Dr. John Ventura stopped by to discuss the NCQA’s Back Pain Recognition Program with me. This episode of On The Other Hand as well as the others can be found on iTunes or at www.ontheotherhand.podbean.com
The importance of using common language when communicating about back pain has been well documented in the medical literature. There are three main areas that lead to difficulties in communication about back pain:
- patients seeking information from health care professionals can experience difficulties understanding them and the medical literature
- misunderstandings among health professionals concerning terminology can arise
- lack of standardized definitions for back pain terms can make comparison of research studies problematic
A study just published in the BMC Musculoskeletal Disorders aimed to explore the meanings and issues surrounding the use of existing medical terms for back pain from the perspective of health care professionals and lay people. Focus groups were used to explore participants’ understanding and samples included general practitioners, chiropractors, osteopaths, physiotherapists, and lay people.
Lay participants understood the majority of the terms explored in the group differently than the health professionals. Some terms were not understood, some misconstrued and some had inadvertent negative connotations or implications. (For example “wear and tear” instead of the harsher term “degeneration” gave implications of wearing away or rotting). The commonness of misunderstandings, unintended meanings and negative emotional responses to terms used in this study have a number of implications.
Firstly, it must encourage providers to ensure their patients understand what has been explained to them including the contextual and emotional implications. Secondly, patients and providers should have an ongoing dialogue to promote understanding of terms and comminality of language. Third, this study should be used as a lesson to chiropractors who cling to old, antiquated terminology that we know has differing meanings both intra- and interprofessionally. If other chiropractors cannot agree on a term’s meaning, and other professions cannot agree on that term’s meaning, you can sure as heck bet that your patients have no idea what you are taking about either.
I was recently told that we should take antiquated terms and reframe them so we can continue using them in a different context. To me, this study implies that is not a wise course of action.
Brett L. Kinsler, DC is a chiropractor in Rochester, NY who avoids using antiquated terms when he blogs at www.RochesterChiro.wordpress.com
Treatment for uncomplicated low back pain varies widely. While most physicians follow the recommended approach of pain management and gradual return to physical activity, some prematurely prescribe costly imaging, epidural steroid injections-or refer their patients to surgery.
NCQA, the National Committee for Quality Assurance, has a Back Pain Recognition Program (BPRP). This program seeks to recognize medical and chiropractic physicians who deliver superior care to millions of Americans who suffer from low back pain. The BPRP program consists of 13 clinical measures and three structural standards that address the broad spectrum of low back pain and focus on underuse, misuse and overuse of treatment modalities.
NCQA developed BPRP requirements from widely accepted medical evidence, with significant input from physician specialists and health plan and employer representatives.
Our office has been recognized as part of this program and Dr. Elliott and I are among only a dozen physicians at this time in New York State to achieve this honor.
We feel the NCQA BPRP program is a step in the right direction toward evidence based chiropractic treatment and are thankful for the opportunity to earn this recognition.
Dr. Brett Kinsler and Dr. Michalene Elliott are NCQA recognized chiropractors in Rochester, NY. Their website is www.RochesterChiro.com
June 29, 2008 at 3:04 pm (Alternative Medicine Products, Evidence Informed Chiropractic, Patient Information, Patient Resources, Uncategorized)
Tags: back pain, backbelts, Cochrane review, corset, lumbar support, scam
I am frequently asked by patients about the use of backbelts for spinal injury prevention. The short answer is that we’ve know for quite some time that these strappy supports rarely do anything to prevent low back injuries and a recently updated Cochrane review supports this practice.
To top things off (or wrap them up I suppose), the corset-like belts may actually allow back and abdominal muscles to weaken as they become dependent on the additional artificial external support.
We do occasionally recommend a support belt for patients in acute pain as a temporary pain relieving measure or for pregnant patients (a different kind of belt for them). We will also on occasion have patients wear a belt for short periods during tasks that may require additional support but long term, all day use should be avoided.
The term cold laser refers to the use of low-intensity or low levels of laser light. Laser therapy can reduce pain and inflammation and promotes wound healing. These lasers are used directly on or over the affected area. New research is being produced daily and the results are encouraging. Cold laser threapy is certainly emerging as a valuable, safe and effective adjunct to non-surgical musculoskeletal care.
Cold lasers can also used for acupuncture, with laser beams to stimulate the body’s acupoints rather than needles. This treatment regimen appeals to those who want acupuncture but who fear the pain of needles. Despite claims to the contrary, scientific evidence does not appear to support claims that cold laser acupuncture is an effective method of helping people stop smoking. (For a truly excellent approach to smoking cessation, visit www.whyquit.com )
Well-controlled scientific studies are rapidly accumulating using low level laser devices for pain, wounds, injuries, and other conditions. This method should not be confused with conventional laser surgery, which is used as a surgical treatment for some cancers. Such hot lasers may be used to shrink or destroy tumors on the skin or on the surfaces of internal organs and are sometimes used to remove colon polyps or tumors. Cold laser therapy produces no or little warmth and has minimal side effects.
In our office, we are using cold laser therapy as a treatment for tendonitis, tendonosis, rotator cuff syndromes, frozen shoulder, pain relief from active fractures, neck pain, back pain, bursitis, carpal tunnel syndrome, cold sores, speeding open wound healing. We are seeing excellent results with many of these conditions. It appears that the sooner cold laser is applied following the injury, the better the chance for a good outcome. Perhaps you have a condition for which you’d like to try cold laser therapy?
Dr. Brett Kinsler uses cold laser therapy or low level laser therapy (LLLT) in his chiropractic practice in Rochester, NY. Visit his website at www.RochesterChiro.com
Top 10 Most “Back Breaking” Jobs
In a recent informal survey, the following occupations were found to cause the most stress and strains on the muscles of the back.
