From the Foundation for Chiropractic Progress:
When The Centers for Disease Control and Prevention (CDC) delivered the grim news in October 2012 that the fungal meningitis outbreak attributed to a Massachusetts compounding pharmacy amounted to 233 cases in 15 states with 15 deaths, Americans were shocked. It hardly seemed possible that individuals seeking relief from debilitating back pain had literally lost their lives in the quest for a solution. With about 80 percent of adults in the U.S. bothered by back pain at some time in their lives, it is feasible that virtually everyone will have a relative, loved one, friend -- or know of somebody -- who could be impacted by this devastating situation.
But the news was actually worse: the CDC allowed for the possibility that 13,000 patients might have received products from the company. In NJ alone, a total of 634 people are at risk because of epidurals they received at six hospitals, surgery centers and doctors’ offices for back pain from May 21 to September 26, 2012.
The fungal meningitis concern is the latest in a series of major issues associated with different forms of pain
medication -- but it is far from the first. Just last summer, the CDC advised that one-third of prescription painkiller overdose deaths were caused by Methadone, and pointed out that some doctors are now prescribing methadone to
treat chronic problems such as back pain – making the drug more widely available.
The conclusions and comment from the CDC sound this alarm: "The primary advantages of using methadone over other opioids for pain treatment are its long duration of action, relatively low cost, and availability in liquid formulation for oral use. Its primary disadvantages are its long and unpredictable half-life and associated risk for accumulating toxic levels leading to severe respiratory depression; its multiple interactions with other drugs, including frequently abused drugs such as anti-anxiety agents; and its ability to cause major disturbances of cardiac rhythm.
"Data suggest that some of the current uses of methadone for pain might be inappropriate. According to an analysis conducted by FDA, the most common diagnoses associated with methadone use for pain in 2009 were musculoskeletal problems (such as back pain and arthritis)…. Most methadone prescriptions were written by primary care providers or mid-level practitioners… Nearly a third of prescriptions appear to have been dispensed to patients with no opioid prescriptions in the previous month…" [snip]
"Back Pain" is not an esoteric symptom or rare disease -- and there is no telethon to fund a cure. The fact is, nearly everyone experiences back pain eventually. A report by the National Center for Health Statistics found that more than a quarter of adults had low back pain in the past three months. It's the second most common neurological ailment in the United States, trailing only headaches, according to the National Institute of Neurological Disorders and Stroke. Only those who have never experienced a bout of back pain will joke about its implications upon day-to-day activities, but anyone who has experienced it may have tried everything from bed-rest to pain medication to surgery. [snip]
While nobody is likely to die as a direct result of back pain, an untimely death from medication or surgical treatment is quite possible. There is a growing body of evidence that suggests an aggressive medication or a premature surgical approach could yield more damaging and debilitating outcomes that could well be fatal. For example, the University of Pittsburgh Medical Center (UPMC) Health Plan, a health maintenance organization affiliated with the university’s School of Medicine, has adopted landmark guidelines for the management of chronic low back pain that seek to avoid inappropriate medication and surgery in favor of conservative approaches such as chiropractic care.
As of January 1, 2012, candidates for spine surgery must receive "prior authorization to determine medical necessity," which includes verification that the patient has "tried and failed a 3-month course of conservative management that included…chiropractic therapy…" Surgery candidates also must be graduates of the plan’s LBP health coaching program. The program features a Web-based decision-making tool designed to help plan members "understand the pros and cons of surgery and high-tech radiology." It is the first reported implementation of such a policy by a health care plan.
According to the December 2011 issue of the UPMC Health Plan Physician Partner Update, which informed participating providers of the new guidelines and rationale for the their implementation, "We feel strongly that this clinical initiative will improve the quality of care for members who are considering low back surgery, and that it will facilitate their involvement in the decision-making process." The update also noted, "Surgical procedures for low
back surgery performed without prior authorization will not be reimbursed either the specialist or the hospital level."
A conservative approach, such as chiropractic care, which includes manual and or instrument spinal care, postural advice, exercise and stretching counsel – along with general lifestyle suggestions and feedback -- holds the potential to help individuals avoid the negative outcomes of the routine approach to back pain problems while enhancing their search for a pain-free way of life.
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Unless otherwise attributed, all content is written by Kyle Johnson, DC, of Johnson Family Chiropractic of Peoria.
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