Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
The authors also admit that "when this result is taken together with those from recent reviews on paracetamol [acetaminophen/Tylenol] and opioids, it is now clear that the three most widely used and guideline-recommended medicines for spinal pain do not provide clinically important effects over placebo."1
Wow! That means a considerable amount of money is being spent every year on drugs that are no better than placebo:
Oddly enough, this is actually good news for chiropractors who have always wanted to prescribe OTC or prescription drugs. They can now give their patients sugar pills and say with absolute certainty they will work just as well as any of the popular pain drugs currently available, and without any side effects.
But Wait, There's More...
An article published last year in The New York Times4 reviewed various surgical procedures the authors call "useless." Among them: spinal fusion, which a 2007 systematic review found "may be more efficacious than unstructured nonsurgical care for chronic back pain but may not be more efficacious than structured cognitive-behavior therapy."5 Yet spinal fusion surgeries increased 2.4-fold between 2000 and 2009.6
The article notes that vertebroplasty (cementing cracked vertebrae) was no better, as a 2009 study revealed: "Improvements in pain and pain-related disability associated with osteoporotic compression fractures in patients treated with vertebroplasty were similar to the improvements in a control group."7
The Power of Promotion
Based on the above, the issue is clearly not what is best for the patient, but what is best promoted. The authors of the NSAIDs article came to a conclusion that reveals a lack of perspective: "There is an urgent need to develop new analgesics for spinal pain." It makes me wonder if perhaps we have been approaching the promotion of chiropractic care in a format the medical profession can't (or refuses to) understand.
As I look at the latest data from the Rhode Island integrated chronic pain program (look for an article on this program in our May issue), it is again clearly demonstrated that chiropractic reduces the cost of care, as well as the use and potential side effects of unnecessary drugs and surgery. But who makes the decision to (dare I say the word) prescribe chiropractic, rather than opioids – and how is that communicated to the patient?
Perhaps we need to begin a campaign to educate MDs on how to prescribe (there's that uncomfortable word again) six initial sessions of chiropractic before they prescribe drugs or refer for surgery. We know that in the vast majority of cases, chiropractic care will meet the patient's need and facilitate the healing and pain relief, while drugs will only mask the problem.
Food for thought...
References
- Crownfield P. "A Poor Choice for Pain Relief." Dynamic Chiropractic, May 15, 2015.
- OTC Sales by Category 2012-2015. Consumer Health Prod-ucts Association.
- Gusovsky D. "Americans consume vast majority of the world's opioids." CNBC, 27 Apr 2016.
- Kolata G. "Why 'Useless' Surgery Is Still Popular." The New York Times, Aug. 3, 2016.
- Mirza, SK, Deyo RA. Systematic review of randomized trials comparing lumbar fusion surgery to nonoperative care for treatment of chronic back pain. Spine, 1 April 2007;32(7):816-823.
- Yoshihara H, Yoneoka D. National trends in the surgical treatment for lumbar degenerative disc disease: United States, 2000 to 2009. Spine J, 1 Feb, 2015;15(2):265-271.
- Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med, 1 Aug, 2009;361:569-579.
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