Herniated Disc Recommendation: Surgery or Chiropractic?
Dear Patients & Friends:
Earlier this year the American Academy of Family Physicians’ treatment guidelines recommended chiropractic care for herniated disc problems. This came on the heels of Federal back pain treatment guidelines first issued in 1994 and updated in 2010, that indicated chiropractic care may be helpful for both acute and chronic back and neck pain.
While most of the evidence had pointed to the benefits of chiropractic for back pain, growing evidence including a study that appears in the October 2013 issue of the Journal of Manipulative and Physiological Therapeutics points to the benefits of chiropractic for herniated discs in the neck as well.
Disc problems are considered harder to treat and potentially dangerous. Unlike simple uncomplicated neck and back pain that given time, usually resolves on its own, neck and back herniated disks can affect nerves that spread pain to the arms or legs, triggering tingling or numbness and eventually weakness to the hands or feet respectively. And they cost a lot more to treat, including up to $80-100,000 for a single fusion surgery.
By 1994, after a 3-year review of decades of research, the U.S. Agency for Healthcare Policy and Research concluded that only 1 in 100 back pain sufferers benefits from surgery. However, according to a recent report in the Washington Post, 56,000 spinal fusion surgeries were performed that year in the U.S., but by 2011 that number had risen to 465,000, a six-fold increase. According to the Post article, this may have amounted to 200 million in Medicare expense just in 2011, mis-spent because conservative treatments weren’t tried first.
Unfortunately, according to a study published last month in JAMA Internal Medicine, many physicians don’t follow guidelines and instead refer back pain patients to surgery or write prescriptions for powerful pain killers.
This is why we rely on our progressive friends in the medical community and on you, who tell your family and friends about your experiences in our office. We thank you for that!
Robert A. Leach, DC, MS, FICC(h), CHES
Research performed by chiropractic scientists at the Department of Chiropractic Medicine at the Orthopedic University Hospital in Balgrist, University of Zurich, Zurich, Switzerland was published in the October 2013 issue of JMPT and provided evidence that chiropractic benefits patients with MRI-confirmed herniated discs in their neck: http://www.ncbi.nlm.nih.gov/pubmed/23948425
The American Academy of Family Physicians guidelines issued to family physicians earlier in 2013 specifically endorsed use of chiropractic as part of the initial treatment of herniated discs, that should also include anti-inflammatory medications, stretches and staying active: http://familydoctor.org/familydoctor/en/diseases-conditions/herniated-disk.printerview.all.html
Spinal fusion surgery in the United States has risen six-fold in the past 20 years, at an extreme cost to society, according to the Washington Post: http://www.washingtonpost.com/business/economy/spinal-fusions-serve-as-case-study-for-debate-over-when-certain-surgeries-are-necessary/2013/10/27/5f015efa-25ff-11e3-b3e9-d97fb087acd6_story.html
According to an article in the September 23rd 2013 issue of JAMA Internal Medicine, many physicians don’t follow treatment guidelines calling for safer medications like NSAIDs and referral for conservative treatment including stretches, chiropractic and physical therapy, and instead prescribe potentially addictive pain killers: http://archinte.jamanetwork.com/article.aspx?articleid=1722522