Daily Health Update for Thursday, 02 Apr 2015

“To the best of our ability, Life in Motion Chiropractic and Wellness agrees to provide our patients convenient, affordable, and mainstream Chiropractic care. We will not use unnecessary long-term treatment plans and/or therapies.”

www.Chiro-Trust.org

 Mental Attitude: Are Parents to Blame for Narcissistic Kids?

If you want to avoid raising a narcissistic child, then the authors of a new study recommend not overvaluing your son or daughter. The researchers found the children whose parents described them as "more special than other children" and who "deserve something extra in life" scored higher on tests of narcissism. Study co-author Dr. Brad Bushman adds, "Children believe it when their parents tell them that they are more special than others. That may not be good for them or for society." Dr. Bushman and his colleagues recommend that parent training interventions could teach parents to express affection toward their children without telling them that they are better than others.

Proceedings of the National Academy of Sciences, March 2015

Health Alert: Nearly Two Out of 3 People with Invasive Cancer Are Surviving 5 Years or More.

The Centers for Disease Control and Prevention (CDC) reports that the overall five-year survival rate for patients following a cancer diagnosis is now just over 60%. While prostate and breast cancer -- the two most common body sites for cancer in the United States -- have high five-year survival rates (97% and 88%, respectively), there's significant room for improvement with lung cancer patients as their five-year survival rate is just 18%.

The Centers for Disease Control and Prevention, March 2015

Diet: Vitamin B1 Deficiency May Affect from 1 in 6 to Nearly 1 in 3 Obese Adults.

Between 15.5% and 29% of obese patients seeking bariatric surgery are thiamine (also known as vitamin B1) deficient. Though important for metabolism, nerve conduction, and muscle contraction, thiamine is not produced by the body and must be derived from food sources. Thiamine deficiency has been associated with weakness, fatigue, psychosis, and nerve damage. While obesity is thought to be a disease of excess nutrition, this finding suggests that it may also be a disease of malnutrition.

Advances in Nutrition, March 2015

Exercise: How to Build a Fitness Support System.

Staying motivated to achieve your health and fitness goals can be easier if you have a strong support system. The American Council on Exercise recommends communicating with a partner or loved one about your goals, finding an accountability buddy to encourage you, and connecting with others who are focused on improving their health.

The American Council on Exercise, March 2015

Chiropractic: Advanced Diagnostic Imaging for Seniors with Back Pain?

While most treatment guidelines generally advise against CT/MRI scans for younger adults with new onset back pain, guidelines for older adults allow for early imaging. However, it's unknown if this improves outcomes or possibly worsens them if such imaging leads to treatments that may have serious adverse effects. To find out, researchers followed 5,239 seniors for the year after their initial visit regarding back pain. Of the group, 349 received either a CT or MRI scan within six weeks of their first appointment. One year later, outcome assessments focused on measuring disability found that early advanced imaging was not associated with better treatment outcomes.

 JAMA, March 2015

Wellness/Prevention: Weight Loss Should Be Part of Cancer Prevention Strategies!

Current research shows that obesity is associated with a higher risk for ovarian and endometrial cancers, as well as postmenopausal breast cancer in women. Though the precise mechanism behind the elevated risk for such cancers is unknown, it's suspected obesity-related changes to a woman's sex hormone levels, insulin resistance, and chronic inflammation may be to blame. Obese women are also at greater risk for cancer recurrence and mortality. Experts recommend that obese women adopt a healthier lifestyle as part of a cancer prevention strategy.

Best Practice & Research, Clinical Obstetrics and Gynaecology, February 2015

This information should not be substituted for medical or chiropractic advice. Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your updated medical history.

Daily Health Update for Wednesday, 01 Apr 2015

“To the best of our ability, Life in Motion Chiropractic and Wellness agrees to provide our patients convenient, affordable, and mainstream Chiropractic care. We will not use unnecessary long-term treatment plans and/or therapies.”

www.Chiro-Trust.org

 Mental Attitude: Loneliness & Depression Associated with TV Binge-Watching.

A recent study has found that the more lonely and depressed a person is, the more likely he or she will binge-watch TV. Researchers say that depressed individuals use this activity to move away from negative feelings and those who lack the ability to control themselves are more likely to binge-watch. This is of concern as past research has shown that obesity and other health problems are related to excessive television viewing, suggesting that binge-watching may be more than a harmless addiction.

