DISABLING AMERICA AND DISTRIBUTING WEALTHPROFITEERING HYPOCRISY

I read with interest a recent holiday message to a health system’s employees about a  young boy who received life saving services from this system through its coordinated  efforts at a state-wide system of communication and best utilization of resources. 

But the health care system in the USA, as we know it has a long way to go to providing  value for it’s out of control and escalating costs. The resources and information are  already here and available to achieve this but they aren’t being utilized; nor are providers  educated in their use or held accountable for using these available proven resources. The  transfer of wealth is a mitigating factor that few are willing to take on, lest it adversely  affect the transfer to them. 

The following is one story of such an example, and sadly I see this type of thing happen  frequently. I’m certain it is of epidemic proportions throughout this system as it is  throughout the country. 

This is the story of a 21-year-old mother of an infant. She had just started a manual labor  type of job in an educational institution and after about two weeks complained of lower  back pain. She was seen by her primary care provider (PCP) who documented no  findings of significant disease or injury, and was referred to me for physical therapy since  I provide a unique and very successful approach using manual therapy and education. 

She presented with her father and her infant child and was in obvious distress, tearful,  and not moving normally. Her examination again was unremarkable for serious  problems and manual therapy provided her with significant relief. Her father remarked  she “was under a lot of stress, and her husband had just left her” in addition to this new  job. She had a history of depression which was currently being treated by her PCP with  medication. 

The patient was given some home corrective maneuvers and asked to return in a week. A  good portion of her therapy session was spent on education, including the futility of  searching for a pain generator; by doing an MRI; and the irrefutable benefits of keeping  active, moving, and doing your normal job – despite pain. 

She returned in a week, moving and walking normally, and reported she was much better,  “just sore”. I found nothing amenable to manual therapy or further corrective maneuvers  or exercise. She could move normally in all directions without any pain. She expressed  concerns about returning to work – this is called Fear Avoidance Behavior and it is  clearly linked to poorer outcomes if not addressed. I advised she not be concerned about  having some pain as a multitude of research studies show this is very unlikely to be  harmful and very highly likely to be helpful if one works through it and builds tolerance.  I suggested it was in her best interest to return to work, and that she should discuss this  with her PCP at the scheduled appointment the next day. 

At her PCP visit the next day it was documented that she was doing much better, and the  therapy had been very helpful. She again expressed Fear Avoidance. She had no  findings of serious problems or any neurological deficits. She was advised to not work,  and was referred to spine surgery for their opinion, and to pain management.  

Four days later she was seen by pain management and this was documented: “She has  been to physical therapy which made things worse…” She had two epidural spinal  injections in two subsequent visits. The first had reduced her pain by 10% according to  the chart. She had also seen spine surgery and a fusion had been recommended. 

She was seen in follow up by her PCP 13 days after the second epidural and the  following was documented: “Depression is not doing well”. It was also documented she  “has not been able to work”. She had been scheduled to have a fusion on December 20. 

I would like to just share some recent staggering statistics: 

🞂 271% increase for epidural steroid injections 1994-2001 

🞂 423% increase for opioids 1997-2004 

🞂 307% increase in MRIs 1994-2004 

🞂 220% increase in spine fusion 1990-2001 

Statistics from: Deyo RA et al. JAFM 22(1);2009 

These authors stated that these increases have not been accompanied by any decline in  the disability rates for low back pain. In fact, they are increasing.  

This 21-year-old will now join this group. 

Dr. Edward L. Scott PT, DPT, OCS 

"We suggest that when treating patients with LBP, medical providers should  pay greater attention to the important role of depression rather than  focusing on the findings or imaging studies". 

Jarvik JG, Hollingworth W, Heatery PJ et al. Three-year Incidence of Low  Back Pain in an Initially Asymptomatic Cohort. Spine. 2005;10(13): 1541- 1548.