Professional guidelines already advise against using common medications such as steroids or NSAIDs such as Ibuprofen as a first line treatment for acute or chronic back pain.

Now a new study has been published which associates early use of these medicines with development of chronic back pain.

Lower back pain is a leading driver of disability across the globe, so the idea that what people commonly reach for to get some relief may be leading to worse outcomes and increased misery for millions of people should be taken seriously.

Hopefully more studies will be done, including clinical trials, which can provide evidence for causation.

In the meantime, it is already the position of numerous professional organizations, including the American Academy of Family Physicians, that non-drug treatment options such as superficial heat, massage, spinal manipulation, and other non-drug treatments should be tried before medications.

Nonpharmacologic treatment, including superficial heat, massage, acupuncture, or spinal manipulation, should be used initially for most patients with acute or subacute low back pain.

Which begs the question, if a bunch of different treatments are all shown to be equally effective for the treatment of a common condition, which treatment do you choose?Chiropractic Care Versus Medication For Chronic Lower Back Pain In Elderly PatientsThe evidence increasingly favors spinal manipulation over prescription drugs when considering patient satisfaction and…medium.com

I’d propose you pick the treatments which are both cost effective and offer the least adverse side effects. While over the counter NSAIDs are certainly cost effective, this study provides some evidence that they may not be as benign in terms of side effects as many people assume.

The tendency to use nonsteroidal anti-inflammatories persists despite their unimpressive performance. An analysis of randomized clinical trials found that these drugs had almost no benefit over placeboes in reducing low back pain.

Chiropractic care often involves several modalities recommended as first line treatments in the care of acute and subacute back pain. Typically a visit to the chiropractor will involve some superficial heat, patient education, reassurance, soft tissue treatment such as massage, spinal manipulation (chiropractic adjustment), stretching, lifestyle modification advice, or home exercise recommendations.When Your Back Hurts, Sometimes It’s Better Not Knowing Exactly WhyYou want an answer, but there are hidden costs to finding out.medium.com

While usually not as inexpensive as a $7 bottle of Advil, chiropractic care is often given some of the highest marks for patient satisfaction and appears comparable in cost effectiveness to standard medical care.

It Can Be Overwhelming

There are so many options when trying to decide what to do about a case of acute back pain. It can feel like you’re in a supermarket with too many options. Not everyone is going to respond the same way to a treatment, further confusing things. Some people love a visit to the chiropractor, other people hate getting adjusted. My wife doesn’t like acupuncture, I find it helps.

What I recommend to my patients is what I understand to be effective, low-risk, and evidence based. It is not in my scope of practice to tell a patient what medications to take or not to take, but as an aspect of informed consent I do tell my patients what other options they have for their care.

If they are in my office I am going to be biased and recommend a trial of chiropractic care for most cases of acute back pain, but they have other options such as yoga, acupuncture, exercise, topical analgesics, medications, et cetera.

Does this recent study pointing out there may be more risk involved in taking common medications confirm my bias towards conservative non-pharmacological interventions for pain? Yes. Does it mean I will stop taking Ibuprofen when I have pain? Probably not, but I might think twice the next time I reach for when my shoulder or back feels cranky.

Works Consulted:

DOI: 10.1126/scitranslmed.abj9954Common Medications Can Prolong Back Pain, Study SaysA clinical trial will be needed to verify the research, which offered a warning about taking steroids or…www.nytimes.com

doi.org/10.7326/M16–2367

Haas, Mitchell et al. “Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain.” Journal of manipulative and physiological therapeutics vol. 28,8 (2005): 555–63. doi:10.1016/j.jmpt.2005.08.006

The post Common Medications Probably Make Back Pain Worse appeared first on Medika Life.

In the early days of the pandemic, two things shocked and dismayed me above other dim-witted responses to the virus: the CDC failing to promote early masking, and public health officials and politicians tripping over themselves to make alcohol more available than ever.

Liquor stores wouldn’t be closed, restaurants could deliver booze, or serve “to-go” alcohol with your take-out order.

The constant refrain I heard about why alcohol needed to be so ubiquitous was, “we will see hospitalizations from alcohol withdrawals go up and we can’t have these people crowding our soon-to-be overwhelmed hospitals.”

Guess what? Hospitalizations for alcohol withdrawal went up anyway.

Meanwhile, public parks, soccer fields, and other outdoor spaces were seen as a danger to public health and would need to be closed.

I can only assume these decisions were made with tax revenue and profits in mind over people’s health. After all, no one is collecting a fee to get into the local skate park.

