In 1994, the U.S. Public Health Service’s Agency for Health Care Policy and Research (AHCPR) conducted the most thorough investigation into acute low back pain in adults and came to the following conclusion in its Patient Guide: “Even having a lot of back pain does not by itself mean you need surgery. Surgery has been found to be helpful in only 1 in 100 cases of low back pain problems. In some people, surgery can even cause more problems. This is especially true if your only symptom is back pain.”
In his 2009 article, “Overtreating Chronic Back Pain: Time to Back Off?” Dr. Deyo speaks of the shortcomings of medical spine treatments in the U.S.: “Jumps in imaging, opioid prescriptions, injections, and fusion surgery might be justified if there were substantial improvements in patient outcomes. Even in successful trials of these treatments, though, most patients continue to experience some pain and dysfunction. Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain. We must rethink chronic back pain at fundamental levels.”
Dr. Deyo is not alone in his call for reform in spine care. The editors of The Back Letter, a newsletter from the Department of Orthopedic Surgery at Georgetown Medical Center in Washington, D.C., agreed with his frustration:
“The world of spinal medicine, unfortunately, is producing patients with failed back surgery syndrome at an alarming rate … There is growing frustration over the lack of progress in the surgical treatment of degenerative disc disease. Despite a steady stream of technological innovations over the past 15 years – from pedical screws to fusion cages to artificial discs – there is little evidence that patient outcomes have improved … Many would like to see an entirely new research effort in this area, to see whether degenerative disc disease and/or discogenic pain are actually diagnosable and treatable conditions.”
Chiropractic: Non Surgical Spinal Decompression =The First Option for Back Pain
According to Pran Manga, PhD, a health economist, “There is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management.”He is not alone in his assessment. Numerous international and American studies have shown that for nonspecific back pain, manipulation is heads above all other treatments. In fact, Anthony Rosner, PhD, testifying before the Institute of Medicine, stated: “Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.”
OVER THE LAST TWENTY YEARS THERE ARE STUDIES WHICH SHOW THAT A CONSERVATIVE APPROACH USING NON-SURGICAL SPINAL DECOMPRESSION HAS POSITIVE EFFECTS ON DAMAGED AND DEGENERATED DISCS.
HERE ARE SOME OTHER RECENT STUDIES:
“Disc distraction shows evidence of regenerative potential in degenerated intervertebral discs as evaluated by protein expression, magnetic resonance imaging, and messenger ribonucleic acid expression analysis.”
Guehring T, et al.: Spine. 2006 Jul 1;31(15):1658-65
“Distraction results in disc rehydration, stimulated extracellular matrix gene expression, and increased numbers of protein-expressing cells.”
Komari H, et al.: The Natural History of Herniated Nucleus with Radiculopathy. Spine 21: 225-229, 1996
58 subjects had an inclusive conservative program including traction (when initially shown to reduce leg symptoms). Overall 86% had good-excellent results.
Mathews, JA: Dynamic Discography: A Study of Lumbar Traction. Annls of Phys Med, IX (7), 265-279, 1968.
“30 patients with lumbar herniations were tractioned in a CT scanner at >50% body weight for -20 min. Hernia retraction occurred in 70% and good clinical improvements were seen in over 93%. The authors concluded improved blood flow was the source of healing. Additionally they speculated previous studies showing traction doesn’t create negative intradiscal pressures perhaps used too light a force.”
Parsons, WB Cumming, JDA: Traction in Lumbar Disc Syndrome. Can Med Jour 77:7-10,1957.
|“100 patients with disc syndrome unresponsive to manipulation were treated with high force traction (+80 lb). 86% of patients had good-excellent outcomes 12 had poor outcomes but most had pain for an extended duration.”
Saal, JA Saal, JS: Nonoperative Treatment of Herniated Lumbar Disc w/ Radiculopathy. Spine 14 (4): 431-437, 1989.
“77 patients verified on pre-post MRI with signs and symptoms of herniation, underwent non-surgical intervention including pelvic traction. Changes in herniation and good-excellent symptomatic improvements were noted in over 82%. The authors draw the conclusion improving the discs contact with the blood supply accounts for healing of herniation.”
Onel,D et. al.: CT Investigation of the effects of Traction on Lumbar Herniation. Spine 14: 82-90,1989.
There are other reasons, of course that have to do with money. One of the reasons that doctors don’t know about non-surgical decompression is because most of their post graduate education is sponsored by pharmaceutical companies and other companies that have vested interest in surgery and rehab. So they continue to learn, but all their new knowledge is controlled by people and institutions that have their own agenda – and not necessarily looking for what is in the best interest of patients.So the question we all should be asking is why don’t more spinal specialists, orthopedic surgeons, and pain management doctors recommend non-surgical decompression before directing their patients to more invasive, more expensive and less effective form of treatment? The simple answer is most of them have never heard of decompression, know nothing about it, and are hesitant to refer any patient to something they are not familiar with…
That is the fault of the system, not the individual doctor.