Recent media reports have been talking about how the medical profession is managing back pain badly – despite back pain being a leading cause of disability (it is estimated that 540 million people worldwide suffer) it is poorly treated.
These reports are following on from articles written in The Lancet in which experts are asking the medical profession to stop offering expensive and ineffective approaches. They are suggesting not only are the approaches ineffective, but they are also potentially dangerous – or as one article puts it amounting to negligence. According to the articles patients are being offered dangerous opioid drugs, unnecessary surgery or poor advice as well as expensive scans and tests which at best are a waste of time and at worst give false hope of resolution.
But is this the truth or are these articles just another example of the media grabbing the wrong end of a story and generating publicity? And if they are the truth what can we do about it?
In my opinion these articles are both a truthful reflection of what is going on and a scare story. Worldwide it is true to say that a large number of patients are offered drugs and scans as a first line approach – and even surgery (this is especially the case in the private medical world of the USA). However, in my experience in the UK we are lucky to have an NHS which does look at the evidence and is more cautious about giving surgery.
But if we start at the basic approach in the NHS, the first line many people use is over the counter medication like Aspirin and Ibuprofen. These medications have been found to have little benefit in helping back pain. The next level of treatment will be opioid drugs and these have little research into their long term benefit and they carry risk of side effects.
Following this we have imaging techniques like MRI – these are incredibly clever machines which can give a real picture of what is going on but how useful are they? When you consider that 37% of 20 year olds who have no symptoms show disk damage and 96% of 80 year olds who have no symptoms show disk damage you have to start questioning their usefulness.
In fact there is a medical profession acronym of VOMIT: Victim of modern imaging technique – this is when you have a test, for instance a routine heart scan – but then something else turns up as an incidental finding and then further tests are ordered and before long you are having surgery for something that was never going to cause you problems but because they have been found, the surgeon feels duty bound to do something about it.
Finally we have injections and surgery. Often patients feel this is the only way to go but again the evidence is mixed at best. The Lancet articles question the validity of this approach.
So having scared your all with all this doom and gloom, you are probably wondering why I have written this article. The reason is that for the vast majority of patients, the approaches needed are much simpler and more low tech – get mobile.
The Lancet articles and many others have stated that mobility and keeping mobile is the best way to help yourself; the worst thing that you can do is bed rest.
As well as keeping you mobile, exercise can also help reduce your weight which lowers your risk of cancer, diabetes, arthritis and heart disease just to name a few.
The other reason I am writing this is that these articles also stress the benefit of physical therapy like Osteopathy. Osteopathy has been around since the late 1800’s and our approach is led by the fact the body has the ability to heal itself – so we have always encouraged exercise and mobility.
Anyone who has come to see me will know I am the first to say I am not a doctor (because I am not) and I will not give advice on medication (because I am legally not allowed to). However, I usually say if I think I can help I will do 3 treatments and if after these treatments we are not making progress we will look at other options. Sometimes these options may be to talk to your doctor about medication as it does have a benefit in a number of cases. But in many cases medication mainly assists in getting the patient back to mobility, so it is a short term benefit.
Sometimes those options are also imaging like x-ray or MRI. But these things don’t treat you, they can indicate problems or an approach but they should only be used as an adjunct to an overall approach. So unless a scan is going to change our approach to your treatment I wouldn’t recommend it.
So, do I agree that the medical profession is always treating back pain wrongly? No I don’t. It is much more complex than that. I believe that if we all do our bit and get more mobile and look after ourselves we can save both the NHS and ourselves a lot of problems. I am disappointed that Osteopathy and other physical therapy isn’t more widely available via the NHS (our outcomes were incredible when we had an NHS contract) as this is exactly what we need to be doing to look after ourselves.
We as Osteopaths can help, we can mobilise, recommend exercise, support with lifestyle advice and generally help you with overall health – exactly as the experts in The Lancet suggest.