The policies on how we manage low back pain are changing. A new revision to international guidelines in low back pain management will be leading GPs in a new direction when it comes to the initial treatment of a very common condition. Here is the link to the article explaining the revision.
To summarize, the new recommendations point docs towards utilizing movement prescription, yoga, meditation, physical therapies, and psychological therapies INSTEAD or, at least before, using pain medications, or more invasive procedures (like surgery/injections) are commonly prescribed.
This is in response to the growing body of evidence suggesting that pain medications are ineffective in the treatment of low back pain, and the existing, staggering, body of evidence supporting exercise prescription in majority of today’s chronic conditions.
Without delving too far into the complexities of pain management and chronic pain.. it’s safe to say it takes more then either a pharmaceutical or a conservative therapy to be the end all be all. Humans and pain have a long, complicated relationship and it takes a multi-factorial approach to really get to the “cure”.
My initial thoughts reading this article were “YES, FINALLY”.
This is obviously a soap box I stand on daily as an Athletic Therapist and Kinesiologist. I see daily the positive effects of movement prescription and lifestyle change guidance in my clients, and in my peers clients. This isn’t news to us. We also regularly see the negative effects of old school pain management protocols (medications, bedrest, surgeries). More often then not, actually in majority of cases, these old methods only lead to minimal symptom relief and decreased quality of life overall.
One of the issues raised on the new suggestions was the increased burden on the patients to now seek out and pay for unsubsidized services such as psychological consults, therapies, and classes- whereas with medication prescription majority of costs are covered by healthcare.
I get that. I really do.. but I do feel as though it’s a very narrow minded thought.
If we look at the big picture statistics are showing that the pain medications that “don’t cost” the patient anything are not effective. Which means they remain bedridden with pain, dysfunctional, and are at a higher risk for other health conditions. All of this of course costs our economy big bucks- and likely the patient is paying for those medications in other ways. Whether that be in seeking out other therapy regardless of the medications, losing time at work due to persisting symptoms, or spending money on other costly “quick fix” routines in an attempt to mitigate their pain.
Here’s the other issue we run into from the health care viewpoint.. Patients want the easy way, and as a result- Doctors often don’t have the time or energy (or sometimes ability/information) to educate them as to WHY the “easy way” actually isn’t going to serve them long term. I think every practitioner alive comes across a number of patients who drop out of programs, refuse to do their exercises, and/or are not mentally ready to work through the pain or the reasons behind the pain. It’s human nature to want a quick fix- unfortunately when pain arrives often it’s because of layers upon layers of quick fixes or blissful ignorance of a problem that has been brewing for a longer period of time.
How do we help the shift in our systems?
I attended a conference not too long ago where this was a large part of the weekend discussions.
How do we create a more multidisciplinary approach to health, and build relationships between practitioners- largely in an attempt to help the policy makers make shifts to support public access to effective treatment of chronic diseases?
In Canada, we spend upwards of $83 billion a year on healthcare expenses related to inactivity. $37Billion is spent on sick day costs alone, and $6billion a year on pain management prescriptions.
Low Back Pain is in the top two reasons why we go to see the doctor in North American Culture.
Physical Inactivity is linked to 25 of our top chronic diseases and morbidities in Canada- and prescribing movement is statistically and proven as the most effective modality and treatment for all those diseases (along with nutrition and habit change, of course).
This is an issue that is not going to go away with a quick fix.
Creating change starts first with simplifying systems. Both for the primary care practitioners doling out advice and guidance, as well as the patients coming in with a complaint.
Humans trust systems. Even if they complain about the systems, they follow the systems.
It’s becoming clear that the systems we have in place are not the systems that support our overall wellbeing.
It needs to be easy for a physician to send a patient to a trusted, knowledgable resource. When that patient arrives at that resource it needs to be an environment that establishes a system for them, and an atmosphere that supports their process.
In an ideal world we would just flip the system on it’s head. Subsidize practitioner services that support long term health change, tax junk foods and lower costs of locally produced nutritionally dense food, create living spaces and work spaces that make movement the most obvious choice, and build policy in all realms around positive choices, not expensive reactions.
Vs shooting down the systems with the stress and worry of short term growing pains before they have a chance to evolve…
Maybe these short term issues of public expense will create opportunity for the rest of these long term changes to happen. Is that wishful thinking?