Back Pain Spending Surge Shows No Benefit

Americans are spending more money than ever to treat spine problems, but their backs aren’t getting any better.
[Not from going to Medical Doctors they're not. Lots of happy patients going to chiropractors though]

Those are the findings of a report in the Journal of the American Medical Association, which found that United States spending on spine treatments totaled nearly $86 billion in 2005, a rise of 65 percent from 1997, after adjusting for inflation. Even so, the proportion of people with impaired function due to spine problems actually increased during the period, even after controlling for an aging population.

“You’d think if you’re putting a lot of money into a problem, you’d see some improvements in health status,’’ said lead author Brook I. Martin, research scientist at the University of Washington’s department of orthopedics and sports medicine. “We’re putting a lot of money into this problem, and it’s a big investment in health care expenditures, but we’re not seeing health status commensurate with those investments.’’

The report is the latest to suggest the nation is losing its battle against back pain, and that many popular treatments may be ineffective or overused. Researchers have produced conflicting data about the effectiveness of spinal fusion surgery for back pain, although one major study called Sport, for Spine Patient Outcomes Research Trial, showed that spinal surgery patients did better than patients receiving more conservative care, which included medications or physical therapy. However, some doctors have questioned whether surgical treatments, injections and narcotic pain medications are being used appropriately in many patients.

“I think the truth is we have perhaps oversold what we have to offer,’’ said Dr. Richard A. Deyo, a physician at the Oregon Health & Science University in Portland and a coauthor of the report. “All the imaging we do, all the drug treatments, all the injections, all the operations have some benefit for some patients. But I think in each of those situations we’ve begun using those tests or treatments more widely than science would really support.’’

To study spending trends in spinal care, the researchers examined annual household survey data from the Agency for Healthcare Research and Quality that was collected from about 23,000 people a year from 1997 to 2005. It included information from pharmacy and medical records and was used to estimate national spending and treatment practices.

The researchers found that people with spine problems spent about $6,096 each on medical care in 2005, compared to $3,516 in medical spending among those without spine problems.

During that time, the biggest surge in spending was for drugs. In 2005, Americans spent an estimated $20 billion on drug treatments for back and neck problems, an increase of 171 percent from 1997. The biggest jump was for narcotic pain relievers, such as OxyContin and other drugs, which increased more than 400 percent.

Outpatient treatment for back and neck problems increased 74 percent to about $31 billion during the period, while spending related to emergency room visits grew by 46 percent to $2.6 billion. Spending for surgical procedures and other inpatient costs grew by 25 percent to about $24 billion.

Despite the growth in treatment of back problems, the data show that the percentage of people with serious spine problems hasn’t improved. In fact, it appears to have gotten worse.

Based on the sample, the researchers estimated that in 1997, about 21 percent of the adult population suffered from back or neck problems that limited their function. By 2005, that number grew to about 26 percent, after adjusting the numbers for age and sex.

It’s not clear why more people appear to be suffering from back and neck pain. It could be that rising obesity rates are taking an added toll on the spine, researchers suggested. Or it could be that excessive treatment of back problems is leading to more problems.

“I do worry there is a combination of side effects and unnecessary treatments and labeling people as being fragile when they’re really not,’’ Dr. Deyo said. “The combination of those kinds of things may actually be in some cases doing more harm than good.’’

Excessive Exercise Causing Free Radicals

“In his book The Antioxidant Revolution, Kenneth Cooper, MD
emphasizes that excessive exercise is a major cause of oxidative
stress.”

“He became very concerned when he began seeing several of
his super exercisers who had been coming to his aerobic center in
Dallas dying from heart disease and cancer at an early age.”

When we exercise excessively, the production of free radicals
goes off the graph, or in other words it increases exponentially.
“Dr. Cooper started the exercise craze back in the early 70’s
when he coined the term aerobics.”

“He has never recommended excessive exercise to his patients;
however, he had previously not discouraged it either.”

“Now he believes it is potentially harmful to your health and
should only be done by the serious, competitive athlete who is taking
large amounts of antioxidants in supplementation.”

Dr. Cooper informs his exercise patients “they should be taking
adequate levels of antioxidants in supplementation all the time.”
“On the day that they exercise, he feels they should actually
increase the amount of antioxidants they are taking.”