10. Auto mechanics work in physically awkward positions, bending over cars, sliding under cars, etc.
9. Nursing home workers have to lift elderly people into and out of bed. The workers’ bodies can become twisted and off-center.
8. Delivery drivers are always running, often carrying heavy and awkward packages. Packages shipped via UPS, FedEx, etc., have increased in weight over the years. The job also involves a lot of driving.
7. Firefighters/EMTs deal with fire, water pressure from hoses, have to chop obstacles with an axe and lifting and moving injured patients, which is particularly difficult if the victim is obese or incapacitated.
6. Shingle roofers are always twisting their bodies and frequently working on sloped surfaces.
5. Farmers lift heavy equipment and bags of feed andgrain. When doing fieldwork, they have to constantly turn backward to watch equipment that is pulled behind a tractor.
4. Police officers sit in their cars for long periods of time, which is rough on the lower back. When called into action, they have to make sudden movements and often face resistance from those they are arresting. Police officers also wear belts that can weigh up to 40 pounds, which can cause chronic back pain.
3. Landscapers lift heavier objects than many other professions. Wheelbarrows can twist and turn, wrenching the workers’ backs.
2. Construction workers’ jobs can involve hammering, lifting, steelwork, or ironwork-all in very awkward positions. Moving steel beams can wreak havoc on the entire body.
1. Heavy truck and tractor-trailer drivers endure constant compression and vibration from trucks. This can damage the back. Prolonged sitting puts pressure on the spine, which can result in disc degeneration. Liquid-carrying trucks are particularly bad. When this type of truck comes to a sudden stop, the fluid in the truck’s tank slams back and forth, and the driver feels the impact. Also, because professional truck drivers are always on the road, their diets are seldom what they should be, which can contribute to back problems.
Dr. Brett L. Kinsler is a chiropractor practicing in Rochester, NY. Visit his website at www.RochesterChiro.com
Eighty percent of people suffer from back pain at some point in their lives. Back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections. Most cases of back pain are mechanical or non-organic—not caused by serious conditions, such as inflammatory arthritis, infection, fracture, or cancer.
The back is a complicated structure of bones, joints, ligaments, and muscles. You can sprain ligaments, strain muscles, rupture disks, and irritate joints, all of which can lead to back pain. While sports injuries or accidents can cause back pain, sometimes the simplest of movements—for example, picking up a pencil from the floor— can have painful results. In addition, arthritis, poor posture, obesity, and psychological stress can cause or complicate back pain. Back pain can also directly result from disease of the internal organs, such as kidney stones, kidney infections, blood clots, or bone loss.
Back injuries are a part of everyday life, and the spine is quite good at dealing with these often “pulled” muscles. These very minor injuries usually heal within 1 or 2 days. Some pain, however, continues. What makes it last longer is not entirely understood, but researchers suspect that the reasons may include stress, mood changes, and the fear of further injury that may prevent patients from being active. In addition, sometimes a painful injury or disease changes the way the pain signals are sent through the body, and, even after the problem has gone away or is inactive, the pain signals still reach the brain. It is as if the pain develops a memory that keeps being replayed.
Until recently, researchers believed that back pain would heal on its own. We have learned, however, that this is not true. A recent study showed that when back pain is not treated, it may go away temporarily, but will most likely return. The study demonstrated that in more than 33% of the people who experience low back pain, the pain lasts for more than 30 days. Only 9% of the people who had low-back pain for more than 30 days were pain free 5 years later.
Another study looked at all of the available research on the natural history of low-back pain. The results showed that when it is ignored, back pain does not go away on its own, but continues to affect people for long periods after it first begins.
If your back pain is not resolving quickly, visit your doctor of chiropractic. Your pain will often result from mechanical problems that your doctor of chiropractic can address. Many chiropractic patients with relatively long-lasting or recurring back pain feel improvement shortly after starting chiropractic treatment.
The relief is often greater after a month of chiropractic treatment than after seeing a family physician. Chiropractic spinal manipulation is a safe and effective spine pain treatment. It reduces pain, decreases medication, rapidly advances physical therapy, and requires very few passive forms of treatment, such as bed rest.
How Can I Prevent Back Pain?
Don’t lift by bending over. Instead, bend your hips and knees and then squat to pick up the object.
Keep your back straight, and hold objects close to your body when lifting.
Don’t twist your body while lifting.
Push, rather than pull, when you must move heavy objects.
If you must sit for long periods, take frequent breaks and stretch.
Wear flat shoes or shoes with low heels.
Exercise regularly. An inactive lifestyle contributes to lower-back pain.
1. Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche C. The course of low-back pain in a general population. Results from a 5-year prospective study. J Manipulative Physiol Ther 2003 May; 26(4):213-9.
2. Hestbaek L, Leboeuf-Yde C, Manniche C. Low-back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J 2003 Apr;12(2):149-65.
3. Stig LC, Nilsson O, Leboeuf-Yde C. Recovery pattern of patients treated with chiropractic spinal manipulative therapy for long-lasting or recurrent low-back pain. J Manipulative Physiol Ther 2001 May;24(4):288-91.
4. Nyiendo J, Haas M, Goodwin P. Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice based feasibility study. J Manipulative Physiol Ther 2000 May;23(4):239-45.
5. Time to recognize value of chiropractic care? Science and patient satisfaction surveys cite usefulness of spinal manipulation. Orthopedics Today 2003 Feb; 23(2):14-15.
Dr. Brett L. Kinsler is a chiropractor practicing in Rochester, NY. Visit his website at www.RochesterChiro.com