A new study reveals that Americans are spending record amounts on treatments for their aching backs. But are these expensive fixes a waste of money?
Comment: Chiropractic care is a major alternative approach to drugs and surgery for back pain, in addition to many other conditions leading to pain in the body. Today's chiropractors are well-trained as primary healthcare providers and provide a different perspective to understanding common ailments.
Comment: The solution to the majority of the lower back pain problems is a nutritional protocol that i have developed. Relief can be experienced in as little as one minute. I have used this protocol on hundreds of people. The primary causes of lower back pain are stress and poor nutrition.
Comment: My husband's father has had several back surgeries as the result of an injury he sustained as a teen. It is scary how many pills he pops in a day. Of course, after a while, his doctor has to up his Rx, and then he tries a different pill for awhile, and keeps cycling through every few months. Whenever we visit, I am always nervous to let my kids get in the car with him driving. He claims they "don't affect" him anymore. Well, then why does he take them? Because he is a DRUG ADDICT! He is not MY father, but I wish my husband would sit down with him and tell him, if the pills don't help, get off of them!! Try alternative therapies! Lose 50 pounds! Stop eating junk! Americans in general need to quit this ridiculous dependancy on prescriptions!! Do what it takes to get, and as much is in your power, STAY healthy!
Comment: There are some good points. I think when you can preventitive measures are the best, like stretching out the back and yoga. Also for pain a friend turned me on to Doctor-rx.com and got some relief when I needed it.
Comment: Doctor-rx.com is pretty good. They send out "nurses" to massage my back and perform other sexual services.
Comment: Terrible article. Full of vague generalizations. No real information that a back pain sufferer could use as guidance. Just because Dr. Deyo was lucky enough to get by with a dose of ibuprofen is no reason to dismiss other treatments. What does he recommend for people with chronic pain and loss of function? What about the effects of long term use of over the counter medications like ibuprofen?
Comment: acupuncture is dangerous sometimes...
Comment: wasn't as productive so I finally ran out of excuses to tell my boss for not trying acupuncture. To make a long story short, I was pain-free after four or five visits (five weeks). My biggest excuse had been the cost- about $80/visit in NC. However, after the first week I started feeling better so the cost didn't seem much then.
I'd like to add that stretching is what *keeps* me pain-free now. You don't have to do yoga; just a few minutes of stretching each day is enough. There's good book called 'relief is in the stretch' or something like that. Good luck.
Comment: This is for all of you back pain sufferers who are tired of drugs and 'treatments' that don't work: go see an acupuncturist. If possible, seek one who did *not* receive all of his/her training in the US-- Chinese are the best in my experience.
I started having back pain after a car accident a few years ago and followed the usual route: MDs, NSAIDs, physical therapy, TENS, etc. When my boss first told me to try acupuncture I said I would but of course I didn't because like most of you I thought it wouldn't work. Four months after my accident I was still in pain (well, not in much pain because my MD was nice enough to prescribe opioids). Either way, it was obvious that I wasn't as productive so I finally ran out of excuses to tell my boss for not trying acupuncture. To make a long story short, I was pain-free after four or five visits (five weeks). My biggest excuse had been the cost- about $80/visit in NC. However, after the first week I started feeling better so the cost didn't seem much then.
I'd like to add that stretching is what *keeps* me pain-free now. You don't have to do yoga; just a few minutes of stretching each day is enough. There's good book called 'relief is in the stretch' or something like that. Good luck.
Comment: Surgical Treatments have a one in four success rate by most published studies. This report Fails to mention chiropractic care which has been shown to have a 89 percent success rate and 96 percent satisfaction rate. for more information. www.villagefamilychiro.com
Comment: Having recent back surgery, I found that this article to be somewhat insulting. In 2005, my neurosurgeon was very upfront with his assessment of my condition, and the treatment. He gave two options. The first being conservative therapy, injections and prescriptions. He also stated that you could not fix a massively herniated disk and spinal stenosis with Physical therapy, exercises anything else. Option 2 was surgery but only after option, one was exhausted and I could not stand the pain. Two years later, I had reached the end of my tolerance of pain. After another MRI to confirm that things had things had changed I scheduled surgery. I now wonder why I waited. It was a decision that changed my life for the better. I understand that surgery is not the answer for all low back pain but when it works, it is a miracle. It is my hope that people who read this make an informed decision with their Doctor, not based on the hype of this study and article. The honesty of what will work and will not help back pain is also vitally important. Over treatment of low back pain could stem from either lack understanding of the diagnosis and or a possible unrealistic expectation instant pain relief. If all Doctors and patients have a relationship to speak openly, honestly and at times bluntly, costs to treat low back pain may drop.
