Overtreating Chronic Back Pain Continued from page 14 Spinal Injections: have limited effi cacy in general, and do not reduce the incidence of sub- sequent back surgery (according to systematic reviews) a recent 7 year interval demon- strated a 271 per cent increase in epidural injections, a 231 per cent increase in facet joint injec- • • • tions, and a 629 per cent increase in associated fees (of note is that the Medicare patient population increased by only 12 per cent in this time) for patients with axial back pain without sciatica there is no evidence of any benefi t from injections Spinal Surgery: there was a 220 per cent increase in spinal fusion surgery in the US be- tween 1990-2001 • • • surgery has a well-established role in treating fractures and deformity, but limited evidence for treating degen- erative discs with back pain alone (no sciatica) from 1995-2000 Medicare data: there was a 40 per cent increase in spine surgery, 70 per cent in- crease in spinal fusions, and a 100 per cent increase in the use of im- plants (it is interesting to note that reoperation rates also increased during this time) CONCLUSIONS AND PRACTICAL APPLICATION: The overall understanding of back pain mechanisms remains rudimen- tary. The use of imaging, injections, and surgery has increased sharply in the management of common back pain complaints, with little corresponding increase in treatment efficacy and suc- cess. Most patients continue to expe- rience some degree of pain and dys- function. American data from 2005 indicates that back pain patients are reporting more functional, social and work limitations, as well as dimin- ished mental health compared to 1997 data. Overall, the current management of back pain is not highly successful. Chiropractors and other manual therapists are ideally positioned to play a leading role in a multidisciplinary ap- proach to chronic back pain. We can ex- pertly provide spinal manipulation and adjunctive therapies, exercise and reha- bilitation, and appropriate biopsycho- social support – all of which have shown promise in the literature. This study did not directly address manual medicine interventions for back pain, but did illustrate that com- mon, often more invasive treatments and interventions do not improve out- comes to a degree that justifies their increasing use. STUDY METHODS: This study was a qualitative and narra- tive review of the literature and Medi- care data on interventions for back pain. Studies on manual therapy inter- ventions were not included. For more information on the literature pertaining to chiropractic interventions for back pain and other conditions, visit www. researchreviewservice.com.• 28 • CANADIAN CHIROPRACTOR | MAY 2009 www.canadianchiropractor.ca
Chiropractic + Naturopathic Doctor May 2009: Page 28
