Research finds back pain assessments show room for improvement
Most people who experience back pain will consult their medical doctor first for treatment and advice. In fact, one third of all office visits to a medical doctor are for spine and spine related problems. Not only is back pain a huge burden on our health care system, it has many causes and is therefore difficult to diagnose. Dr. Jason Busse, Chiropractic Research Chair at McMaster University is conducting research into ways to improve medical assessments for low back pain and create greater efficiency when determining the most appropriate course of care.
Dr. Busse’s research reinforces the notion that most medical doctors are not confident in their diagnosis of spine conditions. Back pain can result from physical, chemical or emotional stress. It can be difficult to pin down the individual factors that are causing each patient’s case of back pain. As a result, many doctors consult advanced medical imaging such as CT Scans or MRIs as part of the assessment process when in reality, these types of imaging are best used to reinforce or rule out a diagnosis. Imaging used for assessment purposes is generally not helpful.
In order to gain confidence in the patient’s diagnosis, Dr. Busse is investigating better assessment techniques that include the involvement of a chiropractic doctor in conjunction with a medical doctor. Through this collaborative approach, Dr. Busse’s research suggests that patients who require conservative care, advanced imaging or surgical assessment would be easier to identify and triage appropriately.
With our current system, back pain patients who do not recover or “fail” are usually referred by their medical doctor for surgical consult to a spine surgeon. The wait time for this consult in Canada is approximately six months. When Dr. Busse polled Canadian spine surgeons he found that 20% of referred patients are rejected without a consult. These patients are left to find another way to manage their condition. Of the patients that do receive a surgical consult, only one in every ten is an eligible candidate for surgery. These patients must then wait another six months for their surgery.
A recent study into the early predictors of lumbar spine surgery after occupational back injury also highlighted another interesting point about the incidence of spine surgery amongst injured workers. Of these patients, 42.7% of those who first saw a spine surgeon had surgery while 1.5% of those who saw a chiropractic doctor first were referred for surgery.
These findings suggest that conservative care can play a key role in the appropriate treatment and management of back problems. Dr. Busse’s research continues to build on this idea with the goal of better patient outcomes and a more streamlined assessment process. Through this shift in cultural behaviour for the treatment of chronic spinal conditions, health care dollars can go farther with less need for surgery and imaging and focus can be given to what is truly best for the patient and their recovery.