Comment: Having recent back surgery, I found that this article to be somewhat insulting. In 2005, my neurosurgeon was very upfront with his assessment of my condition, and the treatment. He gave two options. The first being conservative therapy, injections and prescriptions. He also stated that you could not fix a massively herniated disk and spinal stenosis with Physical therapy, exercises anything else. Option 2 was surgery but only after option, one was exhausted and I could not stand the pain. Two years later, I had reached the end of my tolerance of pain. After another MRI to confirm that things had things had changed I scheduled surgery. I now wonder why I waited. It was a decision that changed my life for the better. I understand that surgery is not the answer for all low back pain but when it works, it is a miracle. It is my hope that people who read this make an informed decision with their Doctor, not based on the hype of this study and article. The honesty of what will work and will not help back pain is also vitally important. Over treatment of low back pain could stem from either lack understanding of the diagnosis and or a possible unrealistic expectation instant pain relief. If all Doctors and patients have a relationship to speak openly, honestly and at times bluntly, costs to treat low back pain may drop.
Comment: Massage therapy by licensed professional therapists has been proven beneficial for back pain. As has chiropractic. Why didn't the article mention these complementary practices?
Comment: Massage therapy provides excellent results for back pain. Why didn't the article mention that?
LMP in Washington
Comment: To Oceanbrisa: (See my previous post). I couldn't agree more with you in terms of people taking better care of themselves when they are younger. Brutalize your body when you are young, and mostly likely you are going to pay for it later. However, no one can tell us that when we are young.
To McFar73: Many times, well conditioned, non-obese, non-smoking careful people have back pain that eludes a precise diagnosis. Obesity, smoking, etc., are just risk factors.
As far as the conspiracy theory goes, (See my post), there is no question that companies want to make as much money off of anything as they can. However, I assure you that there are a lot of very smart people working on this problem, and there are no "secret cures" that are being hidden. Back Pain is a very elusive problem. I give you a quote from Alf Nachemsen, MD, PhD, one of the "Gods" of back pain, shortly before he died, "One of the main goals of my career has been to determine the cause of nonspecific back pain. And in this I have failed. I didn't know the origin of back pain [early in my career], and I don't know now.??? Note that he said "nonspecific back pain", not well known causes of back pain. There are many times when we actually can tell people exactly what their problem is, just not always. At this point, your back pain may well be non-specific.
Comment: I am not over weight or a drinker, but I am a sufferer of back pain and have had surgery twice. I agree that surgery is an expensive way to go, and the it may the road choosen in hopes of the instant gratification that today's society is used to.
When my back flared up for probably the 4th time in 15 years I once again sought medical help, not just relying on time. I may be the rare guess(?) but surgery was necesssary as bones fragments from a disc had caused drop foot and unbelievable pain.
I truly think the answer is in educating young people about the body. In high school I was a gymnast & cheerleader. I wonder had I known how much I suffer today would I have respected my body more. I am a female, 51 living on disability. I have tried pilates, yoga and keep in shape via water exercise.
Point: Surgery is sometimes a must - time cannot cure all. Education!!! and not just about backs, but about knees also.
Comment: I am 35 and have had two lumber spinal surgeries (decompression/laminectomices)--and I had to have them because I had so much pain in my foot and leg I could hardly walk. L4/L5 was bone on bone with nerves directly inbetween. In addition, my blood pressure spiked because of the severe pain. Yes it is expensive, but to say a waste of money is not realistic. I could not hold my son, at the time of my first surgery he was 9 months old. I could not walk with out crying, wash my self in the shower or clean my self well after using the restroom. (thank God for my husband). Granted there are people who would rather get high off the pills, but when faced with being unable to take care of yourself, the cost is justified. There is fine line here between an ache and ruptured disks and nerve compressions. Before my back surgeries, I always thought, oh your back hurts--use some heat and tylenol. After my experiences, let me tell you--it is horriable. My attitude has completely changed. You can not walk, stand, sit or lay down with out hurting. I went months with hardly any sleep because of that. The mental part is almost as bad as the pain from the compression. Who ever wrote this article and or particiapted in the study has not had servere back problems. It is obvious by their lack of knowlege of the "true problems"
And for those of you wondering, I did not gain more than 35 pounds during my pregnancy--it was not the acutal cause of my back injury. I have Degenertive Disk Disease along with Spinal Stenosis (narrowing of the spinal canal). I have had back problems since I was a teenager--posture, shoes, weight all play crutail roles. I have had epidural injections, test after test, medicine after medicine. If you have back problems, you have to change your lifestyle and want to get better. Try Yoga it has helped me more than any other exercise. and realize that you are lucky to be able to walk. I can now play with my son--it is limited, it can not run or jump, but we can play hide and seek--all worth every dime I spent.
