Back Surgery: Too Many, Too Costly, Too Ineffective
This week in particular, we have had more new patients that have come to our office after spinal surgery and have stated,"I have had spinal surgery, my problem is worse than ever, can you help me?" The patient, often battling low back pain for years, being very frustrated are at their wits end.
Undoubtedly the annual cost of health care, nearly $2.4 trillion, could be reduced substantially if unnecessary treatments were decreased. Of the Top 10 list of diseases in America, "back pain" stands at number eight, which according to Forbes.com costs over $40 billion annually for treatment costs alone;18 other estimates that include disability, work loss, and total indirect costs range between $100 and $200 billion per year.19 Back pain sent over 3 million people to emergency rooms in 2008 at a cost of $9.5 billion, making it the ninth most expensive condition treated in U.S. hospitals.20
"Work-related musculoskeletal disorders remain the leading cause of workplace injury and illness in this country," according to OSHA head David Michaels. Although not the killer that heart disease or cancer is, crippling back pain is expensive, disabling, and often leads later in life to osteoarthritis, which ranks ahead of back pain on the Top 10 list at $48 billion; when combined, these two musculoskeletal conditions rank fourth on the list at $88 billion.
Recently a new wave of data by researchers has revealed the high cost and ineffectiveness of most medical back treatments. Yet these revelations have fallen on deaf ears in the medical profession as the use of opioids, epidural steroid injections, and spine surgeries has radically increased despite these warnings.
Ironically, now the chiropractic profession, long ostracized by the medical profession, has emerged as a fiscal conservative to champion this call for reducing costs in health care. Despite the historic medical prejudice, spinal manipulation has now been shown to be the most clinically and cost-effective method for the epidemic of low back pain, which happens to be the single largest cause of disability today.
According to Pran Manga, PhD, MPhil, health economist, "There is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management."He is not alone in his assessment. Numerous international and American studies have shown that for nonspecific back pain, spinal adjustments was heads above all other treatments. In fact, Anthony Rosner, PhD, testified before the Institute of Medicine: "Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option."
Chiropractic care not only has catapulted to the top of the list for back pain care, chiropractic patients are also extremely positive about their treatments. TRICARE, the health program for military personnel and retirees, has evaluated patients' response to chiropractic care. The enormously high patient satisfaction rates astounded the TRICARE administrators with scores of 94.3 percent in the Army; the Air Force tally was also high with 12 of 19 bases scoring 100 percent; the Navy also reported ratings of 90 percent or higher; and even the TRICARE outpatient satisfaction surveys (TROSS) rated chiropractors at 88.54, which was 10 percent "higher than the overall satisfaction with all providers" (78.31 percent). But despite these glowing satisfaction rates for chiropractic care, TRICARE continues to limit access to chiropractors at only 42 of 131 military treatment facilities due to an intransigent medical bureaucracy within the Department of Defense.
Not only are patients well satisfied with chiropractic care, in fact, the more investigators look into this back pain epidemic, the more the medical management has come under attack and, remarkably, that chiropractic treatment has been found best for the vast majority of nonspecific low back and neck pain.
After nearly a century of warfare against the chiropractic profession, defaming it as an "unscientific cult" that deserved to be "eliminated," research now has shown chiropractic care to be very effective and, ironically, now seriously questions the efficacy of the medical management of back pain - opioid drugs, epidural steroid injections, and spine surgery. Indeed, the claim to be unscientific and dangerous now seems to be on the other (medical) foot.
It must be bitter medicine to swallow for the medical profession to realize that back surgery "has been accused of leaving more tragic human wreckage in its wake than any other operation in history," according to Gordon Waddell, DSc, MD, FRCS. As director of an orthopedic surgical clinic for over 20 years in Glasgow, Scotland, he determined: "Low back pain has been a 20th century health care disaster. Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem."
Richard Deyo, MD, MPH, also mentioned the problems with medical treatments and physician incompetence in diagnosis and treatment of low back treatments: "Calling a [medical] physician a back-pain expert, therefore, is perhaps faint praise - medicine has at best a limited understanding of the condition. In fact, medicine's reliance on outdated ideas may have actually contributed to the problem."
Undoubtedly, another knife in spine surgeons' backs occurred in 1994 when the U.S. Public Health Service's Agency for Health Care Policy & Research (AHCPR) conducted the most thorough investigation into acute low back pain in adults and concluded the following finding in its Patient Guide:
"Even having a lot of back pain does not by itself mean you need surgery. Surgery has been found to be helpful in only 1 in 100 cases of low back problems. In some people, surgery can even cause more problems. This is especially true if your only symptom is back pain. (Emphasis added)
The AHCPR study also concluded that spinal adjustments was the preferred initial professional treatment for acute low back pain. The Patient Guide stated: "This treatment (using the hands to apply force to the back to 'adjust' the spine) can be helpful for some people in the first month of low back symptoms. It should only be done by a professional with experience in adjustments...which are only Chiropractors at this point."
This recommendation was, in effect, an endorsement of chiropractic care, since chiropractors do 94 percent of all spinal adjustments in the U.S. After a century of defamation, it was a sweet vindication for the chiropractic profession finally to be endorsed by the U.S. Public Health Service. Of course, the North American Spine Society, consisting primarily of spine surgeons, took a dim view of this precedent and politicked to have the AHCPR's mission to establish guidelines eliminated with help from Newt Gingrich's Republican Congress. It should be noted that of the 14 guidelines done by AHCPR, the acute low back pain guideline was the only one attacked by the medical profession.
Despite the medical resistance, these warnings are escalating as the call for restraint is growing from a whisper into a roar. Certainly when leading medical professionals from prestigious universities, journals, and the U.S. Public Health Service openly criticize the onslaught and ineffectiveness of spine surgery, this has become an epidemic of legitimate concern for payers and patients alike.
So if you are a person who has seen the benefits of chiropractic care, please spread the word to others that need help!
"Watching Your Back,"...Literally!
Your Health Coach,
Dr. Ross Coccimiglio
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Four Points Family Chiropractic
10815 Ranch Rd 2222 Bldg 3C, Ste 100
Austin, TX 78730