An Open Letter to our Medical friends.

462

In the past year, many trusted medical establishments including the FDA (1), CDC (2), Joint Commission (3,4), JAMA (5), and The American College of Physicians/ Annals of Internal Medicine (6) have encouraged medical providers to prescribe spinal manipulation as a first line treatment for acute, subacute, and chronic low back pain.

Most recently, The Lancet echoed that endorsement, and provided a unique perspective:

The reduced emphasis on pharmacological care recommends nonpharmacological care as the first treatment option and reserves pharmacological care for patients for whom nonpharmacological care has not worked. These guidelines endorse the use of exercise and a range of other non- pharmacological therapies, including massage, spinal manipulation, and acupuncture.

Gaps between evidence and practice exist, with limited use of recommended first- line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences. The advances with the greatest potential are arguably those that align practice with the evidence. (7)

Unfortunately, personal experience skews our perception of each other’s merit, i.e., we primarily see each other’s failures since the successes don’t need to seek additional care. Regardless of our professional degree, we all have failed cases mixed into our many clinical successes. We must not lose sight of the evidence supporting each other’s overwhelming proven value for a given diagnosis. If we judge each other by our successes rather than our failures, we will work toward an integrated model where the patient wins. Together, we will help more patients than either working alone.

We are honored for the opportunity to co-manage your patients.

 

References
1. FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain. May 2017. Accessed on May 12, 2017
2. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain- United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49.
3. The Official Newsletter of The Joint Commission. Joint Commission Enhances Pain Assessment and Management Requirements for Accredited Hospitals. July 2017 Volume 37 Number 7. Ahead of print in
2018 Comprehensive Accreditation Manual for Hospitals.
4. Joint Commission Online. Revision to Pain Management Standards. http://www.jointcommission.org/assets/1/23/jconline_november_12_14.pdf
5. Paige NM, Miake-Lye IM, Booth MS, et al. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain; Systematic Review and Meta-analysis. JAMA. 2017;317(14):1451-1460.
6. Qaseem A, et al. for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530.
7. Foster, Nadine EBuchbinder, Rachelle et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, Published Online March 21, 2018 http://dx.doi.org/10.1016/ S0140-6736(18)30489-6

Massage and sleep.

Regular massage sessions have been found to decrease depression and anxiety levels and improve sleep quality, perhaps because they trigger the release of serotonin, a neurotransmitter that can help you feel calm. The technique has been found to benefit children and adolescents, as well

Piriformis syndrome

Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot (similar to sciatic pain).

Trigger points and back pain.

Low back pain can be a complicated condition. Quite often in my practice I will see multiple muscles involved in causing lower back pain in my clients. For example trigger points in the hip flexors like the psoas muscle, along with trigger points in the back muscles themselves, such as the quadratus lumborum or the multifidus, can all be active and refer pain into the low back. When trigger points are active in multiple muscles at once this is called a chronic myofascial pain syndrome.

Trigger points in the quadratus lumborum muscle

The quadratus lumborum muscle or QL. Is a muscle in the lower back. It helps to flex the spine to the side and stabilize the lowback and hip. Trigger points in this muscle are one of the most common causes of low back pain and stiffness. This is probably the most frequent muscle I work on in my practice when treating clients with low back and hip pain.