My general doctor had told me many times how current medicince does not have an answer for backs--has anyone ever wondered since there is sooo much getting made off of it, there is not a cure for a reason. No offense everyone, but this lopsided thinking in the article really hit a "nerve" with me. The researchers should be given major incentives (other than patents) to find solutions--this would reduce costs in the long run..
Comment: FYI: Also, I do not smoke, drink or in awful shape I am 20lbs over my "ideal wieght", not obese. So please stop generalizing people. I also visited Chiropractors--no results. Surgery was my last option to get my life back.
Comment: About 4 to 6 months ago, I started experiencing back pain while jogging. I tried to ignore it and keep jogging. It kept getting worse, so I stopped jogging. I decided to go to a chiropractor to see if it would help get rid of the pain. He said that I had a collapsed vertebrae in your lower back and my hips were not level. I am 53 years old and I have never before had a problem with any back pain, until recently. I don't know whether it is worth going to the chiropractor for a month and see what happens or trying to cure it on my own with rest and ibuprophen. I still do push-ups and sit-ups which don't seem to bother me. As soon as I try to run, and I feel that banging on the pavement, I feel the back pain. I'm looking at getting a Cybex Arc Trainer, instead of jogging. They are expensive to purchase but I wouldn't have the pounding of jogging. Any feedback, I would greatly appreciate.
Comment: How about riding a bike. Might be better than jogging. I do a lot of bodyweight exercises like the bridge and squat really seem to help my back and stay in good shape.
Comment: Shame on Newsweek. I am a Neurologic Surgeon, the specialty that preforms most spinal operations, and as our association has stated time and again herniated discs RARELY cause low back pain. The fact is that only one in three lumbar herniated discs ever come to clinical concern and then only with radicular or limb symptoms. In those situations 3 different studies performed first by Canada-the Quebec study- then the United States-Agency for Health Care Research-and finally by the European Union have found that the treatment of choice for radicular pain lasting longer than six weeks is surgically. Chiropractic management, PT and injections either have no place or should be used in the first 30 days. Surgical management is CHEAPER and is more enduring. The success rate for a simple discectomy for disc herniation approachs 98%- there is up to a 20% recurrence rate that is not influenced by the fact that the patient had surgery or not-this is the natural history of the disease. These are the facts.
Instead of telling this story the authors of the article focus on the grey area of low back pain. Very, very few patients with LBP are surgical- the majority of back surgery is done for radicular or overt structural problems, not for pure low back pain. LBP is primarily a functional problem-weight, tobacco use, deconditioning, etc.. Every reputable practice guidline including those published by the American Association of Neurologic Surgeons requires that all remediable factors are managed BEFORE any sort of intervention- be it PT, chiropractic, pain management, or finally surgery. If your back hurts, chances are VERY high that you are overweight, deconditioned, smoking or all of the above.
Lastly remember that physicians don't confer health on people- ultimately it is the patient's responsibility to become informed-internet, second or third opinions, talk to people who have had similar problems, etc, etc.. We live in an information age, and if people passively accept what they have been told, or refuse to become participants in their own care they bear more than a small amount of responsibility for their failed back.
Comment: Perhaps when the allopathic (drug and surgery) physicians are prevented from initial contact with patients until examined by a chiropractic physician, I might come out of retirement. Until then, the $2 billion spent on drug ads every month keep it a 'drug 1st' society. And lose some weight, America-it's more embarrassing than our foreign policy. There, I feel better now...
