Part Two of Alternative Facts
Bad Poster Child
“Medical spine care is the poster child of inefficient care”
Mr. Mark Schoene, editor of The BACKLetter
It took an opioid crisis of unprecedented numbers created by the AMA and Big Pharma causing hundreds of thousands of deaths and millions of addictions over the past 30 years before the media and government took a closer look at the medical mismanagement of the most disabling condition in our nation – the “Quiet Epidemic” of chronic pain.
As Donald Teater, MD, National Safety Council, once said, “Opioids do not kill pain. They kill people.”[1]
Washington Awakens
The updated American College of Physicians (ACP) guidelines are not the first critical assessment of medical spine care. During the last few years numerous federal agencies have examined the issues of the growing opioid painkiller problem and the consensus was very clear:
- too many opioids,
- too many promiscuous prescribers,
- general physicians uneducated in chronic pain management, and
- the need for nondrug alternatives for care.
Here are a few of the major studies:
- VA/DoD: Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, 2009.[2]
- Office of the Army Surgeon General: Pain Management Task Force; Final Report, May 2010.[3]
- Institute of Medicine (IOM): “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research,” 2011.[4]
- National Institutes of Health: Report of the Task Force on Research Standards for Chronic Low Back Pain, 2014.[5]
- National Institute on Drug Abuse: “America’s Addiction to Opioids: Heroin and Prescription Drug Abuse,” 2014.[6]
- Health and Human Services: National Pain Strategy: “A Comprehensive Population Health-Level Strategy for Pain,” 2015.[7]
- Centers for Disease Control: Guideline for Prescribing Opioids for Chronic Pain — United States, 2016.[8]
- American College of Physicians: “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians.”[9]
This crisis would never have grown to this magnitude if the AMA had not waged a medical war of defamation to marginalize the chiropractic profession, the leading nondrug primary care spine care providers, in order to corner the spine care market.
Now the public and government programs are paying this price of this medical mess, and it’s time to blow the whistle.
Shot in the Back
Although the updated ACP guidelines discouraging the use of opioid painkillers are certainly important and a good place to begin this publicity of medical malpractice, there are bigger fish to fry in spine care—ESI and spine fusions.
Every chiropractor has seen this scenario: when self-care and OTC pain pills fail patients with chronic or acute back pain, they go to the “pain management” clinics for opioids, muscle relaxants, and epidural steroid injections without first taking a detour to the chiropractor’s office for complementary and alternative methods (CAM) as most guidelines now recommend.
Patients are totally unaware epidural corticosteroids injections (ESIs) are used “off-label” for back pain and have been shown to be no better than placebo,[10] sometimes dangerous (such as loss of vision, stroke, paralysis and death), and have never been approved by the FDA for back pain as noted in a FDA publication, “Epidural Corticosteroid Injection: Drug Safety Communication: Risk of Rare But Serious Neurologic Problems.”
The FDA warning clearly states: “Corticosteroids are not approved by FDA for injection into the epidural space of the spine.”[11] Yet “needle jockeys” continue to ignore this FDA warning because it’s easy money.
In 2015, another major review by Roger Chou, MD, sponsored by the U.S. Agency for Healthcare Research and Quality (AHRQ) found the evidence in favor of spinal injections to be distinctly “underwhelming.”
Chou also could not find conclusive evidence that spinal injections were effective treatments for spinal stenosis, facet joints, sacroiliac joints, or non-radicular back pain. The only benefit was temporary relief for sciatica in some patients.
A 2013 study by Nancy E. Epstein, “The risks of epidural and transforaminal steroid injections in the Spine: Commentary and a comprehensive review of the literature,” was just as disturbing as Dr. Chou’s assessment:
“For many patients with spinal pain alone and no surgical lesions, the ‘success’ of epidural injections may simply reflect the self-limited course of the disease…
“Although not approved by the Food and Drug Administration (FDA), injections are being performed with an increased frequency (160%), are typically short-acting and ineffective over the longer-term, while exposing patients to major risks/complications…
“Although the benefits for epidural steroid injections may include transient pain relief for those with/without surgical disease, the multitude of risks attributed to these injections outweighs the benefits.”[12]