65th Annual Conference of the International Communication Association, February 2015

Health Alert: Prescription Combo Can Be Fatal for Seniors.

Combining commonly prescribed antibiotics with a widely used heart medication appears to more than double the risk of sudden death in seniors, finds a new study published in the Canadian Medical Association Journal. Spironolactone (Aldactone) is a common diuretic widely used in the treatment of heart failure. However, investigators have found that when trimethoprim-sulfamethoxazole (Septra, Bactrim) is prescribed to someone on Spironolactone, it can cause blood potassium to rise to potentially life-threatening levels. Over a 17-year period, almost 12,000 people died suddenly after taking this combination of medicines and most of the patients who died were over the age of 85. The authors conclude that pharmacists and physicians must be made aware of this interaction, as it does not appear widely known at present time.

Canadian Medical Association Journal, February 2015

Diet: Toddler Snacks & Meals Have Plenty of Salt & Sugar.

Many prepackaged meals for toddlers contain high levels of salt, and many snacks, desserts, and juices for infants and toddlers contain added sugar. Researcher Dr. Mary Cogswell writes, "It was surprising that more than seven of ten packaged toddler meals contained too much sodium (salt)… Some parents might be surprised that a majority of infant and toddler snacks and sides, such as flavored crackers and rice cakes, contained added sugar. About half the analyzed ready-to-serve mixed grains and fruits products, such as oatmeal and fruit in a jar, contained added sugar." She recommends preparing food for infants and toddlers as a healthier choice over prepackaged foods.

Pediatrics, February 2015

Exercise: You May Want to Take it Easy When Jogging.

After following 1,000 healthy joggers and 4,000 healthy non-joggers for a decade, researchers claim that those who jog 1-2.4 hours per week were 71% less likely to die during the study period than non-joggers. However, they found no mortality benefits when comparing more strenuous joggers to the non-joggers in the study. Study researcher Dr. Jacob Marott adds, "We believe that long-term strenuous endurance exercise may induce pathological structural remodeling of the heart and large arteries."

Journal of the American College of Cardiology, February 2015

Chiropractic: Improvement in Chronic Hypertension Following Cervical Adjustment.

A 55-year-old male with a history of chronic hypertension that did not respond to medical management presented for a trial of chiropractic care. After receiving an upper cervical adjustment using a specific chiropractic protocol, his blood pressure progressively lowered. The findings support the possible use of chiropractic care in the management of unresolved chronic hypertension.

Journal of Upper Cervical Chiropractic Research, January 2015

Wellness/Prevention: Probiotic Pill May Help Diabetics.

Researchers claim that a study involving rats demonstrates that a modified strain of "friendly" human gut bacteria called Lactobacillus appears to have instigated a process that converted cells in the intestinal lining to behave like pancreatic beta cells and release insulin to regulate blood sugar levels. In the study, the rats that received the modified probiotic had blood glucose levels up to 30% lower than rats that did not receive the probiotic. The researchers hope to one day develop a probiotic pill for human use that diabetic patients could take each morning to help manage and possibly cure their condition.

Diabetes, February 2015 

This information should not be substituted for medical or chiropractic advice. Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your updated medical history.

Inversion Tables

I am constantly asked by patients what my professional opinion is regarding inversion tables. In most cases I share my cursory exploration of the subject and advise that they do their homework before buying one. Having been asked this question again only three days ago I felt it only right to review what research literature I could find on the subject so as to provide people with a more detailed point of reference.

My search for credible, unbiased literature revealed a surprisingly scant wealth of resources on the subject. There are plenty of sites with opinion pieces, organizational advocacy, and even consumer testimonials regarding personal experience with inversion (i.e. Spine-Health) but very little medical evidence for or against its use. In fact I could only find two websites where the authors cited medical research to substantiate their advocacy, or lack thereof, for inversion table use in the treatment of musculoskeletal pain.

