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Back Pain: Most Expensive Health Care Problem In The Nation For Employers

A medical center right here in Seattle is pioneering a new system to take away your pain better and faster.

"Oh that hurts!" says 35-year-old Jeff Ng. He is missing work and missing out on his favorite sports, because of back pain.

"So, what brought this one on?" asks his therapist. "This was tennis actually" says Ng.

He's resorted to using 5-year-old muscle relaxers just to get out of bed.

"It was really bad, I mean I couldn't stand up at all."

Back pain is the number one cost to employers-draining 90 billion dollars from our health care system every year. In fact, Starbucks' insurance company went directly to Virginia Mason Medical to try and find a way to cut costs.

"This is an issue for all of us," says Virginia Mason's Dr. Robert Mecklenburg.

So, Mecklenburg says Virginia Mason Medical Center did some research and found the most effective treatment for most people was physical therapy, but most weren't getting it--until after dizzying array of appointments, drugs, and sometimes unnecessary surgery.

Mecklenburg shows us a sketch of all of the appointment people typically go through. It includes family practice visits, emergency room visits, and surgery. "Now what we've done here is eliminate everything that doesn't really help."

Dr. Andrew Friedman from Virginia Mason's Spine Clinic says people want three things: "They want to make sure something's not terribly wrong with them," he says, "they want to feel better and have their symptoms relieved and they want to get back to doing the things that they normally do so, we tried to put that all up front."

Friedman says they re-worked doctor schedules and re-routed calls directly to the spine clinic.

Now, patients usually get an appointment within one day and meet a specialist and a therapist together--in their *first* visit.

Here's some proof it's working: 4 years after Virginia Mason started the program:

Back pain patients their average 4.68 treatment visits, lost 3.98 days of work and got a 61.15 percent functional improvement. According to Virginia Mason, the Puget Sound regional network of providers' average 10.34 patient visits, lost 12.02 says of work for a 54.3 percent improvement.

DR. ANDREW FRIEDMAN, FROM VIRGINIA MASON'S SPINE CLINIC ANSWERS 10 IMPORTANT QUESTIONS ABOUT BACK PAIN:

1. When you see your doctor about your lower back pain problem, what are the most important questions to ask him?
The most important questions to ask your doctor are those things that help you to understand the condition. How do I know if this is serious? Is it safe for me to do my usual activities? If not, how can I get back to them? How quickly do you expect me to improve and what should I do if I don't. If the doctor is suggesting a specific treatment it is very important to understand what the alternatives might be. Often the treatments chosen by a doctor are influenced by their specialty and other alternatives might be right for an individual. It's also very important that good communication exists around how much of a problem the pain is for the person. Often it is the intensity of the problem which drives doctors to decide to do something like add a drug or recommend surgery or an injection and the communication around severity is one that is easy to get wrong.

2. What are the most important "red flags" that indicate a potentially serious problem?
The most important red flags are fever, unexplained weight loss, loss of control of bowel or bladder, weakness in the legs and progressively worsening pain. Also important are morning stiffness lasting more than an hour, a history of osteoporosis or a personal history of abnormalities of the immune system or a history of cancer.

3. What are the potential problems with using prescription drugs?
There are multiple problems with prescription drugs. A recent study showed that those individuals started on narcotic pain medications for more than a week were more than twice as likely to develop a chronic problem with back pain. Sedation and sleepiness are common side effects of the pain meds and of muscle relaxants--another common prescription.

4. What about over the counter drugs? What works and what's the best way to take them?
Over the counter anti-inflammatories such as ibuprofen are effective but can have serious side effects such as stomach ulcers- if taken for too long or by individuals who are sensitive. They should not be taken by people on blood thinners such as Coumadin or those with kidney disease. Tylenol is generally safe if a person has no liver disease and if taken in recommended doses. It should be taken with caution in those individuals with significant alcohol intake. Heat and ice are also often effective for pain management.

5. What are some of the mistakes people make when dealing with back pain?
The biggest mistake people make is probably living an overly sedentary life. Smoking is associated with a 3x risk of back pain. Poor sleep, depression and lack of exercise are also risk factors. When episodes of back pain strike (and about 30% of adults have an episode each year) it is important to try and return back to the level of activity

Previously enjoyed within the first few weeks. While backing off on activities for a while makes sense, studies have shown that prolonged bed rest, longer than one or two days, is generally associated with poorer outcomes. Waiting for the pain to go away completely before resuming activities is one big mistake. Severe pain-which won't allow activity- is something for which a person might want to see a doctor.

6. What types of activities are most likely to cause back problems?
Surprisingly, episodes of back pain are only weakly associated with specific activities. Most episodes occur without a discrete event such as picking up something heavy preceding them. Long periods of sitting-such as while driving or flying on a plane-are as common culprits as are picking up heavy objects with bad form. Probably an event such as this can be implicated 20-30% of the time.

7. What are some important exercises for most people with mild to moderate back pain?
It's hard to have a specific exercise recommendation, but walking and general activities are recommended for most back pain. Whether a person does strengthening or stretching sorts of exercises (which might be considered opposite ends of a spectrum and needed for "unstable vs. tight" body types) depends on the individual. Again, general exercise and return toward baseline levels is a good first step.

8. What can you do quickly if you have a back spasm?
Back spasms usually come from pain and create more pain. The usual recommendation is to take an over the counter pain reliever and rest for a day or so and then try to gradually increase walking and activity. Both heat and ice can be used effectively and whichever one works should be tried. The usual position of comfort is lying on the back with hips and knees bent and supported with a pillow or two under the knees. Remember that staying in this position for too long without getting up and about is not recommended. Usually back spasms will start to disappear after a day or two.

9. How about shoe inserts?
A general recommendation for shoe inserts usually can't be made.

10. What can you do to prevent back problems in the first place?
Studies have shown that back problems tend to occur episodically despite preventative measures. However, being strong in the core muscles has been shown in some studies to reduce the number of episodes. Also, being specifically prepared for sports or work activities one does is important. Avoiding smoking and keeping weight under control are recommended. Proper body mechanics are also a way to avoid injuries.

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Comments (1)

Seems different from your previous posts. Did YOU write this post, or someone else did? Anyway, I think your readers really enjoyed reading it.

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