New study slams medical treatment for back pain

backsA new study on back pain in the prestigious medical journal, the Lancet, roundly criticises medical treat of low back pain. Researchers from all over the world took part and looked at how back pain is treated and they concluded that there is “inappropriately high use of imaging, rest, opioids, spinal injections, and surgery.”  They go on to say that “Doing more of the same will not reduce back-related disability or its long-term consequences.”

Back pain is now the number one cause of disability globally and rates have continued to rise in spite of increased spending on treatment. The authors make a plea for more sense and evidence based treatment. They call for a new direction which encompasses emerging treatments alongside effective solutions that exist already.

Effective treatment for back pain

Guidelines exist for doctors to follow on the most effective sorts of treatment but often these are ignored or not implemented properly. Here in the UK, NICE has issued guidelines and these are mentioned in this study as being helpful and they echo the findings in this paper.  The evidence points to a biopsychosocial model of care which looks at the behavioural, psychological, and social factors as well as the anatomical structures which play a role in the persistence of pain and disability. What does this mean for you if you have back pain?

It means that there is greater emphasis on self-management, physical and psychological therapies, and some forms of complementary medicine, and less emphasis on pharmacological and surgical treatments. So staying active, doing gentle exercises, getting some manual therapy as well dealing with stress, anxiety and depression, especially negative feelings around pain and disability, are very helpful. Some guidelines also recommend massage and acupuncture. One thing the guidelines in the US Denmark and UK agree on is that spinal manipulation is helpful. Which is good news because that’s what we do here at Sundial.

The report goes on to highlight the differences in standards of care throughout the world and it is clear that there is huge variance in practise and approach. For instance in the USA only half of back sufferers are prescribed exercises and in Sweden, USA and Australia electrical modalities like ultrasound are routinely used in spite of being ineffective.

Back pain is not one condition

This review is an excellent summary of the worldwide management of low back pain but has its limitations. Back pain is not one condition but several conditions causing a similar group of symptoms. A muscle spasm, disc derangement and a spinal joint dysfunction all cause low back that can refer pain down to the buttock and leg and a skilled clinician can tell which problem it is likely to be. Whilst several conditions can co-exist it is clear that an accurate diagnosis is important because the treatment is different for all three. Here at Sundial we make sure we make an accurate diagnosis and agree a treatment plan that is the most likely to get the best results.

If you would like a free check up to see if we can help your back pain please give us a call or book online above

 

Reference:

Prevention and treatment of low back pain: evidence, challenges, and promising directions

Foster, Nadine EBuchbinder, Rachelle et al.
The Lancet , Volume 0 , Issue 0 ,

21 March 2018

Neck pain treatment – what works?

Chiropractors BrightonNeck pain is remarkably common with nearly half of us suffering at one time or another. Worst of all it keeps coming back.  Many different types of treatment are currently used so which ones should you choose if you have neck pain? A recent review into the best ways to treat neck pain has just been published and it makes interesting reading.

Manipulation or mobilisation are good treatment options for neck pain especially when combined with laser therapy and advice, stretching and specific exercises. Massage can be helpful in combination with other forms of treatment but not on its own. This package of care is what our chiropractors and physio’s do here at Sundial.

The treatments that don’t have evidence of working for neck pain include TENS machines (is anyone still using these?); traction and trigger point therapy (a form of deep pressure on tender tight points in a muscle).

These findings are broadly similar to the Bone and Joint Decade (BJD) Task Force report on neck pain in 2008.  In this report they go further by recommending acupuncture and pain killer medication. The list of treatments unlikely to help for neck pain are the same but go on to advise against surgery, collars, ultrasound, most types of injection into the neck and radio-frequency denervation.

The BJD report offers some helpful advice about choosing the right sort of treatment for a bad neck. Don’t expect to find a single “cause” for your neck pain. Stay as active as you can, reduce mental stress and try over-the- counter pain relievers first. If pain persists then seek treatment form a practitioner with the right sort of expertise. The authors conclude that no one treatment is likely to help everyone and you may need to mix and match approaches to find what works for you. Any treatment should show some improvement in your symptoms within two to four weeks. If not try something else. This advice also applies if you have mild whiplash from a road traffic collision for instance.

So what are the main points from these two reports? Two groups looking at neck pain independently have come up with very similar recommendations. These recommendations are also similar, as you might expect, for other spine related problems like back pain. Conservative treatment is best, you have to help too by doing the home exercises and keep going to find what works for you.

These messages are a big relief to the thousands of people who endure regular neck pain.

