Articles by JCS

Unravelling Spine Care

Word count: 955

Unraveling Spine Care

By

JCS

 

The recent alarm over patient deaths caused by epidural steroid injections (ESI) for back pain has again cast suspicion over many medical treatments for spine problems. Although portrayed as just a fluke caused by a bad batch of medicine, in fact, ESI symbolizes the tip of the spine care iceberg of ineffective and dangerous treatments.

Since the early 1990s, traditional medical spine treatments—drugs, shots, and spine surgery—have been rigorously investigated resulting in a serious paradigm shift that has rattled the spine industry because medical back pain treatments have not fared well under the scrutiny of research.

As far back as 1994, the US Public Health Service conducted the most extensive investigation into acute low back pain and ruled against these shots as well as other common medical treatments. “There is no evidence to support the use of invasive epidural injection of steroids, local anesthetics, and/or opioids as a treatment for acute low back pain without radiculopathy.”[1]

The only instance where ESI were mildly recommended is an “option for short-term relief of radicular pain after failure of conservative treatment and as a means of avoiding surgery.” Recent studies are less supportive when they revealed side-effects include paralysis, stroke, respiratory failure, and fractures.[2],[3]

 The evidence is mounting not only against the danger of ESIs but also the waste, ineffectiveness, and expense of spine surgery. The Dartmouth Institute of Health Policy suggests 30-40% of spinal fusions surgeries are unnecessary.[4] In fact, one orthopedist admitted that back surgery “has been accused of leaving more tragic human wreckage in its wake than any other operation in history.”[5]

Undoubtedly, the first alarm occurred when the same U.S. Public Health Service study on acute low back pain clearly warned in its Patient Guide:

Even having a lot of back pain does not by itself mean you need surgery.  Surgery has been found to be helpful in only 1 in 100 cases of low back problems.  In some people, surgery can even cause more problems.  This is especially true if your only symptom is back pain.[6]

This guideline also stunned the medical world when it announced spinal manipulation was a “preferred treatment” for the majority of acute low back pain, excluding cases of cancer, fractures, or serious infections that comprise less than 15% of cases. [7]

The guideline also noted physio-therapeutics such as ultrasound, TENS, hot packs, and other standard treatments by physical therapists were short term at best and considered ineffective to correct the underlying causes.

Pain management clinics have also added to the “hillbilly heroin” epidemic. Robert J. Barth believes “pain management does not accomplish anything but getting the patient addicted.”[8] In 2010, American pharmacists dispensed over 101 tons of opioids like pure oxycodone and hydrocodone that caused 14,800 deaths and untold addictions, including to the unborn.[9]

Another shocking revelation occurred when researchers found the majority of medical primary care physicians are very poorly trained in back pain and musculoskeletal disorders (MSD) with their heavy reliance upon outdated concepts and treatments. Inexplicably, it was found that 50% of all medical schools do not require MSD training.[10]

John C. Wilson, MD, former chairman of the American Medical Association’s Section on Orthopedic Surgery, wrote about the poor training of medical students. “MDs often displayed a disturbing ignorance of the cause and treatment of low back and sciatic pain, one of mankind’s most common afflictions.”[11]

Back Pain Treatments: So What’s the Difference?

Not only are most MDs untrained in spine care, undoubtedly the biggest shock happened when the standard medical diagnosis—the abnormal disc theory—was disproved by research.[12] Experts now mockingly refer to these abnormal discs as “incidentalomas” because, like finding grey hair, they are ubiquitous in asymptomatic patients; hence they are deemed incidental to your pain.[13]

To the surprise of many, even the North American Spine Society finally admitted in 2010 that spine fusion should be a last resort and recommended spinal manipulation before surgery.[14]

The insurance industry has even changed policy concerning back fusions. In 2010, North Carolina Blue Cross/Blue Shield said it would not pay for spinal fusion if the sole indication is disc degeneration or herniation since these are present in asymptomatic patients, too.[15]

So, if the disc theory is outdated and standard medical treatments are ineffective, what causes this epidemic of back pain?

