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.
By Randall C Pruitt, DC, DACNB, DAAPM, MUAC, FACFN, CES-NASM
In my practice it is rare to see a patient with lower back pain or neck pain, not exhibit some other condition. Whether it be knee pain, shoulder pain or some other type of joint or muscle pain. However most doctors are so narrow in their focus that they rarely look past the body part wherein they specialize.
This is unfortunate for many reasons. Usually as the back or neck pain improves the other area will begin to affect the person much more significantly and a referral to another specialist is usually made. This can be a source of frustration for most people because who wants to go to an endless series of doctors and specialists when their problem could have been taken care of in one place?
A recent study by Michael Korff PhD and colleagues found that about 20% of the population of the United States has chronic spinal pain at any given time. And of this population 87% reported at least one other musculoskeletal condition. However, these problems are not only an accessory condition but, create about 1/3rd of the persons disability in conjunction with the spinal pain.
Another article written in the journal Pain by Peter Croft MD states that humans are vulnerable to multiple forms of pain, and common conditions will inevitably occur together.
Because of this common thread my team here at the Arizona Back Institute is very well trained in the treatment of a variety of musculoskeletal conditions, injuries to the knee, the rotator cuff and conditions like carpal tunnel syndrome and neuropathy just to name a few. Of course our main focus is on chronic spinal conditions, but my philosophy is that their affect on other areas should be treated as part of the total injury and not as a separate case, requiring a referral.
If you have suffered from lower back or neck pain for any length of time, you may have been given facet joint injections as a part of your treatment. Facet joint injections, are injections into the joints of the spine with a steroid to relieve pain. The theory behind these injections appears sound, since these joints are highly innervated with pain sensitive nerves, it would appear that injections would help. The second step in the injection process is to then ablate or deaden the nerves in the joint to prolong the pain relief. These nerves do however, grow back usually within 3-6 months.
While the rationale behind these injections makes some sense the medical research shows them to be ineffective. In fact several studies have come to the same conclusion, that essentially these injections are no better than a sham injection and do not give the patient any semblance of a long term result.
The problem however with any study is that the treatment is often applied to a more generalized group, lower back pain in this example. What needs to happen in order to give us better clinical indications is to break down the patients by diagnosis and treat only those who fit the criteria. that way the true success rate can be established.
In my own practice we are very meticulous in our selection process and patients are not accepted into any program unless we have been able to establish very specific clinical findings. That is why our success rate is so high, we only accept those we feel very strongly that we can help. Unlike many medical studies published apparently disproving individual treatments, where the study population is a mixed bag.
The truth is no one treatment has all the answers. In my experience the best treatment approach is one that addresses all of the various components of back and neck pain and treats them simultaneously, giving the patient the best possible chance of a successful outcome. That is what we strive for everyday at the Arizona Back Institute.
