Overtreating Chronic Back Pain Study Title: Overtreating chronic back pain – Time to back off? Author(s): Deyo RA et al. Publication Information: Journal of the American Board of Family Medicine 2009; 22: 62-68. BACKGROUND INFORMATION: Pain conditions account for the bulk of visits to primary care providers, and back pain is the most common of these. The frequency of back pain complaints has spawned a vari- ety of diagnostic tests and treatment interventions aimed at reducing pain levels, limiting disability, and reducing recurrence. Sadly, the use of many of these tools is expanding beyond their scientifi cally validated indications, driven by doctor concern or confusion, patient advocacy, and aggressive media and marketing campaigns for various products and interventions. Dr. Shawn Thistle is the founder and president of Research Review Service Inc., an online, subscription- based service designed to help busy practitioners to integrate current, relevant scientific evidence into their practice. Shawn graduated from CMCC and holds an Hon- ours Degree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medi- cal Acupuncture from McMaster University, and is a Certified Active Release Techniques (ART®) Pro- vider. For more information about the Research Review Service, visit www.researchreviewservice.com. The authors state eloquently that: “Innovation has outpaced clinical science, leaving uncertainty about the effi cacy and safety of many common treatments.” This study discussed the impact of common interventions used in the medical man- agement of chronic back pain. Manual interventions, including manipulation, were not included in this study. However, prudent clinicians should be conversant in the current impact of other common medical decisions relating to imaging, medication, and referral for injections and surgery for back pain complaints. PERTINENT RESULTS: Imaging for Low Back Pain: the use of lumbar MRI increased 307 per cent in a recent 12 year period (American Medicare data) surgery rates are highest geographically where imaging rates are highest – patients who receive early imaging (CT/MRI) have higher rates of surgery than those who receive only plain fi lm x-rays, yet the clinical outcomes are no better when judged against clinical guidelines (that all recommend against routine use of imaging for LBP), an estimated 33-66 per cent of spinal CT and MRI studies may be inappropriate • • • • • • • • • 14 • CANADIAN CHIROPRACTOR | MAY 2009 it is well known now that imaging fi ndings correlate poorly with clinical symptoms and also patient outcomes Opioid Analgesics: prescriptions increased 109 per cent between 1997-2004, resulting in a 423 per cent increase in inflation-adjusted expenditures by 2002, there were more deaths attributable to opioid medication use than cocaine and heroin combined more than half of all opioid prescriptions are for back pain Cochrane Collaboration review indicates that there are few high quality trials as- sessing their effi cacy, while potential side effects are well documented (hyperalgesia, hypogonadism etc.) the long-term benefi t of these medications for back complaints is questionable Continued on page 28 www.canadianchiropractor.ca Shawn Thistle, BKin (Hons), DC, CSCS
Chiropractic + Naturopathic Doctor May 2009: Page 14
