Tuesday, May 19, 2009
www.drshoshany.comGuideline for Low-Back Pain Interventions
Herniated disc protocol in our Manhattan NYC clinic is a Intensive interdisciplinary rehabilitation program. This Protocol involves Non-surgical spinal decompression on the DRX 9000, three dimensional rehabilitation using the Spine Force, Massage therapy, Acupuncture,Nutritional support.We custom fabricate corrective orthotics to correct improper gait biomechanics.
Research review by investigators in the Oregon Health & Science University Evidence-based Practice Center prompts America Pain Society to issue new clinical practise guideline
The American Pain Society (APS) has issued a new clinical practise guideline for low back pain that emphasises the use of noninvasive treatments over interventional procedures, as well as shared decision making between provider and patient. The findings are published in the current (May 1, 2009) issue of the journal Spine.
The new APS guideline, based on an extensive review of existing research, provides clinicians with eight recommendations to help determine the best way to treat patients with low-back pain. It also expands its current and previously published guideline for initial evaluation and management of this chronic condition.
"These recommendations are based on an even more complete body of evidence than was available just a few years ago. Consequently, we believe these recommendations will give physicians more confidence when treating patients with persistent back pain," said Roger Chou, M.D., lead author, director of the APS Clinical Practice Guideline Program, and associate professor of medicine (general internal medicine), Oregon Evidence-based Practice Center, Oregon Health & Science University.
"Unfortunately, randomised trials for a number of commonly used interventional procedures are still too limited to generate evidence-based recommendations, and our review also highlights the need for more research," Chou added.
Low-back pain is the fifth most common reason for doctor's visits and accounts for more than $26 billion in direct health care costs nationwide each year. While a number of interventional diagnostic tests and therapies, and surgery are available, and their use is increasing, in some cases their usefulness remains uncertain.
"We have advocated strongly in many of our recommendations for physicians to use shared decision making because of the relatively close trade-offs between potential benefits relative to harms, as well as costs and burdens of these various treatment options," Chou explained. Shared decision making involves a patient's full participation in medical choices after receiving comprehensive information about the impact of all options on his or her particular life situation.
To develop the guideline, a multidisciplinary APS panel, augmented by experts on interventional therapies, reviewed 3,348 abstracts and analysed 161 relevant clinical trials. The panel found that the evidence for the use of these interventions was mixed, sparse or not available. Based on the data the panel gathered, the APS now recommends:
1. Against the use of provocative discography (injection of fluid into the disc in order to determine if it is the source of back pain) for patients with chronic nonradicular low-back pain.
2. The consideration of intensive interdisciplinary rehabilitation with a cognitive/behavioural emphasis for patients with nonradicular low-back pain who do not respond to usual, non-interdisciplinary therapies.
3. Against facet joint corticosteroid injection, prolotherapy, and intradiscal corticosteroid injections for patients with persistent nonradicular low-back pain, and insufficient evidence to guide use of other interventional therapies.
4. A discussion of risks and benefits of surgery and the use of shared decision making with reference to rehabilitation as a similarly effective option for patients with nonradicular low-back pain, common degenerative spinal changes, and persistent and disabling symptoms.
5. Insufficient evidence to guide recommendations for vertebral disc replacement.
6. A discussion of the risks and benefits of epidural steroid injections and shared decision making, including specific review of evidence of lack of long-term benefit for patients with persistent radiculopathy due to herniated lumbar disc.
7. A discussion of the risks and benefits of surgery and use of shared decision making that references moderate benefits that decrease over time for patients with persistent and disabling radiculopathy due to herniated lumbar disc or persistent and disabling leg pain.
8. Discussion of risks and benefits of spinal cord stimulation and shared decision making, including reference to the high rate of complications following stimulator placement for patients with persistent and disabling radicular pain following surgery for herniated disc and no evidence of a persistently compressed nerve root.
Chou and his colleagues also reaffirm their previous recommendation that all low-back pain patients stay active and talk honestly with their physicians about self care and other interventions. "In general, noninvasive therapies supported by evidence showing benefits should be tried before considering interventional therapies or surgery," said Chou.
Recommendations from the first APS Clinical Practise Guideline on Low-Back Pain are intended for primary care physicians and appeared in the Oct, 2, 2007, issue of the Annals of Internal Medicine. For diagnosis, the first APS low-back pain guideline advises clinicians to minimise routine use of X-rays or other diagnostic tests except for patients known or believed to have underlying neurological or spinal disorders
About the American Pain Society
Based in Glenview, Ill., the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practise to reduce pain-related suffering.APS was founded in 1978 with 510 charter members. From the outset, the group was conceived as a multidisciplinary organisation. APS has enjoyed solid growth since its early days and today has approximately 3,200 members. The Board of Directors includes physicians, nurses, psychologists, basic scientists, pharmacists, policy analysts and more.
This is an exciting new study because it confirms what Chiropractors have been saying for many years, Surgery and drugs to manage Low back pain is not the best treatment option.
In our New York City office we combine the best of the latest non-surgical technology like Spinal decompression,3D Spinal rehab, Physical therapy, Medical care and of course Chiropractic care to offer patients the most comprehensive care for back pain treatment.
Visit our website at www.livingwellnewyork.com
or my personal website which has an impressive amount of research on the benifits of non surgical spinal decompression