Monday, October 29, 2012

Common Sense Treatment Progression

     I am seeing a disturbing pattern starting to emerge in regard to the treatment that a typical lower back pain patient goes through prior to seeing a surgeon.  The norm now goes something like this:  The patient goes to his primary care doctor with lower back pain.  His doctor prescribes some medications and orders a MRI.  Sometimes a the patient is referred for some PT, which usually consists of some stretching, massage, and maybe some ball or balance exercises.   If there is any sign of a disc bulge on the MRI, then the patient is referred to pain management for a series of epidural injections.  The next step, should the injections fail to give the patient relief, is referral to a neurosurgeon.  
     When I think about the logical sequence of treatment, it should progress from the least invasive, least expensive care to the most invasive, most expensive care without skipping any steps in between.  Lower back surgery is statistically the least effective and the most expensive care for lower back pain and should be the last resort unless certain red-flag signs are present.  It is generally accepted that the rate of success is about 50%, and a recent study indicates that only 1 in 100 back surgeries are medically necessary.  Injections are not very cost effective either, somewhere around $1500 per injection with most cases requiring a series of three for a total of around $4500.  Injections like these should be used in conjunction with some form of physical treatment because they do not actually fix anything.  The steroids used simply turn off the inflammatory process temporarily.  Don't get me wrong, I have nothing against medical doctors who perform these procedures - I refer many cases to pain management and to neurosurgery every year and they do a fantastic job.  The patients that I refer, will however, never look back and say that they should have tried something else prior to surgery.
     At Northshore Chiropractic, we offer non-surgical treatment for patients suffering from lower back pain and other musculoskeletal conditions.  We take a logical approach that is problem focused and does not skip any of the steps that can potentially save a patient from going through a surgery before it is absolutely needed.  We are happy to co-manage our patients with their medical doctor in order to achieve the best results utilizing the least invasive procedures.  One of the procedures we use is spinal decompression therapy.  It is a non-surgical treatment for bulging and herniated discs that has been shown to be up to 86% effective.  This, coupled with its relatively low cost when compared to injections or surgery, make it a logical step that should be added before these other more invasive and expensive procedures are utilized.

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