The Danger Of Mixing Candy And Poison
By Tim Davern, MD, a liver transplant specialist at the University of California, San Francisco San Francisco Chronicle, August 14, 2004

"First Do No Harm" is a cornerstone of modern medicine. "I think the practice of combining acetaminophen (Tylenol is one popular brand) and an opiate, such as hydrocodone bitartrate, together as a single drug (as Vicodin does) defies logic, if not common sense."

Acetaminophen is a "potent dose-dependent poison for the liver; simply stated, if you take too much, your liver dies."

Acetaminophen overdose is the "leading cause of acute liver failure in the United States today." On the other hand, opiates, such as hydrocodone bitartrate and codeine, while safe for the liver, are highly addictive. "Vicodin is currently the most popular prescription drug in the United States." Some patients become addicted to the opiate component of Vicodin and consume increasing amounts of acetaminophen, "ultimately leading to acute liver failure." "With overwhelming liver injury from acetaminophen, what follows is a particularly grisly death punctuated by bleeding, confusion, coma and, for still largely unclear reasons, brain swelling, damage and death."

"Patients typically take too much acetaminophen for fever or pain over several days, not realizing the potential for liver damage." "Many are unaware that acetaminophen is contained in dozens of over-the-counter cold and flu preparations."

"This situation is particularly tragic in young children accidentally overdosed with acetaminophen, typically in the setting of a flu-like illness, by well-intentioned but misinformed parents."

Acetaminophen packaging should have better warning labels, and should not be sold in 1,000 pill mega-bottles. Acetaminophen-opiate combinations [like Vicodin] should be removed from the market. "The prescription rules in California have made it far easier for physicians to prescribe an acetaminophen-opiate combination, such as Vicodin, than a pure opiate, such as codeine, although the former is far more dangerous."

The FDA banned Ephedra, which "contrasts with its puzzling, relatively meager efforts to prevent acetaminophen hepatotoxicity, which kills far more Americans each year than Ephedra."

Take This Painkiller Carefully Medical News That Matters Second Opinion
By Isadore Rosenfeld, MD Parade, February 19, 2006, pg. 6

"Acetaminophen, whose best know brand name is Tylenol, is one of the most widely used nonprescription painkillers is the US." "Overdosing with is the leading cause of serious poisoning in this country."

"Every year, too much acetaminophen accounts for 50,000 emergency room visits, 42% of liver failures, and an average of 458 deaths." "Never take more than 4,000mg a day—eight 500mg extra-strength capsules."

Numerous other drugs also contain acetaminophen, including Nyquil, Sudafed, Alka-Seltzer, Sinutab, Contac, Actifed, etc.

"If you have two or three alcoholic drinks or more a day, be sure to consult your doctor before taking Tylenol."

"The symptoms of acetaminophen overdose are nausea, vomiting, abdominal pain and lack of appetite."

"The specific antidote is N-acetylcysteine (NAC)."

N-acetylcysteine (NAC) works because it elevates levels of the antioxidant and detoxifier, glutathione. I purchase N-acetylcysteine (NAC) in the product:
(Complete Glutathione From Nutri-West: 800-443-3333 in the USA)
Each Tablet contains: N-Acetyl Cysteine 60 mg, Alpha Lipoic Acid 10 mg, LGlutamine 15 mg, Vitamin C 75 mg, Selenium Chelate 10 mcg, Milk Thistle 50 mg, Silybin 10 mg, Thiamin 10 mg, Riboflavin 10 mg, B-6 5 mg, B-12 50 mcg, Folic Acid 50 mcg, Vitamin E Succinate (natural) 10 i.u., Magnesium Chelate 500 mcg, Zinc Chelate 500 mcg, Rosemary 75 mg, Curcumin extract from Turmeric 10 mg, Superoxide dismutase-G (Glutathione) 25 mg, Catalase 20 mg, Reduced Glutathione 5 mg.

In the last 6 years:

Nearly 3,000 Americans have died in from terrorism
30,000 Americans have died from food poisoning
240,000 Americans have died on our highways
600,000 Americans have died from medical mistakes

Source: U.S. News & World Report 9/03/07, pg. 24
BY Randall Larsen
A retired US Air Force Colonel
The Director of the Institute for Homeland Security in Alexandria, VA
Author Our Own Worse Enemy

Omega-3 used to Treat Neck and Back Pain

American Association of Neurological Surgeons:
High-Dose Omega-3 Oils used to Treat Non-Surgical Neck and
Back Pain

Doctors Guide, April 20, 2005
By Cameron Johnston

"Investigators at the University of Pittsburgh have treated chronic pain patients with high doses of omega-3 fatty acids – the ingredient found in many cold-water fish species such as salmon."