 

References

Evidence-based guidelines for the chiropractic treatment of adults with neck pain. Bryans R, Decina P, Descarreaux M, et al. Journal of Manipulative & Physiological Therapeutics 2014; 37: 42-63.

The Bone and Joint Decade 2000- 2010 Task Force on Neck Pain and Its Associated Disorders; Executive Summary,  (2008), Haldeman S, Carroll L et al. Spine 33(4S):S5-S7

Bupa and Axa PPP cover our chiropractors and physio’s in Brighton

Bupa accpetedHere at Sundial Clinics, Brighton we often get asked if patients can claim their fees back from their health insurance companies. Most of the time, you can.

At Sundial we have chiropractors and physiotherapists who are recognised by both Bupa and Axa PPP.   Both these private health insurers have a restricted list of recognised practitioners in each speciality.  To become recognised, there are a number of requirements, including being in practice for more than 5 years  and having references from medical consultants. We also have to adhere to strict guidelines on quality assurance, patient satisfaction and probity.

If you are thinking of making a claim on your health insurance for chiropractic or physiotherapy then it’s worth checking your policy to see if there is an excess and to check the limit of the cover. You will then need to call your insurer to get a claim number which you can pass on to us. We can claim your fees back from your insurer directly or you can pay us and can claim back the fees yourself. You may also need to be referred by a GP in order to make a claim. This is usually straightforward and GPs are generally happy to do this.

If you need an MRI scan or an x-ray, this will often be covered as well. Things that aren’t covered include extra services such as massage and products such as nutritional supplements and orthotics.

Pre-existing conditions

Most health insurance companies will not accept a claim for pre-existing conditions. If you have back pain that comes and goes, it can be difficult for an insurer to assess whether or not this is a pre-existing condition or whether the back problem completely resolves and each presentation is in fact a new episode. If you have any doubts as to which sort of back pain you have then please get in touch as we may be able to help in providing the insurer with accurate information.

Sometimes an insurer will suggest another practitioner in your area. If, however, a practitioner is on your insurers approved list, you can choose to see who you like. If you have any queries, please give us a call.

 

Axa PPP

Simply Health WPA

Soreness after chiropractic care

Chiropractic care -safe and effective
Chiropractic care -safe and effective

Mild adverse reactions to chiropractic care are quite common. Sometimes this is normal, in much the same way that soreness after unaccustomed exercise can occur. A new study sheds further light on what might be considered normal in conditions like back and neck pain that tends to come and go anyway.

Researchers at Murdoch University in Australia took a new approach to investigating reactions after chiropractic care. They divided chiropractic patients who were in their 20s all the way up to their 80s into two groups. Both groups had spinal pain but one group received normal chiropractic care and the other group received sham treatment. Neither group knew whether they received the real treatment or not.

12 chiropractic clinics and 180 people took part in the trial. Each patient received two treatment sessions and then filled in a questionnaire some while after each one. In this sort of study you might expect at the group that had received the real treatment would have the usual incidence of soreness and the group that didn’t receive treatment would feel fine. But was this the case?

In fact what happened was the group that had the sham treatment had nearly the same incidence of soreness (33%) afterwards as the group that had received the real treatment (42%). In other words, the temporary soreness that many people put down to chiropractic treatment may in fact be the normal ups and downs that their symptoms go through from week to week anyway.

What do we do to limit soreness after treatment?

Here at Sundial, we always aim to treat you as gently as we possibly can. When you first start treatment we will be using the most gentle techniques we can such as table assisted spinal decompression which gently stretches the discs. Here, light pressure is applied to your spinal vertebra as you lie on your tummy and the lower part of the treatment table rocks up and down.

Another gentle treatment we use here at Sundial Queens Road involves using precision electronic instrument adjusting such as the Impulse iQ. The iQ gently mobilises individual spinal bones and senses when movement has been restored. We are the only clinic in Brighton and Hove to use this leading technology. A similar technique involves using a spring-loaded adjusting instrument called the Activator. Most people who have experienced the Impulse iQ or Activator absolutely love it.

Selecting the right technique for you comes down to several factors. How severe your problem is combined with how long you’ve had it as well as your level of general fitness and overall body size and shape are all important. Sometimes, however, it just boils down to your personal preference. Some people don’t like the clicking type of spinal adjustments and fortunately we have several other options. We will discuss this with you before treatment begins.

Reference

Outcomes of Usual Chiropractic; Harm (OUCH). A randomised controlled trial. Spine 2013 Jun 17.
Walker BF, et al