Edward R. Laskowski, M.D., co-director of the Mayo Clinic Sports Medicine Center and a professor at College of Medicine, Mayo Clinic, published a brief article regarding the subject where he opened his commentary by stating, “Inversion therapy doesn't provide lasting relief from back pain, and it's not safe for everyone”. He went on to describe the effects of inversion and ended by citing its contraindications for use.[1]

Kevin Macpherson, M.Ed., ATC, currently employed by Pivotal Health Solutions, published an article where he cites eight relevant publications and ends his commentary by stating, “If more health-care providers were educated on the benefits of inversion, many patients could receive the lifelong benefits of this therapy and the cost savings to both patients and practitioner can be substantial, as we start to equalize gravity’s negative effects one patient at a time”.[2]

However, several of the research studies cited are more than twenty (20) years old and the sample sizes were small (60 subjects or less) which isn't a true random sampling of the general population. This in no way means the findings of these researchers is not legitimate but is dated and cannot accurately formulate a conclusive argument for or against the use of inversion tables.[3]^{, [4], [5], [6], [7], [8], [9], [10], [11]} Dr. Laskowski’s article did however include two literature reviews in which the authors searched medical databases for studies involving treatment methods for low back pain.

The first, published in 2006 in Spine, examined traction therapy for low back pain with or without sciatica. In this review the authors selected studies regarding “randomized controlled trials (RCTs) involving any type of traction”, albeit inversion tables ARE a form of traction this was not the solitary focus of this review. The authors ultimately concluded that “intermittent or continuous traction” is not a recommended standalone treatment for low back pain but that “the literature allows no firm negative conclusion that traction, in a generalized sense, is not an effective treatment for patients with LBP”.

The second, published in 2007 in the Annals of Internal Medicine, examined treatment methods that ranged from acupuncture to yoga but did not primarily examine the benefits and/or risks involved with inversion tables. The authors conclude that cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation exhibited moderate clinical effectiveness for the treatment of chronic or subacute low back pain. [12]

Ultimately I did find one [unbiased][13] research article that exclusively examined the use of inversion therapy in the treatment of low back pain. Although cited in Mr. Macpherson’s article ² it must have been an ad hoc addition by the website because this study was conducted three (3) years after the publication of his commentary. This was a pilot randomized trial conducted at the Regional Neurosciences Centre, Newcastle Upon Tyne in the United Kingdom that examined “the effect of inversion therapy in patients with single level lumbar discogenic disease, who had been listed for surgery”. Although only a small sample size (24 participants) was observed it examined the use of physiotherapy in the treatment of sciatica with and without the use of an inversion device. From a clinical standpoint the outcome measures used in this trial are right on the mark as well as their use of surgery avoidance as a sign of treatment success. The authors concluded that a larger multi-center randomized trial needs to be conducted because it was shown that “intermittent traction with an inversion device [plus physiotherapy] resulted in a significant reduction in the need for surgery”.[14]

So what does all of this mean for you, the consumer? Before commencing any form of treatment due to a spine related disorder you should first consult a licensed medical professional who is specifically trained to differentially diagnosis your symptoms. Internet websites and anecdotal advice from friends and family is not a proper substitute for professional determination of your pain and effective treatment protocol(s). In fact when it comes to inversion therapy there are several contraindications to its use such as deconditioned musculature (spinal instability, spinal injury), eye conditions (detached retina, glaucoma, infection), circulatory problems (clotting issues, heart condition, high blood pressure, atrial fibrillation), fracture, hernia, implanted device(s), middle ear infection, osteoporosis, or pregnancy and only a professional medical consult will help determine if this form of treatment is right for you.[15] You should also keep in mind that no solitary intervention, as stated in the research presented here, is an effective form of treatment for musculoskeletal pain and dysfunction.

“Inversion tables are more or less like traction. I tell patients that want to try an inversion table to make sure they have another person in attendance to help them on and off the table. The same is true with traction. It may help, it may not. Generally, you will know the first time it is used.”[16]

FredrickWilson, DO

Center for Spine Health, Cleveland Clinic

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[1] Laskowski, Edward R. "Diseases and Conditions - Back Pain." Inversion Therapy: Can It Relieve Back Pain? Mayo Foundation for Medical Education and Research, 09 June 2014. Web. 17 Mar. 2015. <http://www.mayoclinic.org/diseases-conditions/back-pain/expert-answers/inversion-therapy/faq-20057951>.

[2] Macpherson, Kevin. "Inversion Therapy." Canadian Chiropractor. Annex Business Media, 30 Apr. 2009. Web. 17 Mar. 2015. <http://www.canadianchiropractor.ca/techniques/inversion-therapy-1461>.