People with years of experience and advanced degrees honestly looked around and thought outdoor spaces were a bigger risk than closing liquor stores to the public? Politicians here in America were obviously going to screw this up and make the wrong call, but public health officials should know better you would think, but then again, here in America many of them are political appointees with one eye on keeping their jobs.

I’m sympathetic to the businesses which relied on alcohol sales to try and stay afloat during that time, but better government policy should have ameliorated their financial suffering. Instead, we got a policy that purported to keep people out of the hospital but instead contributed to the deaths of more people than the virus was capable of killing.

Hell, if the CDC and governments kicked everyone outside for three weeks and made indoor spaces verboten this pandemic would have been over already, considering there is evidence that transmission rates outdoors are less than 1%.Outdoor Transmission of SARS-CoV-2 and Other Respiratory Viruses: A Systematic ReviewRecommendations about methods to curb transmission of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2)…academic.oup.com

Feel free to cram into your local beer & wine though, just don’t take your kids to the park.

Now studies are being published showing just how brain-dead these policies turned out to be.Alcohol-Related Deaths Spiked During the Pandemic, a Study ShowsThe deaths were up 25 percent in 2020 compared with 2019 as stressors accumulated and treatment was delayed, according…www.nytimes.com

Among adults younger than 65, alcohol-related deaths actually outnumbered deaths from Covid-19 in 2020; some 74,408 Americans ages 16 to 64 died of alcohol-related causes, while 74,075 individuals under 65 died of Covid. And the rate of increase for alcohol-related deaths in 2020–25 percent — outpaced the rate of increase of deaths from all causes, which was 16.6 percent.

Deadlier than COVID.

Then you factor in rises in obesity, suicide, narcotics deaths…and you get a fuller picture of just how utterly public health officials and governments failed to enact policies with an eye on harm reduction during the pandemic.

Drug overdose deaths also reached record levels during the first year of the pandemic, with more than 100,000 Americans dying of overdoses during the 12-month period that ended in April 2021, a nearly 30 percent increase over the previous year, according to reports issued in November. The number of deaths from opioids in which alcohol played a role also increased.

Young adults ages 25 to 44 experienced the greatest increases in alcohol-related deaths in 2020, rising nearly 40 percent over the previous year, according to the new report.

Of course, more papers will have to be published to replicate these findings, but I have a feeling these numbers are probably even higher than reported in this study.

My biggest concern is that when the next pandemic hits (COVID-23: Giraffe Flu? It’s never Tofu Flu, Toflu?) it’ll be like day one on the job and the same half-assed and wrongheaded approaches that didn’t work for COVID-19 will get an encore de failure.

The post Alcohol + Capitalism = Deadlier Than COVID appeared first on Medika Life.

Lower back pain is arguably the most burdensome public health problem on a global scale, COVID-19 aside. In terms of years lived with disability and prevalence among adult populations, lower back pain is a perennial top contender in almost any study of global burdens of disease.

Opioid use, abuse, and the damage done to individuals, families, and the societal ramifications of these medications are likewise well documented.

So it is welcome to see that chiropractic care, and other conservative treatments for lower back pain, are associated with less reliance on opioid medications, which do not have a particularly great track record in resolving spinal pain complaints and are not recommended as first-line interventions for acute or chronic lower back pain.

From Reuters Health in 2019:

Patients with spinal pain who visit a chiropractor may receive treatments such as spinal manipulation, massage, acupuncture, exercises and education as appropriate,” said lead author Kelsey Corcoran of Yale School of Medicine in New Haven, Connecticut. These therapies may lead to decreased pain, improved range of motion and increased function, Corcoran said by email. If a patient’s pain is well controlled by the treatment they received from a chiropractor, they may subsequently need less pain medications or even none at all.

Addressing Biases

Of course, you might say, “You’re a chiropractor so obviously you’re going to tout these studies” and you’d be correct. Also, there is selection bias involved, people who self-select conservative care like chiropractic or physical therapy over medical care may be doing so with the explicit intention of avoiding the use of medications.

However, these studies were not just done by chiropractors, and they haven’t only been published in niche journals catering to the chiropractic or manual therapy professions. It is true that these types of studies tend to be retrospective and observational, and cannot imply causation, but evidence will continue to accumulate and it will be interesting to see what future work on this topic elucidates.

Final Thoughts

I’ve written on this subject several times before, but when it comes to addressing your pain, you have options. One of those options is to see a chiropractor. Unfortunately, chiropractic care is a mixed bag ranging from evidence-based multimodal care to, ugh, pretty much any of the trash you will see if you type chiropractic into YouTube.

