What to do about Back Pain? “Tell the Bells!”

CHOOSING WISELY

WHAT TO DO ABOUT BACK PAIN?

Many healthcare professions are setting forth recommendations for their respective practitioners to follow when delivering health care. They hope to open conversations between patients and their healthcare providers and among healthcare providers themselves. Back pain is a huge health issue affecting 80% of us at some point in life. Back pain is managed by many types of physicians in many types of societies. Their societal recommendations are similar regarding (1) imaging (Don’t do imaging within the first 6 weeks of pain unless there are “red flags.”), (2) trying non-surgical care before imaging and/or referring for back surgery, and (3) moving the patient care from passive care to active care. More specifically, the American Academy of Physical Medicine and Rehabilitation recommends not ordering repeat epidural steroid injections without checking for the response to the last one and not prescribing opioid drugs for acute disabling low back pain without evaluation and a trial of other alternatives. (2) The American Chiropractic Association recommends not performing repeat imaging to monitor progress of care, not obtaining spinal imaging for acute low back pain in the first 6 weeks of pain unless there are red flags, and avoiding long term use of passive care but instead move the patient to active care. (3) The American College of Emergency Room Physicians recommends avoiding lumbar spine imaging in non-traumatic back pain unless there are severe or progressive neurological deficits or a suspicion of an underlying condition. (4) The American College of Physicians recommends not obtaining imaging studies in patients with non-specific low back pain. (5) The North American Spine Society recommends not suggesting bed rest for more than 48 hours for low back pain, not using EMG studies to determine the cause of spine pain, and not doing advanced spinal imaging (ex MRI) in the first 6 weeks of non-specific acute low back pain without red flags. (6) The Danish Health Authority recommends not referring patients for back surgery for a lumbar disc herniation with radiculopathy unless the severe and debilitating back pain persists for 12 weeks despite non-surgical treatment.

It’s up to you, the back pain patient or concerned loved one, to choose wisely the course of care for back pain relief. Use these professions’ Choose Wisely recommendations for back pain care to start a conversation with your chiropractic physician about the best plan for you.
Gerald O. Bell, BSc, BA, DC

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