May 01, 2014

Back Pain Overdiagnosed

Articles by Dr. Erdman are for informational purposes, and are not to be taken as specific medical advice.

A few weeks ago an article by Daniel DeNoon of the Harvard Health Blog ran in our local paper. It was titled, “Back pain overdiagnosed, overtreated.” He quotes Dr. Bruce E Landon, a professor at Harvard Medical School, saying, “Most routine back pain will improve on its own WITH conservative therapy in three months, often shorter than that. Even more importantly, when we do more aggressive things – such as injections, [high tech] imaging, and surgery- the long term outcomes don’t change at all. These things have very little impact on what is going on, and they have the potential to make things worse.”

Wow! What a complete indictment of how most people are treated when they present to their medical doctors for back pain. There is so much new evidence coming in every year that shows conservative care for back pain is the first treatment of choice for the best results.

Medical doctors own research and guidelines tell them, based on scientific evidence, to refer to conservative care providers such as physical therapists and chiropractors prior to sending a person for advanced orthopedic referrals. Have they heeded the science? According to Landon and his colleagues, from 1999 to 2010 referrals to medical specialists rose from 6.8% of visits to 14% of visits. Their referrals to conservative physical therapy remained low at 20%. Their referrals for higher imaging rose from 7.3% to 11.3% of visits. These are the exact opposite course of action evidence based care should be producing.  The guidelines are being ignored.

Medical doctors’ biggest complaint about chiropractors is that we aren't “evidence based.” Not true! We have more evidence every year piling up showing chiropractic specifically, and conservative care generally, are the best course of care for back pain. According to this study of care by the medical establishment, they do not follow evidence based care! I can tell you that in my 20 plus years of practice, I can count on one hand the number of patients who came to me via a referral from their medical doctor. What a shame. Are our professions not to have the best interest of the patient as our main priority? Then why do doctors shun the evidence right before their eyes?

Chiropractic’s own studies show less than 7 to 10% of the population ever goes to a chiropractor. A few more have tried physical therapy, and are referred there more readily. Why? Because a PT generally needs a prescription from the medical doctor to treat that patient, and the doctor still has control over that patient. Chiropractors are primary portal of entry doctors, and do not need a referral to treat, so we somehow pose a threat to their pocketbooks. It is not good for our patients. This feud goes all the way back to the fifties and sixties when the medical associations could still put a chiropractor in jail for “practicing medicine without a license.” 

Are all doctors like this? No, but this study shows they still do not value conservative care which is completely based in science. Some still cling to the “chiropractors are quacks and aren't real doctors.”

I have full knowledge that I am not a medical doctor, nor do I pretend to be one. I don’t need to be the one handing out the drugs; we have enough of that. I take a completely different approach and treat your back pain in a far more conservative way based on science before seeking further invasive care outlets when necessary. If you give me 12 weeks, I’ll be able to tell you if conservative care will be of help to you. Will you be cured? Probably not, but most back pain isn’t cured, it is managed. Using adjustments, therapies and exercises, you can return to daily life and control your back pain, instead of it controlling you.

Do you have back pain? Try chiropractic care from your local doctor, it works a lot of the time. It may just save you from over treatment that could leave you worse off than if you had done nothing. That is what this study shows.