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Top 5 Things NOT to do when you have pain

When it comes to pain, often the intensity or severity of the pain is not a good indicator of how bad the problem actually is.  Think about it, papercuts can hurt pretty bad, but in the grand scheme of things, those cuts are insignificant.  When people hurt they are looking desperately for the cause and solution of their pain. The problem is sometimes the answer is so simple that it is overlooked, and sometimes the “cure” is worse than the “disease”.

Here are the top 5 things NOT to do when you have back pain.

  1. Don’t prescribe opioid analgesics as first-line therapy to treat chronic noncancer pain. Consider multimodal therapy, including nondrug treatments, such as behavioral and physical therapies, before the pharmacologic intervention. If drug therapy appears indicated, try nonopioid medication, such as nonsteroidal anti-inflammatory drugs, or anticonvulsants, before starting opioids.
  2. Don’t prescribe opioid analgesics as long-term therapy to treat chronic noncancer pain until the risks are considered and discussed with the patient. Inform patients of the risks of such treatments, including the potential for addiction. Review and sign a written agreement identifying both your and the patient’s responsibilities (eg, urine drug testing) and the consequences of noncompliance with the agreement. Be cautious in co-prescribing opioids and benzodiazepines. Proactively evaluate and treat, if indicated, the nearly universal adverse effects of constipation and low testosterone or estrogen.
  3. Avoid imaging tests, such as MRI, computed tomography, or radiography, for acute low back pain without specific indications. Avoid these interventions for low back pain in the first 6 weeks after the pain begins if there are no specific clinical indications (eg, history of cancer with potential metastases, known aortic aneurysm, progressive neurologic deficit). Most low back pain doesn’t require imaging, and performing such tests may reveal incidental findings that divert attention and increase the risk of having unhelpful surgery.
  4. Don’t use intravenous sedation, such as propofol, midazolam, or ultra-short-acting opioid infusions for diagnostic and therapeutic nerve blocks, or joint injections, as a default practice. (This recommendation does not apply to pediatric patients.) Ideally, diagnostic procedures should be performed with local anesthetic alone. Intravenous sedation can be used after evaluation and discussion of risks, including interference with assessing the acute pain-relieving effects of the procedure and the potential for false-positive responses. Follow ASA Standards for Basic Anesthetic Monitoring in cases where moderate or deep sedation is provided or anticipated.
  5. Avoid irreversible interventions for noncancer pain, such as peripheral chemical neurolytic blocks or peripheral radiofrequency ablation. Such interventions may be costly and carry significant long-term risks of weakness, numbness, or increased pain.

This list was created because many medical doctors are commonly performing these procedures in spite of the fact that evidence-based guidelines suggest they shouldn’t.  At the top of the list is a recommendation to avoid prescribing opioid analgesics for non-cancer pain.  These are commonly prescribed even though there are an extremely high addiction rate and virtually no benefit in terms of outcomes.  As you look through the list, you will find an array of procedures/interventions which are probably being performed on your current patients.  As evidence-based practitioners it is imperative that we stay up to date on these topics and keep our patients informed regarding their health care choices.

Instead, Consider Chiropractic Care FIRST.

Chiropractors take a conservative approach when treating back and other types of pain and the benefits are many.  Here are just a few:

1. Pain Reduction

The first benefit of chiropractic care may be the most impactful- reducing your pain. Before you are living your optimal life, you have to be free of pain.  Multiple research studies have shown that chiropractic is considered one of the safest and effective treatments to reduce pain from your neck, low back, and more. Even if you are suffering from spinal stenosis, disc herniations, or foraminal encroachment- chiropractic may be able to help.

““Patients with symptomatic MRI-confirmed cervical disk herniations treated with SMT to the level of herniation reported high levels of clinically relevant improvement at 2 weeks, 1 month, and 3 months after the first treatment.”

— Outcomes from Magnetic Resonance Imaging-Confirmed Symptomatic Cervical Disk Herniation Patients Treated with High-Velocity, Low-Amplitude Spinal Manipulative Therapy. Journal of Manipulative and Physiological Therapeutics. October 2013

““Most of the patients who were considered surgical candidates for the treatment of radiculopathy from LDH improved with standardized spinal manipulative care to the same degree as those who had undergone surgery. Of those who failed spinal manipulation treatment, subsequent surgical intervention provided excellent outcome.”