Comment: As a non-surgeon pain physician/Physiatrist MD, PhD who has spent 30 years treating spinal pain, I can state that any attempt to discuss back pain comprehensively in less than 20 books or so is impossible. Back pain has many causes, and diagnosis is imprecise. Rarely are two cases of back pain identical. Treatments have to be specific to the cause of the problem. A good treatment for one person may harm someone else. Surgery, injections, chiropractic, physical therapy, medications all have their place. A good spine physician should not be afraid to use any of these treatments for properly selected patients. By properly selected, I mean something like, "if a person had appendicitis, then an appendectomy is the appropriate procedure. If they have gall bladder problems, you treat their gallbladder. For the gallbladder patient, an appendectomy won't work. So is it with spine pain patients. I would make a few generalizations:
1) No one treatment works for everybody
2) Don't try to understand your back pain like you would understand a machine. It doesn't work like that. Rarely can a Doctor (or anyone else!) give a person the exact cause of their spinal pain.
3) Managing back pain is 50% science and 50% art. Find a good back pain practitioner and listen to their advice. A good MD knows when to refer to a Chiropractor and vice versa. As a general rule, don't start with a surgeon.
4) Pharmaceutical companies put incredible pressure on Physicians and the public to use newer, in-patent drugs (Much more expensive/profitable) when older, out-of-patent, cheaper drugs work essentially as well. Similarly, companies who manufacture hardware, equipment, etc., used in surgery market their products very aggressively to both Physicians and patients.
5) Except in emergency cases, surgery should be the last alternative. I have seen many patients do very well after surgery when all else failed. For some patients who are in agony, surgery is the fastest way to relieve their pain.
6) Patients have to do their part. Obesity, smoking, poor spine care habits, poor conditioning can undo anything we medical people (MD's, DO's, Chiropractors, Physical Therapists, etc.) can do from a medical standpoint. The mind-body connection and body awareness/physical conditioning are all very, very important.
7) Eat right, Exercise, and you are still going to die! No one beats aging. After about the age of 45, give or take a few years, every year we are generally capable of less than we were the year before. The only person who gets better after this point is the one who was in terrible shape to start with. If you fit into this category, then you can make things better with some hard work. If you are already in good shape, sorry. How many machines do you own that are your age and good as new?
8) As you get older, what you DON"T do to your back in terms of bad habits is probably more important than what you do in terms of exercise, etc..
Anonymous Physician
Comment: Amazing. Not one mention of acupuncture, podiatry, or massage.
A good portion of chronic back pain is from poor posture, ill-fitting shoes, and stress. Surgery and drugs only address the symptoms, and don't do a particularly good job at that.
If you truly want to have less back pain, try correcting the root cause, not just treating the symptoms.
Anonymous nurse.
Comment: Nurse, your comment is valid, but I believe the Dr is trying to say that each case should be treated differently. Which includes different treatment options for different people. the pain speicalist I know, is open to any and all options. Most patients however are not. It is finding that balance that is hard.
Comment: I am definitely interested to see more discussion regarding conservative interventions for back pain, but I would also like to see the evidence supporting the statement by mfield that "chiropractic is over 95% successful in treating back and neck pain." That seems to be slightly inflated. Research has shown that manual interventions (manipulations/moblizations) coupled with exercise has the best outcomes over manual interventions alone (chiropractic care). I would like to know your reference on your percentage so I can read it myself . Maybe I would actually become more of a believer if it proves to be true!
Comment: http://www.amerchiro.org/level2_css.cfm?T1ID=13&T2ID=67
Here's just one. And I would say chiropractic overall has about an 80% effectiveness rate in LBP syndromes. Be prudent when viewing study results and who was performing the 'manipulation'-often by MDsMD's
performed doen by inadequately
Comment: AMAZING. It's amazing that in a three-page article (not sure how many pages it is in print), chiropractic wasn't mentioned ONCE. Instead the answer is eat well, lose weight, take a pain pill, and let it work itself out. How about trying a chiropractor? Chiropractic is over 95% successful in treating back and neck pain. Where does it say that in the article? I'd be curious to see the print edition and see how many drug ads are flanking the pages. When will they learn? On the other hand, the article did point out that the surgeries that cost thousands of dollars are essentially ineffective. That's a step in the right direction, I suppose.
Comment: I wish they would come up with something that would be a cure for chronic back pain. I was in a freak boating accident 2 years ago. I fractured a lumbar disc and had a "Vertebroplasty" (sorry about the spelling). Basically they injected a medical "cement" around the disc to stabilize it. However, I have had back pain ever since.