[3] Haskvitz EM, et al. Blood pressure response to inversion traction. Physical Therapy. 1986;66:1364.

[4] Lamarr JD, et al. Intraocular pressure response to inversion. American Journal of Optometry & Physiological Optics. 1984;61:679.

[5] Klatz RM; Goldman RM; Pinchuk BG; Nelson KE; Tarr RS: The effects of gravity inversion procedures on systemic blood pressure, intraocular pressure and anteriol retinal pressure. J Am Osteopathic Assoc. 1983 Jul; 82(11) 853-857.

[6] Goldman RM; Tarr RS; Pinchuk BG; Kappler RE: The Physician and Sports Medicine. March 1985.

[7] Nachemson A and Elfstrom G: Intravital Dynamic Pressure Measurements in Lumbar Discs. Scandinavian Journal of Rehab Medicine, supplement, 1970.

[8] Kane M, et al.: Effects of Gravity-facilitated Traction on Intervertebral Dimensions of the Lumbar Spine. Journal of Orthopedic and Sports Phys Ther. 281-288, Mar 85.

[9] Nosse L.: Inverted Spinal Traction. Arch Phys Med Rehabil 59: 367-370, Aug 78.

[10] Dimberg L, et al: Effects of gravity-facilitated traction of the lumbar spine in persons with chronic low back pain at the workplace.

[11] Sheffield F.: Adaptation of Tilt Table for Lumbar Traction. Arch Phys Med Rehabil 45: 469-472, 1964.

[12] Chou R. Nonpharmacologic therapies for acute and chronic low back pain: A review of the evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline. Annals of Internal Medicine. 2007;147:492.

[13] I did find another study published in the Journal of the Canadian Chiropractic Association but found it hard to believe no outcome bias existed when the study was funded by the manufacturer of the inversion device being used in the research.

[14] Prasad KS, et al. Inversion therapy in patients with pure single level lumbar discogenic disease: a pilot randomized trial. Disability and Rehabilitation. 2012;34(17):1473-80

[15] Spinasanta, Susan. "Low Back Pain and Sciatica Treatment | Inversion Therapy." SpineUniverse. Vertical Health, LLC, 17 Apr. 2014. Web. 17 Mar. 2015. <http://www.spineuniverse.com/conditions/back-pain/low-back-pain/turning-back-pain-sciatica-upside-down>.

[16] Wilson, Fredrick. "Osteopathic Manipulation for Back&Pelvic Pain." My.clevelandclinic.org. Cleveland Clinic, 14 Jan. 2011. Web. 18 Mar. 2015. . This is was taken from "Online Health Chat" hosted by the Cleveland Clinic where members of the general public were able to have a Q&A session with Fredrick Wilson, DO.

Efficient Spine Care in the United States

Back and/or neck pain are a prevalent issue in society today and it is estimated that 149 million work days are lost every year in the United States at a cost of $100-200 billion [i.e. lost wages and decreased productivity] due to low back pain alone.[1]^{,[2], [3]} The World Health Organization reports that currently the primary treatment for low back pain is analgesic medication and that the causes for its provocation are rarely addressed.[4] This ineffectual treatment protocol isn't necessarily the fault of the rendering primary care physician due to their “inadequate preparation for practice in the real world” with regards to musculoskeletal medicine.[5] In November 2014, DiGiovann, et al reported that North American medical schools have limited time devoted to musculoskeletal education and cite that only 30% to 40% of schools have required instruction in the musculoskeletal system.[6]^,[7],[8] This is unfathomable when the average total health expenditure per person with back and/or neck pain in the United States is 73% greater than for individuals in other countries.[9]^,[10] The time has come for a truly unbiased and integrative approach to the treatment of low back and neck pain a fact that has been evident within the medical community since 1999.[11]