"The researchers say their findings suggest that this could be the answer to the adverse effects seen with nonsteroidal antiinflammatory drugs (NSAIDs), including cyclooxygenase (COX)-2 inhibitors, which have been associated with potentially catastrophic adverse effects."

Dr. Joseph Maroon, neurosurgeon and specialist in degenerative spine disease at the University of Pittsburgh reported the findings April 19th at the 73rd meeting of the American Association of Neurological Surgeons. Patients who took high doses of omega-3 oils were impressed enough with the outcomes that they chose to continue using the oils and forego the use of NSAIDs.

The 250 study patients suffered from chronic neck or back pain but were not surgical candidates, and they had been using daily doses of NSAIDs.

After 75 days of taking high doses of omega-3s, 59% had stopped taking prescription drugs fro their pain. "88% said they were pleased enough with the outcomes that they planned to continue using the fish oils." "No significant adverse effects were reported."

Test confusion 'risk to patients'

The majority of tests are ordered by junior doctors

Many junior doctors do not understand common hospital laboratory tests and are putting patients at risk as a result, biochemists have claimed.

The Annals of Clinical Biochemistry reports that 18% of more than 80 junior doctors surveyed were happy to order a test they could not fully interpret.

The Association for Clinical Biochemistry blamed poor teaching of the subject at medical schools.

The General Medical Council is planning to review its curriculum guidance.

It's something that scares me - these are the doctors who are going to be looking after me when I'm older
Dr Danielle Freedman
Association of Clinical Biochemistry
The majority of hospital pathology tests are ordered by junior doctors, but in recent years many medical schools have reduced the amount of time they devote to pathology teaching.

Dr Trevor Gray, from the Northern General Hospital in Sheffield, carried out a survey of more than 80 juniors, asking them how they felt about the clinical biochemistry tests they were expected to order on a day-to-day basis.

In 10 out of the 12 common tests listed, some of the juniors questioned said they were not entirely confident about interpreting the results.

In three tests, more than a third of those questioned said they were not confident - and 18% of the doctors said they were happy to order a test which they did not fully understand how to interpret.

Seven out of 10 said they would like more teaching in clinical biochemistry.

Dangerous decisions

Dr Danielle Freedman, from the Association of Clinical Biochemistry, said the results revealed "a national problem".

"It's something that scares me - these are the doctors who are going to be looking after me when I'm older."

She said that errors could be highly dangerous to patients: "If you have someone who has a test which shows they have a low sodium level, further tests need to be done to establish the cause.

"Some junior doctors can order the sodium test, but don't know what to do with the result, and the patient doesn't get the right treatment."

She said that she knew of patients who had been discharged from hospital only to suffer a major heart attack because a key test had not been carried out properly.

The General Medical Council (GMC) is currently preparing to review its guidance on the content of medical education.

"It is essential that the GMC, universities and medical school take note to protect both patients and doctors," Dr Freedman said.

Among those responsible for pathology teaching in UK medical schools is the Royal College of Pathologists, and a spokesman said that it was currently examining what medical students were taught.

"The college has set up a group to review and appraise the new curriculum."

Bad Bad Bouncy Seat

For months before anyone saw a problem with her infant daughter, Ellen Burkhardt would park the child in a bouncy seat without a second thought, grateful for the extra minutes it gave her to make dinner or do a load of laundry.

But then the Arlington Heights mom noticed that 6-month-old Natalie still could not quite straighten her neck or lift her head, and the back of her skull seemed oddly flattened.

Natalie's doctors said the problems occurred in part because of seemingly harmless products like the bouncy seat. By keeping the girl immobilized and on her back, they said, such seats prevented her from using all the muscles she needed to grow normally.

It's a controversial theory, but a vocal contingent of doctors and physical therapists believe the strap-in chairs and carriers that millions of parents have come to rely on are contributing to an increase in cases of misshapen skulls, contorted neck muscles and delayed motor skills such as crawling and walking.

A few frustrated therapists even have a name for the problems that can occur in immobilized infants: "container syndrome." The best solution, they say, is to get children out of their seats and put them on the ground for "tummy time."

"These things may be great for convenience, but they're horrible for your child," said Dr. Frank Vicari, director of the head-shape evaluation program at Children's Memorial Hospital.

