A study published in February 2008 revealed that Americans are spending record amounts on treatments for back pain. While this boom is great news for the pharmaceutical and medical industries, it also suggests that most of these expensive treatments are a complete waste of money…
A couple of years ago a family friend came to me for help with low back pain. A physical examination and an x-ray highlighted the cause of his problem and I prescribed a routine program of chiropractic care and exercises. Over the previous 18 years, I had seen thousands of patients like Neil gain effective control of their back pain without drugs or surgery.
About a month into his program, Neil’s rehabilitation was interrupted by a six week trip over to see his relatives in England. His back pain had subsided considerably initially but there was still some weaknesses that needed to be strengthened before he was out of danger. I warned Neil that he may experience a temporary flare up and to be particularly vigilant with his exercises while he was away.
When Neil returned home to Australia, I wasn’t surprised to learn that his back pain had flared from sleeping on some shoddy mattresses while overseas. I thought that it would take probably two weeks of treatment to get him back out of pain. However Neil wasn’t prepared to wait.
“It looks like your treatment isn’t working,” he said.
“But you haven’t had any treatment for the past six weeks,” I reiterated.
“I’ve been to see a doctor, and I have had CAT scans and an MRI. He says that I have a herniated disk. He has booked me in for surgery next week. I am taking the next four weeks off in sick leave.”
I couldn’t believe it. Neil had a back condition that was easily fixable with chiropractic care and some exercises yet at the age of 36 he chose the surgical magic bullet approach. But according to a 2006 study published in JAMA (Journal of the American Medical Association), 250 herniated disk patients who did not have surgery fared just as well after a two-year period as the 250 who went under the knife.
The price tag for back surgery is hefty. As Newsweek reported in February 2008, about 300,000 Americans have surgery for herniated disks every year—with hospital, anaesthesia and surgery costs running around $10,000 per operation. The bill for a spinal fusion procedure is even higher, at about $60,000 per procedure for hospitalisation costs in 2005. (That’s more than double what it was in 2000.) In 2005 Americans spent $85.9 billion looking for relief from back and neck pain through surgery, doctor’s visits, X-rays, MRI scans and medications, up from $52.1 billion in 1997, according to a study in the Feb. 13 issue of the Journal of the American Medical Association (JAMA).
Having an operation to fix a back problem is not only costly in recovery time for the person, it is placing a tremendous financial burden on businesses. The authors pointed out that people with back problems cost 76 percent more on average than people without back problems each year. Back pain has also been shown to reduce daily work productivity by 20%. Businesses are required to make up for the loss of personnel and productivity in addition to the skyrocketing costs for these procedures. This is rapidly forcing up the costs required for companies to provide health plans for their employees.
What makes this worse is that this drug and surgical approach to back pain that drains millions from us each year doesn’t even work…
Dr. Rick Deyo, co-author of the JAMA report declared, “There’s no evidence that people are getting more pain relief.” In fact, despite all these advances in imaging and surgical methods, patient outcomes following surgery were worse in comparison to measured outcomes in 1997. “This suggests to me that we’re over-treating a lot of people, and we’re providing a lot of services that may not be very beneficial.”
So are there any forms of therapy that are more effective and cost effective in treating back pain other than drugs and surgery?
In fact, for the last 18 years there has been ample evidence demonstrating the benefit of safer, more effective and more cost-effective therapies in the treatment of back pain. But why hasn’t this information been shared amongst health care providers and health policy makers alike? Has the medical profession, the self-proclaimed upholder of the scientific method, all of a sudden become blind towards any studies that don’t enhance medical or drug company coffers?
A cynical statement perhaps? But after looking at the research studies and how long it has been known in the scientific community, it is hard to explain the proliferation of unnecessary spinal surgeries without becoming a touch cynical…
As far back as June 1990 The British Medical Journal reported the results of the 10-year independent study conducted by the British Medical Research Council comparing chiropractic care and medical management on the treatment of people with low back pain. Chiropractic care was so significantly more effective that the authors of the study advocated inclusion of chiropractic services into hospitals and into the British National Health System.
In the largest and most thorough trial on low back pain treatments on 741 patients, the researchers found chiropractic care to be significantly more effective than medical management. The effectiveness was found to be even greater and longer lasting when reviewing the patients after 2 and 3 years.
In 1993, the Canadian Government commissioned Professor Pran Manga and researchers from the University of Ottawa to review all scientific studies on the effectiveness of all forms of treatment for low back pain including chiropractic, bed rest, injections, spinal fusion and surgeries, physical therapy and exercise. The results again were startling in favour of chiropractic care, finding it to be the most effective and cost-effective and the safest. They also recommended that chiropractic be included in hospitals and fully integrated into their health care system.
The researchers even suggested that chiropractors should be the first people consulted in the treatment of low back pain. Many individual MD’s are now recognising the effectiveness of chiropractic with 20% of all chiropractic patients being referred by their GP.
But it is interesting to note how, 18 years later, governments and health regulatory bodies have still resisted incorporating any of the researchers recommendations…so much for acting in the public’s best interest.