I now only get 4-5 hours of sleep a night. Sometimes I get 8 but usually because of sheer exhaustion. After 8 hours I wake up in terrible pain and sit at the side of the bed trembling and trying to control severe nausea because I hurt so bad. X-rays and MRI's haven't revealed anything wrong. They say everything is spaced correctly and no degeneration.
I have tried muscle relaxers and pain pills. I still take a pain pill every now and then but never more than one a day for fear of addiction. I have seen a chiropractor and massage therapist that have provided modest short term relief. I try not to let it stop me. We have a two week Central America trip coming up and plans for a ton of hiking and scuba diving. I'm 36 and do worry what old age has in store with me though.
Comment: I had a lumbar fracture after a freak boating accident a few years ago. They did a Vertebroplasty (sorry about the spelling) which means they put a medical grade "cement" around the vertebrae. I have had constant back pain ever since.
They have done x-rays and MRI's but say everything is spaced well and there is no degeneration. I have tried muscle relaxers, pain pills (I still take those but never more than once a day when I need them). I have seen a chiropractor and massage therapist that provides modest temporary relief.
I get maybe 4-5 hours of sleep a night. Some nights I sleep 8 hours but I think It's just out of sheer exhaustion. Usually after that eight hours I am in severe pain. I sit on the side of the bed trembling and weak in my legs and have severe nausea because of the pain. Life is sometimes difficult but I don't let it stop me. We are planning a two week Central America trip this upcoming winter and have plans for tons of hiking and scuba diving. I'm fairly young (mid thirties) but I worry what old age has in store for me.
Comment: You should try Yoga--it has helped me remarkably. Search "back to health" on any search engine for a great DVD!
Comment: Most poeople -- especially medical doctors - don't understand the mind/body connection when dealing with back pain. I didn't either, until i suffered from intense shoulder and neck pain and no doctors could diagnose the problem accurately. I went to the emeergency room, saw specialists, had injections, strong pain meds, and physical therapy. It was all a joke. Then i picked up the book Healing Back Pain, by Dr. John Sarno, and the realization that my pain was stress-induced and could also be cured by my mind was invigorating. Immediately my body healed on its own because of that realization, and now I can control my symptoms whenever i start to feel the twinges in my shoulder muscles.
Comment: I've had low back pain for over 25-yrs, I'm currently 45 yo. I have multiple herniated discs and irregular spinal curve which is basically flat no curve. When I was in my early 20's a kaiser Doc suggested lower back surgery, during the preOp consultation i elected not to have the surgery, and do not regret doing so. Since I've tried martial arts which made my back worse, and basic exercise and stretching had some improvement. it wasn't until I started physical therapy to strengthen my core improve flexability that I experiences consistant pain relief and better mobility. But the best I've found is Hot Yoga coupled with ongoing core exercise routine. The yoga is by far the best medicine and a must for pain relief, overall stregthening, and flexability. Yoga works the whole body and the secondary muscles groups. Medicine and surgery seem to cause more problems than they alleviate.
Comment: I've had low back pain for over 25-yrs, I'm currently 45 yo. I have multiple herniated discs and irregular spinal curve which is basically flat no curve. When I was in my early 20's a kaiser Doc suggested lower back surgery, during the preOp consultation i elected not to have the surgery, and do not regret doing so. Since I've tried martial arts which made my back worse, and basic exercise and stretching had some improvement. it wasn't until I started physical therapy to strengthen my core improve flexability that I experiences consistant pain relief and better mobility. But the best I've found is Hot Yoga coupled with ongoing core exercise routine. The yoga is by far the best medicine and a must for pain relief, overall stregthening, and flexability. Yoga works the whole body and the secondary muscles groups. Medicine and surgery seem to cause more problems than they alleviate.
Comment: I have used chiropractic for over 20 years for neck and then low back pain. The pain got worse 3 years ago and my primary care MD referred me to a pain management clinic. I spent 2 years doing acupuncture, trigger point injections, physical therapy (along w/chiropractic), and finally disk injections. After 2 years of trying everything else, I was referred to a surgeon. He referred me to a pain psychologist to determine my need and readiness for surgery. After 6 months I did have a lumbar fusion w/implants due to degenerative disc disease and spinal stenosis. This was done by my surgeon who felt that I had exhausted my options and was starting to fall. I also had a fusion in my neck. I don't regret it. It did help and yes I still had to do exercise, stabilize my core, and watch my diet. I felt my medical team worked well together and that I wasn't lining anyone's pockets. I can't imagine what my life would be like if I had not had the surgery. I think we need to remember that we shouldn't stereotype individuals by categorizing them. Each patient is different and should be treated as such. Articles such as these are confusing to those looking for real answers. I think you have done your readers a real disservice by publishing such an off the cuff opinion. Could be my meds, but I don't recall there being any numbers of patients in pain in the studies mentioned. That leads one to question the statistical significance of the "research" presented, nor were there mentions of other modalities of treatment being used to justify the conclusion. Food for thought.