Downside to back sleep

Some of the developmental issues appear to stem from a benign source: the "back to sleep" campaign that began in 1994 and has achieved a dramatic drop in infant deaths by persuading parents to put infants to sleep on their backs. No expert interviewed for this story suggested any change to that policy.

But the change in sleeping habits came with a downside. Infants who sleep on their backs are more likely to develop a somewhat flattened skull, which also may throw off neck development. That, combined with the modern affinity for products that keep infants on their backs, can result in developmental delays that take thousands of dollars in therapy to correct.

Numerous therapists who treat such disorders say they have observed an increase, though no one has done a thorough national study. Vicari said that in the early 1990s, he typically would see a dozen cases of misshapen skulls, or plagiocephaly, each year. Today, that number stands at about 750.

At Children's Healthcare in Atlanta, senior physical therapist Colleen Coulter-O'Berry said that a decade ago she saw about 30 children annually who needed therapeutic helmets to correct head shape. Now they treat about 500 kids that way.

"It's unbelievable, the difference," she said.

Slowly, evidence has mounted that infants who sleep on their backs are more likely to have slight developmental delays, though experts are divided over whether the effects are long-lasting. A 2006 Canadian study published in the Journal of Pediatrics found that 22 percent of babies who slept on their backs had some delays in motor skills such as sitting up, rolling over and climbing stairs.

'Tummy to play'

Parents can compensate for this trend by putting babies on their bellies while they're awake and having them play in that position, the 2006 report found. Many therapists now have lengthened the old slogan to "back to sleep, tummy to play."

That can be harder than it sounds. Infants who rarely spend time on their bellies often cry and fuss when parents try to give them more tummy time.

"If you haven't put a baby on her stomach by the time she's 5 days old, she decides she shouldn't be on her stomach," said Mary Weck, a clinical specialist and physical therapist at Children's Memorial. "They really get in the mind-set that they shouldn't have to work physically."

The time infants spend on their backs has risen with the proliferation of products such as detachable car seats that can be used as infant carriers or snapped into strollers. Such seamless transitions are convenient, but many physical therapists recommend that parents reserve car seats for use in the car.

Children who sit all the time have little motivation to exercise their muscles, Weck said.

"When babies are on their tummies, they're driven to move around ... but when they're lying back in a seat they can just look out and see what's going on," she said. "They don't have to move to keep themselves entertained, so they lose that drive."

Some therapists also point a finger at exersaucers, stationary devices that suspend the child in a bucket seat. Use of exersaucers grew in the 1990s as a replacement for mobile walkers, which can cause injury if a child tips down stairs while strapped inside.

But being strapped in an exersaucer can force babies to keep their legs bent or stand on their toes, which may lead to "toe-walking" when the child gets older. Walking on toes instead of the whole foot can prevent a child from developing proper coordination and can cause back pain later in life, therapists said.

"Exersaucers are often marketed as a way to help your baby learn to stand," said Timmie Wallace, a physical therapy instructor based in Santa Fe. "But all of these baby containers just restrict how they move."

That view is common among physical therapists, yet many doctors and surgeons are not convinced that baby seats and other products can slow development.

In addition, so far there is no evidence that the documented delays linked with sleep position and lack of tummy time affect children permanently, said Dr. James Kemp, a specialist in the pediatric sleep laboratory at St. Louis Children's Hospital.

"If you don't give kids tummy time they may learn some skills a bit later, but unless the child has to run over mountains it may not be a big deal," he said. "Kids figure out a lot of stuff in spite of you."

Even if the delays are not permanent, many families seek therapy to get their kids on track, and that can be costly. Weck of Children's Memorial said a typical course of therapy for plagiocephaly or toe-walking can cost $10,000 to $12,000, most of it covered by insurance plans.

Devices hard to resist

Still, many parents say it's hard to resist all the baby equipment that seems to pour in when a new infant arrives.

Katie Turek of Chicago said relatives gave her three exersaucers when her son Charlie was born last year.

But Turek became concerned when Charlie, at 9 months, still could not get into a sitting position on his own or crawl normally.

Turek took Charlie to Children's Memorial, where physical therapists counseled her to stop putting him in exersaucers and other devices, and start doing more play activities centered on tummy time. If she needed time for chores, she could place him in a playpen, where he could move around more freely.

Charlie, now 1, now can crawl and do many tasks that were impossible a few months ago, said his therapist at Children's, Katie Rule.

"When you take the equipment away, the problem goes away," Rule said.