Pain in the Back and Pocketbook! What to do?

The Economist reports “Backs to the future” January 18th, 2020 pp17-19

“The medicalization of back pain sees huge amounts spent on treatments of little if any benefit to patients. There are better ways forward?”

More that 85% of back pain is not definitively linked to mechanical damage caused by accident, tumor, infection, arthritis or pressure on the nerve. Having said that, patients, physicians, specialized surgeons are nonetheless compelled to carryout diagnostic procedures and treatments in hopes of relieving pain and disability. Policy makers, employers, insurance companies as well want to reduce this leading disability which rings-up Americans for an economic impact of $625B plus $85B spent on medical intervention.

But are surgeries and other procedure-based treatments any better than treatments like physiotherapy etc.? Surgeons think so, it is consistent with their years of training and experience. Do Surgeons remember successes better or are they satisifed with a low rate of success beyond a small incision that heals well without complication? Cigna claims, from a 2011 follow-up study, “two years after [surgery] 87% of customers were still in pain severe enough for medication or some other treatment, 15% had more surgery”.

As healthcare is an increasingly large expenditure, policy makers, insurance companies and others are hoping to reduce spending by “Choosing Wisely” treatments proved effective. Interestingly, scans (MRI) often show similar back abnormalities in pain-free normal patients and in back patients with pain. In light of all this and research findings, some pain specialists believe the defect causing pain is often not mechanical but rather neurological involving faulty management nerve inpulses and the brain’s signaling response “that keeps it switched on [pain]”.

So what to do? The idea of “Choosing Wisely” is largely without effective advocates but in 2017 [The American College of Physicians] “stopped recommending medication as the initial response to back pain, suggesting instead acupuncture, yoga, tai-chi, and psychological therapies aimed at reducing stress….“

Read the article for more.

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