Comment: I used to have terrible back pains. Through a combination of acupuncture and Yoga practice, I'm now pain free. Surgery is rarely the answer for back ppains. I highly recommend that people check out alternative treatment such as acupuncture, as well as Yoga and relaxation techniques.
Comment: All the commentary by chiropractors is very intertesting, particularly when one realizes the preponderance of evidence from well designed clinical trials indicating value in the limited use of spinal manipulation has been done by physical therapists. This must, however, be taken in the context that manipulation is not appropriate for every presenting patient.
The reality is that back pain is, indeed, a multifactorial, complex problem. There is no magic bullet. The article and research has numerous flaws which are eloquently stated by Dr. Fessler. As is typically the case, the popular press fails to adequately assess research and makes dramatic, sweeping statements.
Comment: Most back pain is caused by the psoas muscle. Unfortunately the medical ignores this possibility.
The psoas (pronounced "so - az") primarily flexes the hip and the spinal column. At about 16 inches long on the average, it is one of the largest and thickest muscles of the body (in animals it's known as the tenderloin). This powerful muscle runs down the lower mid spine beginning at the 12th thoracic vertebrae connecting to all the vertebral bodies, discs and transverse processes of all the lumbar vertebrae down across the pelvis to attach on the inside of the top of the leg at the lesser trochanter.
It is the pressure of tight psoas muscles that squeezes the vertebrae and disks. When the muscle becomes contracted due to injuries, poor posture, prolonged sitting, or stress, it can alter the biomechanics of the pelvis and the lumbar, thoracic and even cervical vertebrae.
The psoas can torque your spine to the right or left, pull it forward and twist the pelvis into various distortions. Frequently one psoas will shorten and pull the spine and/or pelvis to our dominant side. The distortions of the spine and pelvis can also show up as a short or long leg. This all results in scoliosis, kyphosis, lordosis, trigger points, and spasms in back muscles trying to resist the pulling of the psoas.
It can also pull the spine downward, compressing the facet joints and the intervertebral discs of the lumbar spine. The pressure can cause the discs to degenerate, becoming thinner and less flexible. This degeneration makes the discs more susceptible to bulging or tearing, especially with twisting and bending movements.
Comment: What about patient responsibilty and follow through with conservative care to prevent surgery and following through with aftercare to increase positive benefits of surgery. It is important to take care of your own body, everybody wants a quick fix but its your responsibility to lose weight if you are overweight, get in shape, learn and use proper body mechanics - I realize this won't cure all back pain it would signigicantly reduce the occurences and increase the success of conservation treaments and post op success
Comment: What about the responsibility of the patient pre and post surgery and in the prevention of surgery - lose weight, get fit, strengthen your core, take care of your own body. Everybody wants the quick fix but if you spend the time learning proper body mechanics, strengthening weak muscles and lengthening tight muscles a majority of back pain will resolve.
Comment: Sadly, this article is terribly symbolic of the type of dismissive attitude the medical profession harbors for chiropractic. With years of patient testimony and ever increasing scientific data, the belligerant exclusion of chiropractic care as the most consistent and effective course of care is so blatently obvious that it makes this article and Dr. Deyo laffable. Maybe if these sort of MD's weren't so focused on power and prestige but the desire to help their patients, they would research the benefits of chiropractic and make the appropriate referral or suggestion.
Comment: 2 and a half years ago, I suffered a major hernia in the L5 vertebrae of my lumbar spine. The pain was beyond belief, far worse than child birth. At the emergency room they did an MRI and the surgeon wanted to operate. He told me that if I didn't get the operation I risked permanent paralysis. Despite the pain, I refused the operation and went to my Chiropractor. Thank God I did. I was very quickly well again and have not had any problems since. But I have learned that there were very serious risks attached to the surgery that could have actually left me in a wheelchair.
