LBP is big business at $100 billion annually in the US while affecting 540 million people worldwide at a cost approaching one trillion. Many types of practitioners and non-practitioners are cashing in whether or not their services or products are proven to be effective; indeed, most are no better than placebo and many are addictive or even deadly. Most are simply a waste of money.
Yet where is the chiropractic voice in this din of back pain?
According to Scott Haldeman, LBP patients have “31 destinations offering over 200 treatments… analogous to shopping in a foreign supermarket without understanding the product labels.”[i]
Aside from unintelligible products labels, Dr. Haldeman should have mentioned the danger of shopping without warning labels for many of these 200 LBP entrees.
I daresay since 2008 when Dr. Haldeman first penned his research the problem of bad choices for LBP this situation has only worsened with the recent onslaught of opioid addiction as well as the side effects of OTC drugs, epidural steroid injections (ESI), and now the newest gimmick, minimally-invasive spine surgery (MISS).
We wonder why LBP has become the leading disability in the workplace, military, nation and in the world when the medical spine industry refuses to follow the new guidelines aimed to restore sanity and safety in spine care. Indeed, Mark Schoene, associate editor of TheBACKLETTER, an international medical research journal, criticized the ineffective methods when he declared, “Spinal medicine in the U.S. is a poster child for inefficient care.”[ii]
Drugs for Sale
Perhaps as a chiropractor I am overly observant about products for back pain, but it seems more than half of ads I see on TV during prime time are drug ads. Initially I thought I was becoming unjustifiably wary about drugs ads on television until I found an article proving me right.
An exposé in The New York Times, “Think You’re Seeing More Drug Ads on TV? You Are, and Here’s Why,” found 771,368 drugs ads were shown in 2016, an increase of almost 65 percent over 2012. Crunching this number by 365 days in the year reveals there were 2113 drug ads on TV daily throughout the US.
TV ads with Shaquille O’Neal touting TENS or Icy/Hot with lidocaine for back pain are now ever-present. It’s bewildering how he became an expert spokesman for back pain treatments, but it seems to be working considering the regularity of his ads.
A big problem with OTC meds for back pain is the lack of required warnings for side effects unlike prescription meds, such as the following for Advil (ibuprofen):
- upset stomach, mild heartburn, nausea, vomiting;
- bloating, gas, diarrhea, constipation;
- dizziness, headache, nervousness;
- mild itching or rash;
- ringing in your ears;
- renal (kidney) failure; or
- all NSAIDs, including ibuprofen (Advil) and naproxen (Aleve), were found to be associated with an increased risk of acute myocardial infarction.
Two press releases concerning drugs for back pain and sciatica were released in March 2017; one reported Ibuprofen can increase heart attack risk by 31% and another from the New England Journal of Medicine found Pregabalin (Lyrica) for acute and chronic sciatica was no better than placebo.
Direct-to-consumers ads must be working well considering both of these NSAIDs rank in the top 10 OTC products with Advil ranked #1 at $490 million annually and Aleve at $364 million, which equates to $854 million. Indeed, back pain is big business even for temporary relief with an armful of side effects.
Now we see new ancillary products in the supermarket for LBP such as Brett Farve selling copper back supports. Unfortunately for Brett’s credibility, Consumer Reports suggests, “There’s little evidence to support manufacturer claims about copper-infused garments,” but many patients invest in these hoping for a quick fix because Brett says so!
[note: no back support will work well if not fitted correctly. Most people put them on incorrectly while in the standing position after the spine has compressed. I recommend icing the spine first before putting the support on while lying in the supine position to decompress the lumbar spine. Give it a try and feel the benefit.]
My Pillow Problem
Aside from the tsunami of drug ads, another big splash on TV is the guy hugging his My Pillow. I’ve heard many mixed reviews from patients about this expensive and heavily advertised My Pillow, but to my surprise I discovered this product has lost its accreditation by the Better Business Bureau due to consumer complaints.
The engaging TV ad with the owner glibly hugging his money-making pillow is cute, but his convincing squeeze has been ruled misleading advertising in another lawsuit: “My Pillow Settles Consumer Lawsuit Over Health Claims for $1 Million.”
Instead of this big lumpy My Pillow (that may be good for under or between your legs, but not under the neck), I recommend the Therapeutica pillow, which is designed for people who sleep primarily on their back and side. I’ve had mine for 30 years and love it.
The most ubiquitous commercial nowadays is the seemingly never-ending TV ad about inversion tables. Certainly not a new concept considering gravity-assisted decompression has a storied history, they also are not without controversy.
Actually they are useful and I recommend them to some patients, but these are not cure-alls for LBP as implied in the commercials. I equate inversion tables, Ab-lounge tables, and Ab-doer seats equivalent to a toothbrush, toothpaste, and flossing—important ancillary dental treatments, but none will replace the work of the dentist; nor will these spine tables replace the skill of a chiropractor to correct the mechanical problems with the spine.
Stay tuned for Part Two: Minimally Invasive Surgery—Quick Fix or Quick Con?
[i] Haldeman, S., Dagenais, S., Evidence-Informed Management of Chronic Low Back Pain Without Surgery, The Spine Journal, January/Feb 2008,Volume 8, Number 1.
[ii] The BACKPage editorial vol. 27, No. 11, November 2012.