Chiropractic + Naturopathic Doctor • May 2018 • Roundup

Millions of people across the world are getting the wrong care for low back pain, with many treatments causing harm and even early death, a global review has confirmed.

The review was conducted by over 30 leading experts in countries across the world, including two chiropractors: World Federation of Chiropractic (WFC) Research Council member Professor Jan Hartvigsen, and Dr. Alice Kongsted. The study, published in The Lancet, highlights that many health systems are wasting valuable health care resources by continuing to fund tests and treatments known to be ineffective and even harmful.

The series of three papers on low back pain notes that standardized approaches to managing low back pain are commonly misconceived and outdated, and best practice is frequently ignored.

Worse still, the series adds, the interests of companies and health care professionals, who stand to gain financially from promoting unproven medicines or unnecessary scans and surgery, are often given priority over those of patients.

WFC President, Dr. Espen Johannessen emphasizes that non-drug, non-surgical approaches must be the standard of care in the management of low back pain.

“It is not simply about avoiding the use of drugs and surgery, although we can see from this report that they are often not the best approach for most people. It is also about ensuring that patients are not exposed to unnecessary tests and that chiropractors and others take note of evidence-based guidelines,” he says.

• Health care funders should stop paying for ineffective and harmful tests and treatments, and commission research on those that are unproven

• New tests and treatments should not be marketed before they have been adequately tested for safety, efficacy and cost-effectiveness

• Standardized approaches to managing low back pain should be redesigned and payment systems changed to ensure delivery of the right care to patients

• Health and social services should work with employers to provide support and incentives to stimulate early return to work, and to define work conditions adapted to employee capacity.

Myelofibrosis (MF) is a rare hematological disease. Currently available therapies mainly offer symptom control with limited curative benefits.

A 58-year-old man was referred for chiropractic care in March 2013 with a diagnosis of myelofibrosis. He had progressive abdominal discomfort and accelerated back pain. Acetaminophen and tramadol had been used for his pain treatment with mild improvement. Acupuncture had been tried but did not give significant and lasting effect in his back pain.

The patient sought chiropractic treatment for pain relief in 2013. He characterized his neck pain as being dull (6 to 8/10 on pain scale) and radiated into his left upper arm, and his back pain as widespread. Physical examination yielded painful cervical paraspinal and lumber musculature with hypertonicity and restricted range of motion. Chiropractic treatment aimed to reduce hypertonicity, restore the spinal mobility and proprioceptive function, including spinal mobilization and stretching exercises. The initial (three month) results of chiropractic provided three times weekly were notable. The patient reported his pain as 2/10 on pain scale and a significant improvement of fatigue. He had reduced his daily reliance on analgesics and returned to work. The second phase of chiropractic treatment performed twice per week for another three months achieved improved spinal mobility, reduced paraspinal muscles tenderness, and stopping of pain relievers. Subsequently the patient had received maintenance therapy to enjoy a feeling of wellbeing in the following 15 months.

During the period of fall 2015 to March 2016, he was brought to the clinic in a wheelchair, appeared anemic, jaundiced and debilitated. He continued chiropractic therapy once every two weeks to retain mobility and independence. In April 2016, the patient passed away due to septic complications.

The role of spinal manipulation in the relief of pain is becoming clearer as time passes. Theories pertaining to the chiropractic adjustment include the reduction of nerve root encroachments, release of entrapped intra-articular synovial fold, suppression of inflammatory mediators, and the release of beta-endorphin.

Psychoneurochemically, the net effect of all the above is to reduce pain generation or its aggravation caused by anxiety. These conjectures are supported in both theory and fact. Chiropractic manipulation would appear to be one of the leading alternatives to relieve painful symptoms following surgery, chemotherapy or radiation.

This report describes a case where pain control was satisfactory with chiropractic care in a patient with myelofibrosis. In rare diseases like myelofibrosis, the main limitation of our report was the lack of the related references for comparative analysis. Further studies regarding the efficacy of chiropractic therapy in controlling various cancer pains are needed to guide decision-making.

– Eric Chun-Pu Chu, Raymond S.M. Wong, published in New Horizons in Clinical Case Reports

TORONTO — Hundreds of health care providers in Ontario are billing insurance companies for an improbable number of daily hours spent treating car crash victims, recent insider data suggest.

However, no one appears to be leading a charge against the potentially fraudulent overbilling worth millions of dollars a year, leaving it to drivers to pick up the tab in the form of higher insurance premiums.

“Right now, it’s a shared problem between the industry, individual insurers, the colleges that oversee these different types of practitioners...and then the government,” says Ben Kosic, CEO of the Canatics insurance consortium. “It isn’t clear that any one party holds either the keys to the solution or the responsibility.”

The closely held data obtained by The Canadian Press suggest some chiropractors, physiotherapists, massage therapists or other providers are billing for an excessive number of hours – frequently averaging more than 24 hours per day.

The so-called “impossible day” data are drawn from the mandatory clearing system known as Health Claims for Auto Insurance or HCAI. Health care providers are required to submit claims forms electronically through HCAI to bill auto insurance companies directly for treatment of patients and clients.

Canadian Insurance Crime Services (Canatics), has been quietly using massaged HCAI data in an effort to identify individual high billers throughout the past year.

Canatics, which comprises nine insurance companies owning about 75 per cent of the auto-insurance market in Ontario, identified at least 700 “suspicious” billers through the new process.

The Financial Services Commission of Ontario, which regulates the insurance industry and has the power to fine or take other action against scoff-laws, has reported an “unacceptable” 70 per cent of providers were in violation of various rules in 2016- 2017 – an improvement from the 85 per cent non-compliance reported a year earlier. Violations included submitting unsigned claims forms or failing to verify patient identities. Prosecutions, however, are rare.

A spokeswoman said the commission will conduct a “thorough” investigation where it has evidence of non-compliance, and encourages the industry and those providing health services to report suspected fraud.

The Ontario government, which did not respond to questions, is in the process of setting up a Serious Fraud Office although it remains to be seen how much of its attention will be devoted to auto insurance. The Insurance Bureau of Canada, which speaks for most of the industry, said the office should help – once it’s up and running.

Colleges, which regulate the various health care professions, say members must adhere to rules and guidelines around billing.

“If you are aware of any inappropriate behaviour, I encourage you to bring it to the attention of the college,” says Jo-Ann Willson, registrar of the College of Chiropractors of Ontario. “If there is HCAI information about chiropractors, please feel free to forward that to us for review.”