In July 2011, Murphy et al published a commentary expressing the need for the implementation of a primary spine practitioner (PSP) to effectively triage patients experiencing spine related disorders (SRDs), conditions that include back pain, neck pain, many types of headache, radiculopathy, and other symptoms directly related to the spine. They state that the PSP “would function as the first contact for patients with SRDs, i.e. the first practitioner that a patient consults when he or she develops a spine problem and could also function as a resource for traditional PCPs (family practice physicians, general internal medicine physicians, pediatric, obstetrical/ gynecological physicians, primary care nurse practitioners or physician’s assistants) to refer patients who present with SRDs”. This implementation exhibits potential benefits to SRD patients (i.e. faster recovery, cost savings, iatrogenic[12] disability avoidance, increased productivity, decreased likelihood of becoming a chronic pain sufferer, high patient satisfaction, focus on prevention), our society ( i.e. knowledgeable care coordinator, SRDs as a public health initiative, improved worker productivity, less long term disability), and the overall healthcare system (i.e. controlling costs, unburdening traditional PCPs, more strategic specialist referrals, disruptive innovation, standardization of care, new evidence and technologies). [13]

Candidates for the role of PSP within our current system would be currently licensed healthcare providers (i.e. chiropractor, physician, physical therapist, nurse practitioner) who would receive additional training based on a spine care pathway which has already been implemented in hospital systems, accountable care organizations, patient centered medical homes,  and privately operated PCP and specialty groups.

The effectiveness of integrative care for SRDs has not only been clinically demonstrated but has been mandated by a renowned medical center’s health plan:

- A 2013 study of Washington state workers who had recently filed worker’s compensation claims due to back injury found a 41.2 percent decrease in lumbar spine surgeries when the claimant consulted a chiropractor first.[14]

- Priority Health a major health plan in Western Michigan found that when they required spine patients who were heading for a non-urgent surgical consultation to first consult a physiatrist, surgical referrals decreased 48 percent, spine surgeries decreased 25 percent, and surgical costs dropped 25.1 percent.[15]

- University of Pittsburgh Medical Center Health Plan requires that patients with chronic back pain undergo a minimum of three months of chiropractic and/or physical therapy before any spine surgery is approved.[16]

So why am I so adamant about this subject? In September 2013, Spine Care Partners in conjunction with Lifetime Health Medical Group and Excellus BlueCross BlueShield commenced the inaugural spine care pathway training which was conducted at Excellus’ corporate headquarters in Rochester, NY. Dr. Fralick and I had the honor of being part of that inaugural class and have experienced first-hand the benefits this evidence based and patient centered program exhibits. Everything the Murphy et al commentary envisioned, at least in regard to SRD patient benefits, has become a reality for the patients who have sought care in our office.

The desire for this integration on a community level became evident to us upon receiving a letter from Excellus Blue Cross/Blue Shield of Rochester dated 29 December 2014. In this letter they outlined a “Waived Copayment Pilot Program” whose purpose is to “help drive care to spine pathway trained practitioners so that the program’s value can be measured and compared to other modalities of treatment for back and neck pain”. This program will extend until 31 December 2015 and only include Excellus employees and their covered family members but underlines the fact that a major health insurer believes PSPs are credible portal of entry providers for patients who present with musculoskeletal conditions.

So I urge all of you who are reading this to share this information with your healthcare providers and encourage them to seek out these practitioners in your community and integrate them into their treatment plans for spine related disorders.   

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[1] Guo HR, Tanaka S, Halperin WE, Cameron LL. Back pain prevalence in US industry and estimates of lost workdays. Am J Public Health, 1999, 89(7):1029-1035.

[2] Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am, 2006, 88(suppl 2):21-24.

[3] Rubin DI. Epidemiology and risk factors for spine pain. Neurol Clin, 2007, 25(2):353-371

[4] Duthey, Beatrice, PhD. "Background Paper 6.24 - Low Back Pain." Priority Medicines for Europe and the World 2013 Update. Background Paper 6 - Priority Diseases and Reasons for Inclusion. BP 6.13 to 6.24 (part 2). World Health Organization, 15 Mar. 2013. Web. 11 Mar. 2015. <http://www.who.int/medicines/areas/priority_medicines/BP6_24LBP.pdf>.

[5] Association of American Medical Colleges. Medical School Objectives Project. Contemporary issues in medicine: musculoskeletal medicine education. Report VII. 2005.

[6] DiGiovann, Benedict F., , MD, Richard D. Southgate, , MD, Christopher J. Mooney, , MA, MPH, Jennifer Y. Chu, , MD, David R. Lambert, , MD, and Regis J. O’Keefe, , MD, PhD. "Factors Impacting Musculoskeletal Knowledge and Clinical Confidence in Graduating Medical Students."The Journal of Bone and Joint Surgery E185 96.21 (2014): n. pag. The Journal of Bone and Joint Surgery, Inc. The Journal of Bone and Joint Surgery, Inc.; STRIATUS Orthopaedic Communications, 05 Nov. 2014. Web. 17 Jan. 2015. <http://jbjs.org/content/96/21/e185>.

