Tag Archives: conservative care

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?