we treat back pain wrongly

In December 2019, I attended a workshop at the National Academy of Sciences, Non-pharmacological approach for pain management. At the end of the meeting, as expected, the panelists concluded that more research was needed. But surprisingly, some scientists have called for urgent action on how to treat back pain. They asked clinicians to implement the evidence they already have in their clinical practice. for policy makers to enact payment reforms that support such implementation; You have to commit to making a difference.

Where did this reaction come from? It stems from the fact that low back pain is overly medicalized, exacerbating a very bad problem, and the need for recalibrated incentives to encourage clinicians to follow current evidence and treatment recommendations. I’m here.

nothing to do with health bigger obstacle again higher cost More than back pain, and commonly used medical approaches often do more harm than good.imaging is rarely needed Developing an evidence-based treatment plan can not only exacerbate devastating pain, but also lead to accidental findings “rabbit holes.”Prescription drugs may help some patients in certain circumstances, but overall risk Often outweighs the benefits. According to the CDC, Over 260,000 Deaths in the United States from 1999 to 2020 were associated with prescription opioids.Non-steroidal anti-inflammatory drugs (NSAIDs) can cause intestinal bleedingespecially in the elderly, is associated with a higher incidence myocardial infarction. surgery and corticosteroids It may lead to short-term pain relief for some patients, but results are often not durable or better than less invasive options.

Most importantly, many of these medical diagnoses and treatments approach — Initial imaging, surgical examination, corticosteroid injections, prescription opioids, NSAIDs –In fact, more patients may transition from acute to chronic pain.

The problem is not lack of evidence.of CDC, veterans health careand the American Medical Association (ACP) has released comprehensive guidelines backed by highly convergent supporting evidence for the management of low back pain. Recommended first-line treatments include exercise, education, self-care options, and non-pharmacological approaches such as spinal manipulation, acupuncture, and massage. Specifically, his ACP guidelines ask patients and clinicians to consider using nonpharmacologic treatment approaches for back pain before trying prescription medications.

The problem is that we don’t follow the evidence. There are multiple barriers to widespread implementation of known best practices. Healthcare systems are slow to change, especially when such changes may not be in the best financial interest.Orthopedic surgeons consistently rank among the top sources of income for the health system, with an average of $3.3 million annuallyFamily doctors may not have learned about non-pharmacological treatments in medical school and are often working with frightened patients. Patients understandably want a clear explanation of their pain and prompt treatments such as pills, injections, or even surgery.

Additionally, there is a significant gap between existing payment policies and best practices for back pain. Payers offer strong reimbursement for prescription drugs, corticosteroid injections, and surgery.In contrast, private and public insurers often serious restrictions For coverage of guideline-compliant treatments such as chiropractic care, acupuncture and massage. Such policies offer little incentive to change clinicians or the healthcare system.

If you want real change, you need a whole team.”devoted citizen.”

Health systems can deploy providers whose clinical practices are better aligned with the guideline’s recommendations. Payers can change their policies to align their payments with the guidelines’ recommendations. Some health systems and insurance companies are moving in the right direction. The health system at Duke University spine health program Provides coordinated, guideline-compliant care for patients with back pain.united health care do not charge a common service fee For members visiting a chiropractor or physical therapist for the first time for back pain.Traditional Medicare recently launched a limited offer Acupuncture coverage.

We also need to promote clinician education about the evidence for proper diagnosis and treatment of low back pain. Familiarize yourself with ACP guidelines and read good guidelines. lancet series about back pain. Patients can be told that MRI can worsen outcomes, that surgery is rarely needed, and that ACP recommends the use of nonpharmacologic treatments before prescription drugs. increase. Most importantly, in the absence of red flags, these tests or treatment orders can be withheld unless clearly necessary after the patient has engaged in a full course of evidence-based non-pharmacological treatment.

We cannot ignore the fact that part of this problem is systemic. The U.S. healthcare system is built on the belief that patients benefit from treatment. However, this is often not the case with low back pain. By ignoring the evidence and continuing to tolerate policies that over-medicalize this condition and encourage the wrong treatment, we are doing real harm to those we trust to care for them. .

Christine Goertz, DC, PhD, He is Professor of Musculoskeletal Studies at Duke Clinical Research Institute in Durham, NC, Vice Chair for Spinal Health Innovation Implementation at Duke University’s Department of Orthopedic Surgery, and a principal faculty member of the Duke Margolis Center for Health Policy.