ArizonaBackInstitute

By Randall Pruitt, DC, DACNB, FACFN, DAAPM, MUAC, CES-NASM

In my practice I am often asked my opinion on a number of pain procedures. One that I have been asked about time and again is facet injections. In a recent editorial in the Back Letter the evidence or lack of evidence for facet injections was discussed. Even though the scientific literature has shown that they don’t work there has been a 543% increase in their use over the past several years. What is interesting to me is that many doctors will be quick to bash a treatment like spinal decompression, because they say there is lack of evidence at this point and time. However, when the evidence clearly shows that a procedure like facet injections doesn’t work they discount it and try to somehow justify it’s utilization. It isn’t too hard to see why the Medicare system is failing, for example the cost to Medicare for facet injections was 229 million dollars in 2002 and as recently as 2006 it had gone to 511 million. Can you imagine what it is today? Probably close to a Billion.

This is the type of issue that drives me crazy when it comes to the treatment of back and neck pain. There is so much waste out there and so many procedures that are expensive and unnecessary and most of them don’t offer a long term solution to low back pain or neck pain. A program designed to actually treat the underlying cause and restore function is really what is needed and there are protocols like that, including the program at the Arizona Back Institute.

So if your doctor wants to do facet injections or some other procedure that you’re not sure about, make sure to ask him or her about the evidence, the long term ramifications and the treatment goals before you agree.

By Randall C Pruitt, DC,DACNB,FACFN,DAAPM,MUAC

It never ceases to amaze me how much money is wasted in the treatment of back pain. In my practice alone, I see patients every day that have been through the most idiotic treatments just because their insurance covered it. It’s not their fault, but doctors out there that offer things like epidurals, facet blocks, spinal cord stimulators as well as some of the newer spinal fusion technologies just keep going until the patient is out of options.

This happens way more often then you think, and everyday my job is to try to regain the patients trust in doctors again and come up with a game plan to help them with their suffering.

Recently, in the April 7th Arizona Republic a small article discussed how complex spinal surgeries in older adults have gone up 15 times in the period between 2002 and 2007, and complex spinal fusions accounted for 14.6 percent of all back surgeries for Medicare patients in 2007. Compare this to just 1 percent in 2002.

There is no reason for this other then money. As these big medical manufacturing companies come up with new technology they persuade doctors to use the technology by showing them how much money they can make and next thing you know a patient who never would have been recommended for a fusion in the past is now getting a fusion.

There are better solutions out there, that don’t come with the risk associated with a spinal fusion. Treatments like high powered laser and spinal decompression. These treatments work for the majority of back pain patients and at a fraction of the cost of a spinal fusion. Not to mention they are safe.

One of the things I have often been surprised by is the overwhelming amount of health care and non-health care providers offering some type of treatment for back pain.

It is interesting to say the least to hear from my patients about the different types of treatments and practitioners that they have endured in a quest to heal their back pain. These range from infomercial gadgets to spinal cord stimulators from massage therapist to Neurosurgeons and everything in between. So how is a person suffering from back pain supposed to decipher between these providers? How is one to know truly who to trust and who to stay clear from?

A recent commentary in The Spine Journal by Scott Haldeman DC, MD, PhD and Simon Dagenais DC, PhD addressed this very topic. In their estimation trying to choose a back pain treatment was akin to “shopping in a foreign supermarket without understanding the product labels.”

I think this analogy fits quite well and I definitely see the correlation in my practice. Many patients come to me out of desperation after other treatments have failed and as I mentioned I am often puzzled and at times outraged by what they have gone through.

Most really have no idea what is wrong or even a clue as to what the doctors think is wrong. The majority have never seen their MRI or really understand the nature and reasoning behind any treatment they have received.

In my practice I think it is imperative that the patient understand their problem in detail, what my program goals are and what can be expected. This sounds relatively straight forward and much like simple common sense, but according to my patients this is not what they’ve experienced.

When choosing a provider for your chronic back pain make sure the explanation of your problem (if you get one) makes sense and has merit. Make sure you feel confident with their level of knowledge and training. And finally make sure you feel comfortable with them, in this health care environment it has never been more important to work as a team and that team has to have trust. Good luck!

By Randall Pruitt, DC, DACNB, DAAPM, FACFN, MUAC, CES-NASM

I find it very ironic, that many spine doctors are skeptical about certain procedures, yet run with something unproven because it fits into their little specialty box. I see every day in  my practice the poor people who’ve been caught in the trap of the current medical approach to back and neck pain. I can tell you with certainty that the typical treatment plan for back or neck pain includes the following; medication, physical therapy, spinal injection then surgery. That is as scientific as it gets, and you know what? This approach is a horrible failure.

Treatments like spinal decompression, manipulation under anesthesia and MedX spinal rehabilitation have all been proven more effective then any of those mentioned above, yet many pain sufferers know nothing about them. Why? Because their doctor was taught the above formula and breaking out of that paradigm is a difficult thing to do. It’s much easier to send a back pain patient elsewhere by writing a prescription, and let’s face it, most doctors don’t have time to educate themselves on the newest treatments on back pain, so they do what they’ve always done. Which is why we have a 90 billion dollar per year price tag on the treatment of back pain and more people are reporting severe functional limitations then ever.

Which brings me to the topic of this particular blog post, complications with neck surgery. You see very often new techniques or instruments are introduced into the spinal surgery world without adequate testing. For example two recent studies highlight this problem, referring to the inability of the current research and regulatory systems to monitor and restrain the spread of new technologies and avoid unnecessary safety problems related to their use.  These two studies found significant growth in the use of bone-morphogenetic proteins (BMP’s) in spinal fusion surgery. And the rapid uptake of the new technology has led to a rash of complications related to their premature use in anterior cervical spine surgeries. In fact one of the studies found  an approximately 50% higher complication rate after BMP use in anterior cervical fusion.

My point to all of this, is that technologies are used everyday in the spine world that unfortunately are unproven and even worse can lead to severe complications. Spinal decompression on the other hand, is safe and proven effective. It is beyond me why anyone would have spinal surgery without at least going through spinal decompression. My practice routinely saves patients from surgery and often gets people better after surgery has failed. So my advice, ask questions, look at the rationale behind treatments offered to you and look at the long term benefits as well as the potential complications.