Bad back? Who to see?
From back problems to headaches, chronic pain is the leading cause of disability in American adults. If you’re suffering, who should you call?
The chiropractor
Chronic neck, back, knee, foot, shoulder, headache pain, sciatica, carpal tunnel, scoliosis and other conditions don’t just happen overnight, but are often the result of years of abnormal mechanical stress to our ‘human machine.’ The chiropractic orthopedist is adept at ending pain with the correct application of therapy, nutrition, ergonomic considerations, rehab exercise and other modalities while addressing any underlying bio-mechanical issues involved without using drugs.
While I have great respect for the medical profession, neither the MD nor the surgical specialist has much training in the conservative, non-surgical diagnosis and management of spinal, joint or other forms of bodily pain. Recent literature highlights the variable and often inadequate exposure to musculoskeletal education in medical schools, the journal Orthopedics reports. In a survey of fourth-year Harvard medical students, fewer than a quarter passed a standard musculoskeletal exam, reporting insufficient curriculum time devoted to musculoskeletal education. This lack of training is a leading cause for the willy-nilly and overabundant prescription of opioids that have brought us to a national drug epidemic.
Chiropractors receive four years of graduate training in a curriculum similar to medical school, the major difference being that chiropractors have little training in pharmacology, but in addition to their other course load, receive a year of physiotherapy, two years of X-ray/MRI/CAT Scan interpretation and two years of direct one-on-one patient care without the benefit of drugs to mask pain. Chiropractic students address patient spinal complaints as well as other muskuloskeletal problems and they must be adept at evaluating musculoskeletal complaints to be successful in treating them without medication. Board certification in chiropractic orthopedics requires another five years of focused, conservative muskuloskeletal training.
One of my first patients had knee problems and was scheduled for surgery. On examination it was seen that this gentleman had severely flat feet. Every time he took a step his knee would deviate inward, stressing the knee as his arch collapsed. After supporting his arch with a podiatric grade shoe orthotic his pain went away.
- Dr. Calvin Hargis, chiropractic orthopedist and neurofeedback specialist at Warwick Brain & Spine Therapy
The medical doctor
Pain is not only a physical problem, particularly when it persists more than 12 weeks or beyond the expected time of recovery. Chronic pain is deeply tied into the emotional experience of the sufferer and involves the intricate neural networks of pain messaging. Pain can become so consuming that it not only causes physical impairment, but also affects daily activities, recreation, relationships, jobs, and even the very meaning of life.
What many providers treating chronic pain fail to apply is that the patient is the key participant in management and recovery. It is the patient who understands themselves and their cause of suffering, and finds meaningful ways to cope with that suffering, who conquers pain.
There is no cookie cutter approach, because as varied as individuals are, so do treatments need to be. A comprehensive program often involves more than one modality, whether it be exercise, chiropractic care, neuropathic medications, trigger point injections, stress management, postural retraining or new behavioral coping strategies, and above all, the notion that pain can get better with better understanding. I embrace a holistic approach, including mind body strategies such as medical acupuncture and yoga, and often encourage patients to seek “complementary alternative medicine.”
I have reviewed thousands of spine MRIs, which mostly reveal aging discs and stenosis to varying degrees of severity, but I always keep in mind the bigger picture. The images on screen are only one piece of the puzzle. I determine when surgery is truly necessary, which is rare but indicated in certain cases like neurological decline, or “red flags” such as tumor, infection, or serious spinal cord compromise. Much more often I dissuade patients from seeing more surgeons, and instead work to broaden minds.
Pain sufferers who believe they will never get better often stop participating in exercise and daily life and become depressed and deconditioned, which only escalates the suffering. I try to prevent the catastrophic notion that pain is irreversible. Do newer treatments work, such as regenerative stem cell therapies, transcranial magnets, or laser surgery?
Understanding is empowering, and it is what doctors do best.
- Jennifer Kurz, MD, physiatrist and pain management interventionalist affiliated with Massachusetts General Hospital