Low Back Pain a Burden for the Patient

Low Back Pain a Burden for the Patient Blog  Low back pain

Four out of five adults will experience low back pain (LBP) in their lifetime. In many cases, the onset of pain is sudden, intense and the pathology is hard to pinpoint. Patients treated for this type of generalized back pain often use extraneous services, such as, diagnostic imaging, invasive surgical procedures and opioid prescription pain medications that considerably push up costs for the health insurance payer. The 2015 issue of the BMC Health Services Research journal featured a study that showed when patients with lower back problems opted for physical therapy at the initiation of their care, and followed clinical treatment protocols, that they avoided using nonessential treatments and costs to the payer were significantly reduced.

Physical therapist John D. Childs and colleagues, followed 122,723 patients who had an occurrence of low back pain, visited a doctor and were treated with physical therapy within 3 months of the initial complaint. Twenty-four percent of the study patients received treatment within 14 days after the initial treatment and adhered to the protocol for active physical therapy treatment. Almost 24,000 patients (33.5%) received delayed treatment, 14-90 days after the primary incident, but still followed physical therapy treatment guidelines. Both groups were followed for two years, and it was revealed that the patients who were treated earlier and had followed treatment guidelines used less advanced diagnostic and treatment resources than the other patients who failed to receive the same timely treatment. Early-adherent patients also had 60% lower costs, compared with the delayed-adherent group.

Childs and colleagues performed their research within the large, single-payer United States Military Health System, and their findings have expanded on research from civilian health care settings. Both research populations show a correlation between early clinical guideline-focused care, utilization of services, and costs to the health care system. Clinical practice guidelines for both military and nonmilitary health care settings advise against the prescription of opioids and the indiscriminate use of advanced diagnostic technology for patients with a new complaint of lower back pain. Research in the non-military setting shows that when clinicians are in conflict with practice guidelines, patients use excess resources and the system spends more money. Childs’ research shows the opposite, that adhering to clinical guidelines has a positive effect and may reduce costs for the single-payer health care system.

Paul Rockar Jr, physical therapist and President of the American Physical Therapy Association, supports the utilization of physical therapy as an early treatment option for low back pain. According to Rockar, physical therapy may reduce excessive and nonessential treatments that may burden single-payer systems with extraneous costs. The American Physical Therapy Association is the voice of over 90,000 physical therapists, physical therapy aids and physical therapy students across the nation. Physical therapists provide essential care that helps patients manage a multitude of injuries and conditions.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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