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Why managing your lower back pain is key: Dr. Erik Klein

A plan to manage the narcotics epidemic

Published in KV Style: June 2017

The management of musculoskeletal pain is at the center of the narcotics problem. Western society has been faced with an escalating prescription narcotics problem over the past decade. Governments, universities, and medical organizations have been studying how to combat this issue, however, Canadians are still the second highest users of opioids in the world. For non-cancer cases, 50% of prescription narcotics use is for low back pain. If low back and musculoskeletal pain was managed according to updated guidelines (and what actually works), we would have the upper hand on the battle against narcotic dependency in Canada. This is low hanging fruit.

McMaster University published guidelines on prescription narcotics for chronic non-cancer patients, in April 2017. The number one and strongest recommendation was to avoid all use of opioids until all conservative avenues have been exhausted. It also strongly advised against the use of opioids in individuals with a history of substance abuse whatsoever.
In my last article in May, I discussed the proper management of low back pain, and what patients should be asking from their doctors and therapists. Proper care should be hands-on including “full-body biomechanical analysis, assessment of skeletal and muscular imbalance, work/home habits, diet, stress and other emotional issues”. Failing to treat an individual uniquely is what leads to people having chronic pain, with a subsequent higher risk of being prescribed a narcotic.
Even clearer, a recent paper on the management of low back pain, published in March 2017, provided an even greater spotlight on how we can help remedy the opioid problem. In this particular guideline, the American College of Physicians recommended against ALL pharmaceutical interventions, in lieu of, heat, massage, spinal manipulation, and acupuncture for pain lasting less than six weeks. It strongly advised against common treatments such as ultrasound and TENS. For chronic cases lasting longer than six weeks, the advice was to still favour non-pharmacologic treatment with a focus on exercise, multi-disciplinary rehabilitation, acupuncture, spinal manipulation, and psychotherapy. Most prescriptions of opioids is for low back pain of a chronic nature.

The narcotics problem is significant but we have clear possibilities. If we were to focus on an outcomes and results-based functional approach, rather than to simply manage pain, we would see a reduction in prescription narcotic dependency, especially among our most vulnerable. Considering how common low back pain is, this should not be viewed as a challenge, but as an exceptional opportunity to make a difference.

After all, this isn’t about drugs, this is about people.

Dr. Erik Klein is a health policy expert, published author, and practicing Chiropractor in Saint John and Hampton.  Dr. Erik is the CEO of The Town Chiropractor with clinics across New Brunswick and a former member of the Horizon Health hospital board.  He can be reached at 652-5222 or erikfcklein@gmail.com.  For further information please go to www.thetownchiropractor.com or search us on Facebook.

 

You are probably receiving the wrong treatment for your lower back pain: Dr. Erik Klein

Published in KV Style and Telegraph Journal online: May 2017

Original source here

 

Chances are, the treatment you receive for your low back pain is probably not the right one.  This is because even with this common problem, scientists have yet to be able to agree on what works even after decades of trying to figure it out.  The reality is, there are commonly two huge problems, especially with therapists: too many hold old-school beliefs and choose not to further educate themselves.  On the other hand, others treat every patient pretty much the same way, seeing low back management with a catch all solution.  This is very concerning, because getting people better is all that matters.  Full stop.  Unfortunately I see this go on every single day.  The factors affecting low back pain are diverse and require a full body biomechanical analysis, assessment of skeletal and muscular imbalance, work/home habits, diet, stress, and other emotional issues.  The American College of Physicians just released brand spanking new guidelines and they recommend therapy before drugs.  Below we discuss what you should and shouldn’t do.

 

Low back pain is most often temporary muscle or joint stress that is coming from some form of overcompensation.  Essentially an on-going issue that tends to rear its ugly head every once in a while.  If you had a car where the strut was rusted out, would you continue to patch the strut and have repeated breakdowns, or would you fix the car so it worked optimally? Some of the most popular treatments are merely patches.  Getting ultrasound treatment, TENS, IFC, ice packs is effectively patching the strut.  These passive modalities don’t fix any problems.  Active modalities such as hands-on deep muscle work, the advice to stay active, spinal manipulation, and mindfulness/stress reduction DO fix problems.  Mechanical spinal syndromes require hands-on, active solutions to return your body to optimal function.  Further, these strategies are proven to show more positive responses in the brain (vs. electronic tools like ultrasound).  How the brain responds to the sensations you are experiencing is just as important as the problem itself, because the brain modulates how you feel pain.

 

Sometimes, when I am being asked for a second opinion, people want to know what to look for in a great therapist. There are a few simple guidelines: your therapist should apply active, hands on-care and encourage you to keep moving.  Your therapist should understand the WHY of the problem and be able to explain it in simple, yet specific terms, what is going on, and how they are fixing your problem in a step by step fashion.  For mechanical spine syndromes, if you’re under care at a clinic, you should see some symptomatic change by the third visit, and you should feel great by visit ten.  Even with sciatic problems, fifteen visits is all that should be required for acute flare-ups in most cases.  If not, a referral is likely warranted.  Finally, find out that your therapist is doing a TON of continuing education, continuing to build their skill sets and tool belts so they can help you be your greatest as quickly as possible.  When you begin care, demand the best and if you aren’t improving fast, seek a second opinion. 

 

There really is a dog’s breakfast out there for options for low back pain, and much of it is frankly wrong, because it’s easy or quick to implement and a lot of people can be covered in a short period of time.  Efficiency is frequently rewarded over results.  With new guidelines though, we know better.  Great clinicians dive deep in (both mentally AND physically) to unravel WHY this is happening and this takes attention and time, but the results speak for themselves and people see the difference. 

 

Dr. Erik Klein is a health policy expert, published author, and practicing Chiropractor in Saint John and Hampton.  Dr. Erik is the CEO of The Town Chiropractor with clinics across New Brunswick and a former member of the Horizon Health hospital board.  He can be reached at 652-5222 or erikfcklein@gmail.com.  For further information please go to www.thetownchiropractor.com or search us on Facebook.