Alternative Medicine

Care for Low Back Pain: Can Health Systems Deliver?

By Frank M. Painter|March 30, 2020|Alternative Medicine, Low Back Pain, Medicare|

Care for Low Back Pain: Can Health Systems Deliver?

SOURCE: Bulletin of the World Health Organization 2019 (Jun 1)

Adrian C Traeger, Rachelle Buchbinder, Adam G Elshaug, Peter R Croft, and Chris G Mahera

Institute for Musculoskeletal Health,
University of Sydney,
PO Box M179, Missenden Road,
Camperdown NSW 2050, Australia.

Low back pain is the leading cause of years lived with disability globally. In 2018, an international working group called on the World Health Organization to increase attention on the burden of low back pain and the need to avoid excessively medical solutions. Indeed, major international clinical guidelines now recognize that many people with low back pain require little or no formal treatment. Where treatment is required the recommended approach is to discourage use of pain medication, steroid injections and spinal surgery, and instead promote physical and psychological therapies. Many health systems are not designed to support this approach.

In this paper we discuss why care for low back pain that is concordant with guidelines requires system-wide changes. We detail the key challenges of low back pain care within health systems. These include the financial interests of pharmaceutical and other companies; outdated payment systems that favour medical care over patients’ self-management; and deep-rooted medical traditions and beliefs about care for back pain among physicians and the public. We give international examples of promising solutions and policies and practices for health systems facing an increasing burden of ineffective care for low back pain.

We suggest policies that, by shifting resources from unnecessary care to guideline-concordant care for low back pain, could be cost-neutral and have widespread impact. Small adjustments to health policy will not work in isolation, however. Workplace systems, legal frameworks, personal beliefs, politics and the overall societal context in which we experience health, will also need to change.

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Primary Care for Low Back Pain

By Frank M. Painter|March 29, 2020|Alternative Medicine, Low Back Pain, Usual Medical Care|

Primary Care for Low Back Pain: We Don’t Know the Half of It

The Chiro.Org Blog

SOURCE: Pain. 2020 (Apr); 161 (4): 663–665

Peter Croft; Saurabb Sharma; Nadine E. Foster

Primary Care Centre Versus Arthritis,
School of Primary, Community and Social Care,
Keele University, Keele, United Kingdom.

Evidence-based medicine helps health care professionals and patients decide best care, drawing on research about effectiveness and safety of interventions. Systematic reviews summarise the evidence; guidelines report consensus between experts (including patients) on interpreting it for everyday practice. Although guideline recommendations are only one component of shared decisions that will vary patient-to-patient, the hoped-for outcome is health benefit for each individual. Guidelines also inform starker decisions by policymakers and health care leaders — for example, when to withdraw approval or funding for a poorly evidenced or harmful intervention. To assess whether all this research-driven activity is useful, 2 questions need answering: how well are guidelines followed in real-life practice and do patients benefit in the long-term?

In a new systematic review, Kamper et al. [9] tackle the first question in relation to first-contact care for patients with low back pain provided by family practice and emergency department physicians. (aka “usual medical care”) As the authors state, low back pain has major significance for the international pain community. It is the leading single cause of years lost to disability globally, [17] and there is good evidence for what constitutes best first-contact treatment. [6] The review selected best-quality studies of routine health care data to investigate whether first-contact physicians are putting back pain guidelines into practice (“usual care”).

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The Use of Complementary and Integrative Health

By Frank M. Painter|March 25, 2020|Alternative Medicine, Cost-Effectiveness of Chiropractic|

The Use of Complementary and Integrative Health Approaches for Chronic Musculoskeletal Pain in Younger US Veterans: An Economic Evaluation

The Chiro.Org Blog

SOURCE: PLoS One. 2019 (Jun 5); 14 (6): e0217831

Valerie F. Williams, MA, MS; Leslie L. Clark, PhD, MS; Mark G. McNellis, PhD

RAND Corporation,
Santa Monica, California,
United States of America.

OBJECTIVES: To estimate the cost-effectiveness to the US Veterans Health Administration (VA) of the use of complementary and integrative health (CIH) approaches by younger Veterans with chronic musculoskeletal disorder (MSD) pain.

PERSPECTIVE: VA healthcare system.

METHODS: We used a propensity score-adjusted hierarchical linear modeling (HLM), and 2010-2013 VA administrative data to estimate differences in VA healthcare costs, pain intensity (0-10 numerical rating scale), and opioid use between CIH users and nonusers. We identified CIH use in Veterans’ medical records through Current Procedural Terminology, VA workload tracking, and provider-type codes.