— Manipulation or microdiskectomy for Sciatica? A Prospective Randomized Clinical Study. Journal of Manipulative and Physiological Therapeutics. Volume 33, Number 8. October 2010

2. Reduce The Frequency, Severity, and Intensity of Headaches

The second health benefit of chiropractic care, especially important if you have struggled with chronic headaches. Researchers have discovered that chiropractic care can reduce the frequency and intensity of headaches.  With over 20 million people suffering from headaches every day, this is a massive development in healthcare! The most common type of headaches includes; tension headaches and migraines. Tension headaches often include neck pain, muscle pain, and facial pain. Migraines are usually throbbing, can cause nausea and light sensitivity, and some even include an aura.

““With regard to the weekly register on frequency and intensity of pain, these parameters showed significant improvement in the groups with manipulation and combined treatment…”

— Efficacy of Manual and Manipulative Therapy in the Perception of Pain and Cervical Motion in Patients with Tension-Type Headache: A Randomized, Controlled Clinical Trial. Journal of Chiropractic Medicine. (2014) 13, 4-13

3. Improved Function and Quality of Life

Many people don’t go to the doctor when they have pain. They go to the doctor when that pain interferes with their quality of life!  If you have a healthcare issue that is keeping you for enjoying your hobbies, hanging out with friends and family, and limit your ability to perform well at work- then you are likely going to start researching on Google and eventually call a doctor to get answers.  Fortunately, getting back to your active lifestyle, and improving your quality of life (or in science-speak, “functional ability”) is one proven benefits of chiropractic care.

4. Reduced Medication Usage

Reducing medication use, and specifically, opioids are one of the primary focuses of our healthcare world today.

Each day over 100 people dies due to an opioid overdose. And it’s not only affecting addicts and junkies. A majority of opioid deaths come from people who were taking medications prescribed by their doctor.  Not only are these medications addictive and deadly, but in many cases, they are ineffective at helping people recover from spine pain, which is why most people start taking them. This vicious cycle leads people to take MORE medication an attempt to find relief, which only increases the likelihood of an adverse event or addiction.

There is a better way. Researchers have discovered that people who receive chiropractic care are 49% less likely to fill an opioid prescription. And, in my opinion, if we were able to reduce opioid use by nearly 50% just be helping people get well with chiropractic care- this world would be a different place!

Even what many people consider to be “safe” medications like NSAID’s contribute to over 100,000 hospitalizations, and over 3,000 deaths each year. Drugs should rarely be viewed as a first line treatment for spinal pain. Your body is designed to move and recover- so going to a doctor focused on movement and recovery seems like a good idea to not only reduce your medication use but to get the best results possible.

“patients who visited a chiropractor for a musculoskeletal pain condition were 49% less likely to receive an opioid prescription than their counterparts who went to other healthcare providers.

— MedScape- Chiropractic Care Tied to Significant Reduction in Opioid Scripts

5. Improvement in Sports Performance

Did you know that every major sports team has a chiropractor available to their athletes to help with injury prevention and sports performance?  That’s right, teams in the NFL, MLB, NBA, and NHL all have chiropractors integrated into their healthcare team to keep their athletes performing at their top level all season long.  No one can perform their best when in pain, so chiropractors are used to keeping the athletes feeling good, but with a focus and eye towards sport-specific performance.  Working with the athletes on flexibility, biomechanics, and range of motion, and sport-focused training is critical to raising the bar of performance.

““The increased V-wave amplitudes observed in the current study possibly reflect an increased cortical drive in the cortico-spinal pathways and corresponding increased excitability of the motoneuron following spinal manipulation.”

— The effects of a single session of spinal manipulation on strength and cortical drive in athletes. European Journal of Applied Physiology. January 2018

Quite frankly, whether you are working at an office or whether you are on the professional sports field, a balance of strength and flexibility is one of the top keys to stay well long term.  So those are the five significant benefits of chiropractic care. If you’ve experienced any of those, please comment down below let us know, or if you have any questions, I’m happy to answer those as well.

 

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