Overcoming Back Pain: New Doctor Recommendations

According to an American College of Physicians (ACP) press release posted 2/14/17 and entitled ACP Issues Guideline for Treating Nonradicular Low Back Pain:

<The ACP>…recommends…that physicians and patients should treat acute or subacute low back pain with non-drug therapies such as superficial heat, massage, acupuncture, or spinal manipulation.

“Physicians should reassure their patients that acute and subacute low back pain usually improves over time regardless of treatment,” said Nitin S. Damle, MD, MS, MACP, President, ACP. “Physicians should avoid prescribing unnecessary tests and costly and potentially harmful drugs, especially narcotics, for these patients.”

I had a chance to catch up with Sandra Doman, DC of Aventura to learn more about the new guidelines, how the updated protocol affects the approximately one quarter of U.S. adults who have reported having low back pain lasting at least one day in the past three months, as well as the providers who care for them.

JH     Why is this good news for patients?

SD    These therapies are safer, more effective, and less expensive in the long term. They allow a patient to take on-going responsibility to decrease their back pain and improve their overall health. Combining meditation-based movement therapies like yoga and tai chi along with other non-drug approaches such as spinal manipulation, acupuncture, and massage have provided unbelievable breakthroughs and sustained relief for back pain sufferers.

JH     In my experience medical doctors are skeptical of alternative therapies. Is this some long-sought validation for alternative practitioners?

SD    Reasonably good evidence in favor of these approaches has been available for more than a decade depending on the specialty. That being said, it takes a long time to shift the establishment and maybe even a crisis, like the opioid epidemic, that forces thought leaders to take a closer look at safer alternatives. MDs and alternative care providers can now work together more formally towards the common goal of delivering excellent and safe outcomes for patients.

JH     Let’s say you are a patient who suffers from lower back pain. You go to an orthopod who recommends an interventional approach: pharmaceutical pain medications and an eventual surgery. You then go to an osteopathic physician or a chiropractor who recommends a non-interventional approach: nutrition, yoga, acupuncture, meditation, etc. How do you resolve the conflicting treatment plans?

SD    The decision always falls with the patient. It is incumbent now upon the orthopod or managing MD to discuss the new recommendations with the patient and hopefully provide resources. The new ACP recommendations illustrate that lifestyle-based therapies that improve your physical and emotional health ARE the most effective for reducing low back pain. Medical intervention is best for emergencies, not for restoring health.

JH     If the ACP recommends it, eventually the payers will be compelled to cover it. Alternative medicine practitioners often enjoy the benefits (higher reimbursements, less red tape, less regulatory oversight) of cash driven practices. If alternative medicine becomes increasingly mainstream, does that threaten to spoil it for alternative practitioners by bringing in the insurers and regulators?

SD    Chiropractors, acupuncturists and massage therapists are already highly regulated and covered by most payers! The other movement therapies are working on more stringent regulations as we speak. For example the International Association of Yoga Therapists (IAYT) governs over a longer, more intensive training protocol geared towards health care than previously available. Insurance companies are in for a big win to include these natural therapies, thereby decreasing the need for expensive surgeries.