because more aggressive treatments have not been shown to improve the pain and subject patients to risks.
“One of the biggest things to realize is that when patients first present with back pain, the majority of them will have complete resolution of their symptoms within a couple of months,” said Dr. Bruce Landon, an author of the study and professor of health care policy at Harvard Medical School.
What works for back pain is time, and if needed, over the counter pain relievers like acetaminophen (Tylenol) and ibuprofen – along with staying active and physical therapy.
“They don't necessarily need expensive imaging tests such as MRIs, CT scans, and they don't need referrals to specialists,” he said. Studies have shown that these advanced imaging techniques do not lead to improvements in back pain.
The researchers compared data between two periods—1999 to 2000 and 2009 to 2010. They found that narcotic use increased from 19.3 percent to 29.1 during that time and use of the recommended over-the-counter pain relievers decreased from 36.9 to 24.5 percent.
“To me, the most worrisome findings were the rapid rise in narcotic prescriptions,” Landon said. Narcotics have not been shown to improve back pain, and they can lead to addiction. “In 2008, nearly 15,000 people died from narcotic prescription overdoses,” he added.
The study also found that the number of CT scans or MRIs increased from 7.2 percent to 11.3 percent during the study period, and the rate at which physicians referred patients to specialists, such as orthopedic surgeons, doubled from 7 to 14 percent. These referrals to specialists likely contributed to the rise in MRIs and the recent increase in back surgeries, the authors said, even though studies of lumbar fusion surgery have not shown an improvement in pain.
“I believe for the vast majority of patients with back pain, primary care physicians should be taking the lead on managing back pain,” Landon said. Part of the reason primary physicians refer is because patients demand to see specialists and to get high-tech screenings and pain killers.
“For the majority of cases, these things are not necessary, since the majority of back pain improves with time and minimal treatments,” he said.
Lastly, the study found that referrals to physical therapy remained unchanged at about 20 percent. Physical therapy such as stretching and core strength building, as well as regular exercise like walking, have been shown to improve back pain – particularly back pain that lasts more than a couple of months.
The best advice is to wait and see, Landon maintained. “I know it's hard to accept this in a society of instant solutions to our problems,” he said.
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Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2