This question begs a rudimentary understanding of the spine itself.

The chiropractic principle is easily understood when you think outside the medical box of discs. Consider these facts:  the spine has 313 joints between the 24 vertebrae, ribs, skull, and three pelvic bones, so any compression, injury, or jolt to the spine may cause these joints to buckle and nerves to inflame causing pain.[16]

John McMillan Mennell, MD, a distinguished orthopedist, professor, and expert on manipulative therapy who had taught at eight medical schools mentioned the value of chiropractic care. “Manipulative therapy relieves symptoms of pain arising from mechanical joint dysfunction and restores lost joint function. No other modality or physical treatment can do this as effectively.”

He also mentioned “…nearly 20 million Americans today could be spared suffering and be returned to normal pain-free life were manipulation therapy as readily available to them.” [17]

With this new evidence mounting, researcher Anthony Rosner, PhD, testified before The Institute of Medicine: “Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.”[18]

Research has now vindicated chiropractors as America’s primary spine care providers by virtue of their superior education and effective treatments. The key for you is to find a chiropractor to check your spine and to teach you the basic principles of the chiropractic brand of spine care so you, too, can enjoy the benefits of a healthy, aligned spine.



[1] Bigos et al. US Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Clinical Practice Guideline, Number 14: Acute Low Back Problems in Adults AHCPR Publication No. 95-0642, (December 1994). p. 47.

[2] Steroid Injection Linked to Increased Risk of Bone Fractures, ScienceDaily (Oct. 25, 2012)

[3]Megan Brooks, Epidural Steroid Injections Provide Modest Relief for Sciatica, Medscape, 04/24/2012

[4] Elliott Fisher, MD, on the CBS Evening News, “Attacking Rising Health Costs,” June 9, 2006.

[5] G Waddell and OB Allan, “A Historical Perspective On Low Back Pain And Disability, “Acta Orthop Scand 60 (suppl 234), (1989)

[6] Bigos et al. US Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Clinical Practice Guideline, Number 14: Acute Low Back Problems in Adults AHCPR Publication No. 95-0642, (December 1994). p. 12

[7] Ibid.

[8] Robert J. Barth, “Saying No!—Unjustified Surgeries, Pain Management and Tests,” For the Defense 48/3, (March 2006):33-39. Washington & Lee Law School Current Law Journal Content

[9] Popular painkillers exploding in U.S. by Chris Hawley, The Associated Press, 4/06/2012

[10] Matzkin E, Smith MD, Freccero DC, Richardson AB, Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am 2005, 87-A:310-314

[11] JC Wilson, “Low Back Pain and Sciatica: A Plea for Better Care of the Patient, Chairman's Address,” JAMA, 200/8, (May 22, 1967):705-712.

[12] SD Boden, DO Davis, TS Dina, NJ Patronas, SW Wiesel, “Abnormal Magnetic-Resonance Scans of the Lumbar Spine in Asymptomatic Subjects: A Prospective Investigation,” J Bone Joint Surg Am. 72 (1990):403–408.

[13] Richard A. Deyo, MD, MPH and Donald L. Patrick, PhD, MSPH, Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises, AMACOM books, (2005): 36-37

[14] MD Freeman and JM Mayer “NASS Contemporary Concepts in Spine Care: Spinal Manipulation Therapy For Acute Low Back Pain,” The Spine Journal 10/10 (October 2010):918-940

[16]G Cramer,  Dean of Research, National University of Health Sciences, via personal communication with JC Smith (April 29, 2009)

[17] G Null, PhD, “Medical Genocide, Part Four:  Painful Treatment,” Penthouse (November 1985).

[18] Testimony before The Institute of Medicine: Committee on Use of CAM by the American Public on Feb. 27, 2003.

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