After all the discussion of drugs and their role in pain management, and the problems inherent in using drugs for pain.
MedRisk CEO Shelley Boyce introduced experts from the Netherlands and the US. There are several key differences between the US and the Netherlands. The Dutch health care system is compulsory and based on managed competition between insurers; consumers can switch insurers yearly without penalty. The disability system is employer based with total annual costs of about 465 million euros.
Rehab centers are licensed, with Ciran one of the largest providers with annual revenue of about 16.6 million euros. Interestingly Ciran operates on a franchise model, with uniform operating standards and guidelines. Ciran doesn’t use any medications in their work, instead relying on their structured approach, inclusion of cognitive behavioral therapy, and pre-planned treatment course that is developed in advance of treatment. Patient progress and achievement of goals are measured weekly.
Ciran’s outcomes are remarkable.
In a population where 77% present with musculoskeletal, pain, and mental health problems; and a large percentage have ‘claims’ more than two years old. Clearly these are tough patients. The data presented by Ciran clearly indicate improvements in physical function, reduced levels of depression and anxiety, and improved coping over the 16 week treatment regimen. Health complaints are also dramatically reduced and health status improved.
The session’s final speaker reported that fully 13.5% of the US population were treated for spine issues in 2006. Over the ten years before 2006, inpatient costs went up 53%, medications more than doubled, and overall cost of treatment doubled.
Yet there was no discernible improvement, and the data actually indicate functional health status of patients declined across several metrics over the same period.
That’s right: cost of spinal care doubled and outcomes were worse.
The presentation continued with what can only be described as a debunking of ideas and concepts that are commonly accepted as truisms. Spinal issues are not caused by injuries but rather by genetically-driven disc degeneration due to – you guessed it – aging.
The implications are enormous. Work activities account for 1% of disc degeneration, genetics accounts for 74%.
Back pain isn’t caused by accidents or work-related injuries or disc degeneration but by genetics. And there is no real association between herniated discs, bulging discs, or even ruptured discs and pain.
This is big news and deserves a dedicated post. I’ll do that next week.
Nov
17
You had me until the following statement:
And there is no real association between herniated discs, bulging discs, or even ruptured discs and pain.
Surely I’m not the only one who knows someone who had a herniated or ruptured disc whose pain was immediately relieved by surgery addressing the herniation. While admittedly not always the case, to say or suggest that a herniated or ruptured disc does not have a real association with pain is an incredulous statement and one that I believe the vast majority of spine specialists would refute.
Any second thoughts about that bold of a statement?
The assertion is not bold, the fact is simply little-known. The science has been around for awhile. Bulging discs are found in people with pain and those with no symptoms.
Discectomy, laminectomy and spinal fusion all have disappointing outcomes. I’m sure you can find someone who had surgery and found relief. I know somebody who found relief with a magnetic belt.
There’s just no science behind the surgical interventions for back pain.
Check out Nguyen in the recent Spine, Volume 36, Number 4, pp 320–331
Lumbar fusion is associated with significant increase in disability, opiate use,
prolonged work loss, and poor RTW status.
It’s always bothered me that back pain is considered to be attributable to bulging discs. Granted, some individuals have discs that actually produce symptoms, but many who are completely symptom free have bulging discs. And many with symptoms have intact discs. It appears to me that discs are only one of the elements in a complex problem. The Back Book (by Burton et al) says back pain can be attributed to backs that are not working and are out of condition. That works when we think about heart problems. Why not consider the same for back pain?
It wasn’t by accident that my discussion of the statement in question excluded “bulging discs”.
Clearly there are factors other than herniated or ruptured discs that play a part in back pain. But to say they have no real association with back pain does not work for me.