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Complementary and Integrated Health Approaches

By Frank M. Painter|May 3, 2019|Alternative Medicine, Veterans|

Complementary and Integrated Health Approaches: What Do Veterans Use and Want

The Chiro.Org Blog

SOURCE: J Gen Intern Med. 2019 (Apr 22) [Epub]

Stephanie L. Taylor, PhD, Katherine J. Hoggatt, MPH, and Benjamin Kligler, MD, MPH

Center for the Study of Healthcare Innovation,
Implementation and Policy,
Greater Los Angeles VA Healthcare System,
Los Angeles, CA, USA.

OBJECTIVES: Non-pharmacological treatment options for common conditions such as chronic pain, anxiety, and depression are being given increased consideration in healthcare, especially given the recent emphasis to address the opioid crisis. One set of non-pharmacological treatment options are evidence-based complementary and integrative health (CIH) approaches, such as yoga, acupuncture, and meditation. The Veterans Health Administration (VHA), the nation’s largest healthcare system, has been at the forefront of implementing CIH approaches, given their patients’ high prevalence of pain, anxiety, and depression. We aimed to conduct the first national survey of veterans’ interest in and use of CIH approaches.

METHODS: Using a large national convenience sample of veterans who regularly use the VHA, we conducted the first national survey of veterans’ interest in, frequency of and reasons for use of, and satisfaction with 26 CIH approaches (n = 3346, 37% response rate) in July 2017.

RESULTS: In the past year, 52% used any CIH approach, with 44% using massage therapy, 37% using chiropractic, 34% using mindfulness, 24% using other meditation, and 25% using yoga. For nine CIH approaches, pain and stress reduction/relaxation were the two most frequent reasons veterans gave for using them. Overall, 84% said they were interested in trying/learning more about at least one CIH approach, with about half being interested in six individual CIH approaches (e.g., massage therapy, chiropractic, acupuncture, acupressure, reflexology, and progressive relaxation). Veterans appeared to be much more likely to use each CIH approach outside the VHA vs. within the VHA.

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Agents of Change: How Do CAM Providers Play a Role

By Frank M. Painter|June 4, 2018|Alternative Medicine|

Agents of Change: How Do Complementary and Alternative Medicine Providers Play a Role in Health Behavior Change?

The Chiro.Org Blog

SOURCE: Altern Ther Health Med. 2011 (Jan); 17 (1): 22–30

Pamela A. Williams-Piehota, PhD; Fuschia M. Sirois, PhD; Carla M. Bann, PhD; Karen B. Isenberg, MPH; Edith G. Walsh, PhD

RTI International,
Research Triangle Park,
North Carolina, USA.

BACKGROUND: Recent investigations indicate that complementary and alternative medicine (CAM) use may be conducive to health behavior change.

OBJECTIVE: The goal of this study was to investigate how this change occurs.

METHODS: Using Social Cognitive Theory (SCT) and Self-determination Theory (SDT) as guiding frameworks, we surveyed a convenience sample of 216 CAM consumers abouttheir CAM therapy and iors and conducted focus groups with 36 CAM consumers.

RESULTS: Consumers reported encouragement from providers and improved energy resulting from treatments as reasons for making health behavior changes. Multivariate analysis showed that increased odds of self-reported dietary change were significantly associated with increasing body awareness as a result of therapy, endorsing the statement that sustained improvement for their health conditions required self-care, using an acupuncturist, and being 44 years or younger. Comparable results were found for exercise change, except using an acupuncturist was a significant negative predictor and age was not significant. Focus group findings echoed these themes.

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The Manipulative Therapies: Osteopathy and Chiropractic

By Frank M. Painter|March 2, 2018|Alternative Medicine, Complementary Medicine|

The Manipulative Therapies: Osteopathy and Chiropractic

The Chiro.Org Blog

SOURCE: British Medical Journal 1999 (Oct 30); 319 (7218): 1176-1179

Andrew Vickers and Catherine Zollman

Osteopathy and chiropractic share a common origin. Their roots can be found in folk traditions of “bone setting,” and both were systematised in the late 19th century in the United States: Daniel D Palmer, the founder of chiropractic, is said to have met with Andrew Taylor Still, the founder of osteopathy, before setting up his own school. The therapies remain relatively similar, and many textbooks and journals are relevant to both. The term “manipulative therapy” refers to both osteopathy and chiropractic.

From the FULL TEXT Article:

Background

Osteopathy and chiropractic are therapies of the musculoskeletal system: practitioners work with bones, muscles, and connective tissue, using their hands to diagnose and treat abnormalities of structure and function.

The best known technique is the “high velocity thrust,” a short, sharp motion usually applied to the spine. This maneuver is designed to release structures with a restricted range of movement. High velocity thrusts often produce the sound of joint “cracking,” which is associated with manipulative therapy. There are various methods of delivering a high velocity thrust. Chiropractors are more likely to push on vertebrae with their hands, whereas osteopaths tend use the limbs to make levered thrusts. That said, osteopathic and chiropractic techniques are converging, and much of their therapeutic repertoire is shared.

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