Why Your MD May NOT Be the Best Choice for Your Back Pain
From time to time I will get on Facebook and notice that a friend has some sort of back pain and they are wondering what they should do. This morning I saw this one:
"So I have this sharp pain in my lower back and left hip that knocks me down if I don't handle it right. I can stand just fine, but sitting, lying down, bending, squatting, turning, and walking are killer. My face is developing permanent grimace lines. I don't have to go to a chiropractor, do I?"
The comments section will fill with the advice of well-meaning friends. Ice it then heat it. Heat it then ice it. Go see a chiropractor. Go see an acupuncturist. Don't see and acupuncturist or a chiropractor. Come to my Yoga class. You need surgery. You have sciatica. Physical therapy is the answer.
It's almost as if the flurry of advice compounds the problem instead of making it better. Like I said before… well-meaning friends… but what is somebody to do when they are faced with all of these options? Well I really just want to comment on the piece of advice that irks me the most which is probably one of the least productive things you can do. That is: Go to your MD. They can decide if this is something minor that can be handled by a chiropractor or if it is serious and needs surgery.
People who give this advice operate under the false assumption that MDs have a lot of training in diagnosing or treating back pain. The truth is that there is very little training on musculoskeletal (that is muscle and joint) conditions in medical school. Unless an MD receives specific orthopedic or sports medicine training then their training is very basic. When I receive a referral from a medical doctor or review chart notes by an MD treating a low back pain case the most common diagnosis they use is code 724.2 which is the code for "Low Back Pain". Yes that's right. You go to the MD and tell them you have low back pain and they diagnose you with… low back pain. Usually this only costs you a couple hundred bucks. There are dozens of more specific ways to diagnose back pain but MDs typically don't have the training to identify the different types.
Shocked? I'm not just picking on MDs. They know this themselves. A 1999 survey of the Steering Committee on Collaboration among Physician Providers Involved in Musculoskeletal Care revealed that the percentages MDs who felt adequately prepared to physically assess problems of low back pain was 31%. See what I'm saying? The problem is that most MDs would never let you know that they didn't feel confident about treating your back pain. They are trained in school to appear confident regardless of the challenge. As a result we expect them to have all of the answers when we have a problem. You can see though that less than 1/3 of them do.
As a result they tend to offer the riskiest and least effective treatment methods with comparrison to what they have labeled "Complementary and Alternative" methods. Narcotics are routinely prescribed to cover low back pain symptoms without thought or attempt to ascertain the actual cause of the problem. Some patients risk drug interactions, adverse reactions and even addiction. Over-the-counter drugs also pose significant risks as NSAIDs like ibuprofen, aleve, and advil which kill about 16,000 people every year. MDs also frequently order unnecessary and expensive tests such as MRI for simple problems. Meanwhile much safer and more effective therapies such as Chiropractic or Osteopathic Manipulation are considered a second tier option by MDs for treating back pain? It is time to switch our thinking about the role of these therapies when it comes to musculoskeletal conditions. Or more to the point, drugs and surgery need to be considered the alternative treatment methods.
As a Doctor of Chiropractic my primary training is in the diagnosis and treatment of musculoskeletal conditions. To become a chiropractor requires thousands of hours in the study, diagnosis and treatment of these problems. In all my years of practice I have never diagnosed a low back condition as 724.2 – Low Back Pain. Let's be honest. You can diagnose yourself with that for free. Because of my training I know when to order an X-Ray, MRI or refer for surgery. I know the difference between a simple strain, a disc injury or even evidence that the problem could even be cancer. My treatments carry a very low level of risk and chiropractic is consistently rated as the treatment method with the highest level of patient satisfaction for low back pain. When you have back pain you want an expert. Typically, that is not your MD. Don't get me wrong… MDs are great at many things but for low back pain you have much better options.
So in the future, if you want to help a friend you can post a link to this post in the comments. You'll be doing them a favor!