In my personal opinion, and knowing the majority of lower back pain has a favorable natural history, I’m inclined to recommend conservative treatments such as yoga, walking, chiropractic care, PT, or a general exercise program over medical care and definitely before considering opioids, advanced imaging, injections, or surgery.

Thank you for reading and let me know what you think or share your experiences in the comments.

Works Consulted:

Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020;8(6):299. doi:10.21037/atm.2020.02.175

Whedon, James M et al. “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain.” Pain medicine (Malden, Mass.) vol. 21,12 (2020): 3567–3573. doi:10.1093/pm/pnaa014

Whedon, James M et al. “Association Between Utilization of Chiropractic Services for Treatment of Low-Back Pain and Use of Prescription Opioids.” Journal of alternative and complementary medicine (New York, N.Y.) vol. 24,6 (2018): 552–556. doi:10.1089/acm.2017.0131

Kazis, Lewis E et al. “Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use.” BMJ open vol. 9,9 e028633. 20 Sep. 2019, doi:10.1136/bmjopen-2018–028633

The post Chiropractic Care May Led to Reduced Opioid Use appeared first on Medika Life.

The global burden of disease places lower back pain (LBP) as the leading cause for years lived with disability at the top spot for the past three decades.

LBP may be treated with pharmacological therapy, surgical interventions, or rehabilitation…physical therapy, exercise, spinal manipulation, and other practices. Combination therapy and interdisciplinary approaches to LBP are considered helpful in many cases.

Everything works, but not for everyone.

Ask one hundred people what you can do to get rid of your back pain and you might get one hundred different answers. Read a hundred different articles, scientific studies, look at one hundred different videos online, you will hear and see it all.

Chiropractic care is my bias, it’s how I pay my bills, but that doesn’t make it better. Relief from pain isn’t open and shut. What works for some people won’t necessarily work for you. Doing you own research may point you in a direction, listening to experts may sway you, hearing from a friend or family member might land you in a different office. Some interventions are apparently bogus based on today’s prevailing evidence: TENS, ultrasound, and kinesiotaping for pain don’t appear to do much. Ice (cryotherapy) is also out of favor at the moment.Should Your Chiropractor Adjust Your Neck?Cervical spine manipulation is controversial, should it be abandoned?medium.com

No one has a monopoly on what works the best, because nothing works the best. There is no gold standard for effective back pain treatment. Some people respond well to one thing but aren’t going to respond well to another. Many cases will resolve on their own no matter what procedure or technique is performed.

If treating back pain is a crap shoot, why go to a chiropractor?

There are some first-line treatment recommendations that show up perennially in study after study for what works for lower back pain.

From the American College of Physicians evidence-based clinical practice guideline 2017:

Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation)

And:

For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation)

So you can see that good chiropractic care covers several of these recommendations for acute, sub-acute, and chronic types of lower back pain. A competent chiropractor is going to perform a detailed history and physical exam, provide you with a working diagnosis, and form a plan based on the best available evidence, their own clinical expertise, and your preferences and values as the patient — the key player in all of this.

Chiropractic can check a lot of these boxes, but not every chiropractor will employ multiple treatment modalities. In my own office I frequently use:

1. Nonpharmacologic treatments
2. Superficial heat
3. Massage
4. Spinal manipulation
5. Exercise
6. Yoga

Final Thoughts

As a human being, there is a good chance you will develop lower back pain at some point in your life. Most cases of lower back pain will resolve on their own with time. No matter what you try or who you see first for a case of lower back pain, it may or may not improve your symptoms.

So from my professional standpoint what you do for your back pain should be based primarily on what you value in a treatment approach. Some people are comfortable with medications or injections, others are not. Some people value exercise over more passive treatments such as massage.

In the case of chiropractic treatment most patients who seek this type of care for their lower back pain are likely attracted to it being drug-free, non-invasive, hands-on, and of a low risk of side effects.Fruit Is Not Making You FatIf you go to a health professional and they tell you fruit is bad, turn and run in the other direction.medium.com

Works Consulted:

Pergolizzi, J.V., LeQuang, J.A. Rehabilitation for Low Back Pain: A Narrative Review for Managing Pain and Improving Function in Acute and Chronic Conditions. Pain Ther 9, 83–96 (2020). https://doi.org/10.1007/s40122-020-00149-5

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians https://doi.org/10.7326/M16-2367

The post Not All Lower Back Pain Treatments Are Equal appeared first on Medika Life.