Comment: Don't go to a barber unless you don't want a haircut.
Comment: Shouldn't we all cast a jaundiced eye on the opinions of a "spine surgeon" in such matters? I'm sorry, NWdoc1, but my experience has been that I never (and I mean never) met a surgeon who did NOT recommend surgery when it was an option for treatment. After a while, one can't help but see self-interest shape professional opinions of doctors. Doesn't that make those opinions "at best, uninterpretable and at worst, misleading?"
Comment: This is in response to Dr. Fessler. I have all the respect in the world for the medical profession and all the miracles that happen each and everyday with the practice of medicine. However, I take exception to the HOGWASH that you have written here. It's just like the medical profession to put some kind of spin on the fact that pharmacological and surgical management for most spinal related problems simply is NOT EFFECTIVE. It would be nice, one of these days, for people like you, a well respected Neurosurgeon I'm sure, to wake up and start researching how and why CHIROPRACTIC CARE IS SO EFFECTIVE WITH THESE TYPES OF PROBLEMS. You can comment on how the Newsweek study was performed and what kind of parameters surround it, but the bottom line is that your profession and the surrounding medical community has to acknowledge the efficacy and validity of Spinal Manipulation performed by a Chiropractor (AND A CHIROPRACTOR ONLY, NOT OSTEOPATHS OR PHYSCIAL THERAPISTS WHO THINK THEY CAN PERFORM JOINT MANIPULATION) who has virtually perfected the art of a short lever spinal adjustment. There are alternatives and I can't tell you how many spinal surgery patients have come into my office and seen relief in only a few treatments and forever regret not giving CONSERVATIVE CHIROPRACTIC CARE A SHOT. Please wake up and tell the rest of your profession to start referring to the DOCTORS who truly know what to do with musculoskeletal disorders. What do you possibly have to lose?!?!
Respectfully
Backdoc-
Comment: You can also include that the cost of medical procedures have ramped up considerably due to the increased costs associated with Managed Care, the heretofore bastion of cost-containment. Add the inflationary costs and you could probably bet that the provider of the service is not the one driving the trend.
Comment:
As a spine surgeon, I read Ms. Springen???s article with great concern. Debate of this nature deserves more than the seven paragraphs Newsweek has provided. The manuscript she references concludes that patient outcomes have not improved during the period of 1997 to 2005 despite increased medical expenditures for spine care. The methodology and statistical analysis of the data is so problematic as to make it, at best, uninterpretable, and at worst, misleading. There are numerous methodological problems with the data presented in this manuscript.
1) The Medical Expenditure Panel Survey (MEPS) is not a valid tool to assess a patient???s condition, their treatment, and certainly not their outcome. It was not designed for this use, and has not been subjected to the routine validity testing that is required of assessment tools for scientific publication. The nature of the data collected, i.e. self-report, is generally accepted as only a weak source of accurate data.
2) The ICD-9 codes to which the MEPS data are correlated are an entirely different set of patients. In other words, the individuals reporting the economic data in the MEPS survey are DIFFERENT individuals than those reporting the health outcomes data. How can conclusions on ???outcome??? be made on artificial correlations created from two unrelated populations of patients? An appropriate analogy might be to suggest that the crop of oranges was larger over this period of time because apple growers spent more time polishing their apples before sending them to market! Clearly there is no logical connection between these events.
3) A full 53 percent of the patients in the ICD-9 group were ???unspecified disorders of the back???. This makes it impossible to draw meaningful conclusions about back and neck problems because the population of patients was so poorly defined.
4) The difference in expenditure increase between the study groups (spine vs non-spine problems) over the years of the study was not statistically significant (p = .07). Nonetheless the authors ignore this and make broad sweeping conclusions regarding the higher expense of caring for spine problems.
5) The authors admit that when co-morbidity (other unrelated illnesses) was included as co-variate in the analysis, it ???weakened the diverging trend between the respondents???. (In other words, the patients with spine problems tended to be sicker patients in general, and therefore, more expensive to care for. p < .001) But the authors chose to not include that data in the analysis they reported and from which they made conclusions.
In summary, the conclusions of this manuscript are neither rational nor supported by the data reported.
Sincerely,
Richard G. Fessler, M.D., PhD.
