New recommendations emphasize non-opioid treatments
Hurt your back, take a pain pill. That’s a common treatment, right? Sure is. In 2014, more than 240 million prescriptions were written for opioids. That’s more than enough to give every adult in the nation their own bottle of pain pills. Today, the opioid situation in the United States has escalated to an epidemic.
Overdose deaths from opioids have nearly quadrupled since 1999. And prescription opioid abuse has a $55 billion annual impact in health and social costs, according to a June 2016 report from the Department of Health and Human Services. Many of those who suffer from low back pain — one of the most common types of pain — turn to prescription opioids for relief.
Drugs have long been the traditional first-line therapy for low back pain, but new recommendations from the American College of Physicians encourage non-pharmaceutical treatments such as heat therapy, massage, acupuncture and spinal manipulation. Physical therapy can also help for chronic pain, it says. The new protocol aims to standardize care, cut costs, ditch opioids and reduce unnecessary MRIs.
Michael Allgeier, DC, a chiropractor with Mercy Hospital and Medical Center, sees a lot of patients seeking relief from low back pain. That’s not a surprise given that about 31 million Americans are living with low back pain at any time, according to the American Chiropractic Association.
“Over the past 20 to 30 years, we as a healthcare community have generally overmedicalized low back pain with a lot of expensive diagnostic testing and aggressive treatments too early in the episode of pain,” Allgeier says. “This has led to a lot of people thinking they have more of a pathology than they really do.”
This translates into many an expensive MRI yielding misleading or inconclusive results. “Ironically, using imagingstudies or very strong medication too early in care has been shown to worsen outcomes in the long term,” he says.
This is where chiropractic can lend a hand. Allgeier incorporates treatments including McKenzie exercises (stretch exercises that can relieve low back pain quickly), manual manipulation to the spine (e.g. “cracking” a joint), myofascial release and stabilization exercises to help patients find relief.
Allgeier often refers his patients to additional therapies. “I refer about 15 to 20 percent of my patients to an advanced specialist like a pain management or surgical practitioner at least for a consult,” he says. “I’ll also refer some patients for physical therapy, acupuncture, massage, yoga, Pilates or to just get a gym membership to exercise four or so times per week.”
“Sometimes there’s not a lot of value in finding the source of a patient’s pain,” says physical therapist Tom Denninger, DPT, with ATI Physical Therapy. “What makes more of a difference is how people describe their symptoms.” By better understanding a patient’s pain, along with how and for how long they experience it, Denninger can tailor therapies to decrease discomfort and improve their overall quality of life.
Denninger spends significant time with his patients getting to know their low back pain and how it impacts their lives. “Pain is personalized,” Denninger says. Which means treatment plans must be, too.
Roughly 70 percent of Denninger’s patients experience improvement in their low back pain (decreased pain levels, increased range of motion and better quality of life) in as few as four to six treatments over one month, he says.
“The biggest myth with low back pain is that you should just rest and let it heal,” he says. “Resting can actually prolong pain and disability. It’s important to keep moving, but make sure movements are within your tolerance. Also, see a healthcare provider who can make sure you keep moving.”
Prior to seeking alternative treatment for her low back pain, Julie Martin’s life was frustrating, to say the least. A college professor, she couldn’t carry her laptop to the building where she taught classes because of the severity of her pain. “I wasn’t able to do basic daily tasks such as unloading my dishwasher or going grocery shopping,” Martin confides.
“I’m a very independent person, so having to ask for help with these types of things was extremely frustrating for me.”
She finally found relief when her physical therapist introduced her to therapeutic dry needling (TDN). The needles look much like those used for acupuncture and are inserted into the skin at trigger points to relieve muscular tension. “It turns out that the TDN treatment really worked for me, and we incorporated that into my sessions along with more traditional physical methods.”
Today, Martin no longer has low back pain. She gets massages regularly and works out with a personal trainerat least once a week, but she credits the combination of alternative therapies for her much-welcomed pain-free life.
“When you have a problem like back pain that impacts daily life, it’s important to give every possible option a try,” Martin says. “I’ve found that it’s key to communicate with everyone giving you care. I also made adjustments in my daily routine that made a huge difference, like using a standing desk. All these things worked well together. My physical therapist was the point person for helping me to understand how each thing was contributing to my progress.”
While low back pain sufferers might not have caused the nation’s current opioid epidemic, specialists are doing their best to keep it from getting worse. A pill only masks the pain, but alternative treatments can help patients better manage the pain and live fuller, more mobile lives. Instead of running to the pharmacy, patients can actually hit the trails and go running.