Tag Archives: back pain

Thank you for the bottle of wine!

Dear Readers and followers of my blog,

I’ve always wanted to be a chiropractor.  At least from age 4 on.  Prior to that who knows?  By age 15 I was already working in my father’s office.  I was one of his assistants.  I monitored therapies he had applied on his patients and made sure no one got burned or the electrical stimulation wasn’t too strong and painful.

One afternoon my dad had an X-ray on his view box and asked if I saw anything wrong on the film.  I was probably only a sophomore or junior in high school and haven’t had any gross anatomy yet.  I hadn’t learned skeletal anatomy either.  After a minute or 2 of staring at the film I told dad that I thought something was wrong with this patient’s coccyx.  Surprised he asked me to explain more.  I told him I thought the person’s “tail” had a weird angle to the bones.

Dad was really surprised and I remember a feeling of pride was conveyed in his face.  He then told me the patient had fallen on her buttocks and broken her coccyx.  Those small bones of what people know as the tail bone were broken like a finger that looked bent at 90 degrees.  I remember asking him how he would “fix” this person.  He explained to me that she would have to referred to an orthopedist.  The orthopod would have to anesthetize the patient, reach into her rectum and then re set the bones back into place.  It would be too painful to do this in his office without anesthesia.

Fast forward now 35 years.  A week ago I had a patient who called me to say that her son had fallen on his tailbone months ago and still wasn’t well.  She had taken the young teen to see her family medical practitioner who correctly made a referral for an X-ray.  She was requesting for me to get a copy of the report and give my opinion.  The report arrived too late for me to read it to her on Friday evening, but I came back to my office on Saturday morning with this single task in mind.  I read the report as normal and called her to tell her so.  Still not convinced she asked if I would view copies of the films, which is actually a good idea.  I say that, because it was just a year ago that I referred a patient out for an X-ray that the radiologist misread as normal, however upon viewing the DVDs I was of the opinion that a spinal compression fracture was actually present.

On Monday I was provided with a CD of the films.  It only took me a moment to see a 90 degree angle between the 1st and 2nd coccygeal bones.  It was probably broken/dislocated.  I called the mom to tell her my findings and that her hunch was probably correct.  My next call was to the radiologist out of Columbus that interpreted the films.  After a short phone call he expressed the need to get a third opinion from one of his colleagues.  Without being definitive he agreed that this coccyx appeared irregular and could be fractured.

I spoke next to the mom.  I told her exactly what was happening and how I thought we should proceed next.  Remembering my father’s experience at age 16 or so I told her that he needed to see an orthopedist and possibly have this straightened.  We discussed an orthopod out of Findlay, OH. that my wife had needed when she broke her wrist.  I have sent this doctor a few other patients.  As a doctor I can sense who really cares and who is also a sharp.  This ortho is one of those kind of doctors.

As a professional courtesy I forwarded a copy of the radiology report, with my notes that I had spoken to the radiologist, to the family practitioner.  The notes also contain the fact that a referral to an orthopod was being made and who.

On Friday of last week I was greeted by the mother of this teenager in my office.  She had brought a lovely bottle of Malbec from Argentina to me as a thank you gift.  Needless to say I was tickled to death.

Thank you for the bottle of wine and thank you dad for the lessons you taught me oh so long ago.

Cost of back pain (part 2)

Part 2- Back Pain and Costs: As previously mentioned, the costs of back surgeries can run as high as $169,000 for a lumbar fusion and $112,000 for a cervical fusion. In 2010, researchers reviewed the Ohio BWC’s data of 1,450 patients diagnosed with either lumbar disc degeneration, herniation, or radiculopathy. Half of the aforementioned group went through lumbar disc fusion surgery for 2 or more vertebrae. The other half didn’t have surgery even though they had similar diagnoses.

After 2 years post surgical, only 26% of those patients who had surgery had returned to work. The non-surgical group comparatively had a 67% return to work rate. The surgical group (again nearly half of 1,450 patients) had a 36% complication rate with a re operation rate of 27%.

The most eye opening fact was that researchers determined there was a 41% increased use in pain killer usage. And that 76% of patients continued opioid medication use after surgery. A shocking 17 of the post surgical patients actually died during the course of this study!
A review of pain management therapies by R. Norman Harden, MD in the American Pain Management Bulletin states “we practice at a time when unproven experimental, invasive, and expensive procedures are often compensated without question. Many of the surgical and interventional techniques have never been subjected to evidence based inquiry. Oddly, the FDA approves devices and procedures relatively easily … in this context, there has been a proliferation of extremely goofy therapies, which are expensive at best, and downright dangerous at worst.”
Another criticism of epidural steroid injections appeared in the American Pain Society Bulletin by Steven H. Sanders, PhD, who revealed nerve blocks for back pain are not supported by scientific research: “From the current review, we must conclude injections and nerve blocks produce a large amount of money with very little science to support their application.”

Part 3- Back Pain and Costs: Medical Myths

“But my doctor told me I need a back surgery!” I’m sure he did, but did you know that of the nearly 500,000 plus back surgeries performed annually only about 10% were necessary? Dr. Richard Deyo, MD, MPH is quoted as saying, , “It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just six years,” and he mentioned one strong motivation included “financial incentives involving both surgeons and hospitals.”

In 1994, Drs. Cherkin and Deyo performed a study that examined the international rates of spinal surgery with that of the United States. They found that back surgery rates in the USA were nearly 40% higher than that of any other country. They also determined that back surgery rates in the U.S. were 5 times higher than that of England or Scotland (socialized medicine is practiced there). It was apparent to Deyo and Cherkin that the excessive number of neurosurgeons and orthopedic surgeons had a linear on the number of surgeries performed per capita. Basically said, since we have so many surgeons over here, then we can expect each one of them to do more than their share.

But you’re going to tell me that an MRI or a CT scan revealed this large herniation. I’m sure it did, but did you know that a repeatable study employing an MRI on 100 and a 1,000 pain free patients, who never had back pain, revealed 30% of these people had bulging or herniated discs, but were pain free! It’s not surprising that in areas of the world (and of course the US) where MRIs and CT scans are in high numbers that they also have a high correlation of back surgeries.

I personally have seen patients with lumbar strains, facet syndromes, arthritis anteriorly and posteriorly, and mild stenosis who also had positive MRIs for disc herniations of bulges, but their source of pain wasn’t from a disc herniation. And when I treated their cause they responded. The med docs aren’t alone. I too have seen MRIs with large disc lesions that I referred out to surgeons only to hear the patient be told to return to my care for a few more weeks of conservative treatment and ultimately they didn’t need surgery. Or the patients who refused surgery after being referred out who later became symptom free.

The problem isn’t just the abundance of surgeons or imaging facilities, the problem is that doctors are often not treating the biomechanical causes of patients’ back pain. Even covering up the pain with narcotics, steroids, and injections isn’t treating the true cause of their pain. All too often doctors rely on radiographic findings rather than a good history and examination. Many of my patients tell me that their exam was lacking, the doctor never touched them, or worse yet they were examined by a non-physician (nurse or physical therapist). My question is how do you determine which structures are actually at fault or injured if you don’t examine the patient fully.

Continued-

“But my medical doctor doesn’t believe in Chiropractic and wants to send me to a surgeon.”

First off, we’re a profession, not a therapy. Chiropractic is a profession. What we do is adjust or manipulate and more. Many of my colleagues perform acupuncture, taping, rehab., nutritional and diet counseling, sports medicine, neurology, imaging interpretation, mid-wifery, pediatrics, applied kinesiology, reflexology, and much more. You don’t just clap your hands and believe in us. How unscientific is that comment?