Professor of Neurosurgery
Feinberg School of Medicine
Northwestern University
Comment: Dr, Your correct. This article has manipulated statitics to get a headline. Unfortunately, Sensationalism is at work here. Yes there are problems with back care in this country, however getting the word out should not include inflated numbers, ideas, ect inorder to get a headline. I am a collgee professor (who has taught Stats) who has had two back surgeries--after seeing chiropractors and other alternative treatments. This article should be removed or corrected. I have lost faith in this news source and will no longer recommend to my students as a reference.
Comment: Prolotherapy was a 95% cure for my 10 years of chronic back pain. Most doctors have never heard of it, or scoff at the way the did chiropractic 20 years ago. Orthopaedics don't want it main stream because it would cut down on all their surgeries. C Everett Coop endoresed it, yet no one has ever heard of it.
Its tiem to expose why this treatment is available and not more well known.
Comment: Chiropractic care has been shunned by the medical community and the insurance companies, yet it is less expensive and more effective than any other treatment. In a society that is constantly pushing new prescriptions via television commercials and magazine ads, we need to look for safer alternatives that do not have the side effects that these meds can cause. It is time for this very necessary group of professionals to be given the respect that they deserve. They are DOCTORS that have gone through many years of education and exams to practice their specialty. Chiropractic care should be considered prior to these costly surgeries and injections that may cause severe complications.
Comment: No, they are not doctors.
Comment: Prolotherapy is the answer to a lot of back pain problems. Most Doctors have never heard of it or scoff at it, like Chiroractic 20 years ago. Prolotherapy cured my chronic pain by 95%. Even C Everett Koop endorsed it, Yet people have never heard of it.
Comment: Where I work as a chiropractor the progression of intervention is from the most conservative to the least conservative. It includes; NSAIDS, Chiropractic, Physical Therapy, Pain Management (which could include acupuncture) and then finally low invasive intervention and surgery. This approach has the advantages of cost containment and prevention of idiopathic complications that arise out of treatment which becomes more serious with less conservative interventions
Comment: I have had back pain and saw a Chriopractor with no avail. It didn't stop the pain which would occur when I would stand for long periods of time and cost me over $1600 in several months. When pain would start I would have to sit immediately. I eventually went to another chiropractor who offered spinal decompression therapy and back strengthening on a MEDX machine. I did Physical Therapy exercises to strengthen my core, back and had 20 sessions in a matter of 5 or 6 weeks. they cost me $50 a session and then I did the back strengthening on the MEDX about 2 times a weeks for 10 weeks - with continued back exercises done daily to keep the core and back strong. It cost me about $1500 and it has been 1 year since I completed it and I am pain free. I have 3 bulging disks in my low back and one in my neck but have no issues now. Prior to doing this a neurosurgeon was ready to operate on my neck -anterior spincal decompression with fusion - to which I said no. This was for tingling in my right arm which also went away. I would suggest spinal decompression to anyone who is having back issues, sciatica, etc and qualifies for the treatment. At the time I did it insurance didn't cover the cost but I hear it is covered now. You have to do it all though - the decompression and strenghening. If you don't complete the entire program you won't reap the benefits.
LP - Gilber, AZ
Comment: Just want to clarify that I am not saying Chiropractic isn't good. It has worked for me in the past but not for the problem I was having at the time. Adjustments weren't working for me and I was going 4 or 5 times a week. The decompression and strenghening worked. I definitely will seek a Chiropractor again for back pain if the need arises.
Comment: I agree with PUTYYCHIRO. I had a terrible series of back spasm and chiropratic care cleared it up in less then a week! MY pain comes and goes from an auto -accident. My regular MD loves to hand me narcotics. I have a drawer full of them. He is otherwise an excellent Doctor. I just think in MD based medical schools they teach to proscribe drugs and surgery. I highly suggest trying non-invasive therapy first.
Comment: IT IS AMAZING THAT NO ONE MENTIONS CHIROPRACTIC CARE FOR BACK PAIN. THEY SEE MORE PATIENTS FOR BACK PAIN THAN ANYONE ELSE. WE SPEND BILLIONS OF DOLLARS ON SURGERY AND MEDS THAT APPEAR TO BE USELESS. BUT NO ONE MENTIONS A 35.00 VISIT TO A CHIROPRACTOR. TIME AND TIME AGAIN IT HAS PROVEN TO BE EFFECTIVE. YET IT CONTINUES TO BE IGNORED. SOMETIMES WE CAN'T SEE THE FORREST FOR THE TREES.
EP
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