[7] DiCaprio MR, Covey A, Bernstein J. Curricular requirements for musculoskeletal medicine in American medical schools. J Bone Joint Surg Am. 2003 Mar;85(3):565-7.FREE Full Text

[8] Pinney SJ, Regan WD. Educating medical students about musculoskeletal problems. Are community needs reflected in the curricula of Canadian medical schools? J Bone Joint Surg Am. 2001 Sep;83(9):1317-20. Abstract/FREE Full Text

[9] Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingsworth W, Sullivan SD. Expenditures and

health status among adults with back and neck problems. JAMA, 2008;299(6):656-664.

[10] Rosner, Anthony. "Going About Spine Care the Wrong Way - Spine Care "bass-ackwards."" Dynamic

Chiropractic - News, Articles, Research & Information for Chiropractors. MPA Media, 01 Jan. 2014. Web.

10 June 2014. <http://www.lifeinmotionchiro.com/Educational%20Brochures/Going-About-Spine-Care-the-Wrong-Way.pdf>. Vol. 32, Issue 01

[11] Andersson GB, et al. A comparison of osteopathic spinal manipulation with standard carefor patients with low back pain. N Engl J Med 1999;341: 1426-1431

[12] of or relating to illness caused by medical examination or treatment.

[13] Murphy et al. The establishment of a primary spine care practitioner and its benefits to health care reform

in the United States. Chiropractic & Manual Therapies 2011, 19:17 http://chiromt.com/content/19/1/17

[14] Keeney B, Fulton-Kehoe D, Turner J. Wickizer TM, Chan KC, Franklin GM. Early predictors of spine

surgery after occupational back injury: results from a prospective study of workers in Washington

State. Spine, 2013;38(11):953-964.

[15] Fox J, Haig AJ, Todey B, Challa S.. The effect of required physiatrist consultation on surgery rates for back

pain. Spine, 2013;38(3):e178-e184.

[16] "DC Receives Federal Grant to Study Nonsurgical Alternatives to Surgery for Spinal Stenosis: Interview

With Michael Schneider, DC, PhD." Health Insights Today, March 2013.

Chiropractic Care Boosts Surgery Avoidance

This PSA from the Foundation for Chiropractic Progress discusses how chiropractic care has enabled many people to avoid invasive surgical procedures. 

Back on the Job - Chiropractic Care

Thank You for your Trust and Support!!

Just wanted to take a moment and express my sincere thanks to all of my LinkedIn connections who have taken time out of their day to endorse my knowledge, skill, and ability with assessing and treating musculoskeletal pain and dysfunction. I am very humbled and honored to have your support. Have a great day!!

https://www.linkedin.com/in/drseanpkonraddc

Making The Case for Primary Spine Practitioner Care

Better Option to Back Surgery

“The American Association of Medical Colleges has identified musculoskeletal medicine as an area in which students receive inadequate preparation for practice in the real world.[1] North American medical schools have limited time devoted to musculoskeletal education. Only 30% to 40% of schools have required instruction in the musculoskeletal system.[2][3] Graduates entering practice experience the effects of this lack of instruction; one survey found that half of family physicians reported inadequate musculoskeletal training for clinical practice.[4]”[5]

These are not the words of an opinionated and/or biased chiropractor but those of clinical researchers at the University of Rochester School of Medicine and Dentistry. They admit that as of November 2014,[5] most primary care physicians graduating from medical school lack the confidence to assess and treat musculoskeletal complaints. This fact alone creates a substantial argument for the necessity of an integrative system of healthcare delivery that incorporates Primary Spine Practitioner (PSP) trained providers who possess the knowledge, skill, and ability to triage[6] patients with musculoskeletal complaints.

PSP trained providers [DC, PT, MD, NP, PA] can evaluate and manage the majority of patients with musculoskeletal conditions based upon best available evidence, and in a patient centered model of care. This portal of entry into the healthcare delivery system can then streamline the referral process for those patients who need a level of care beyond that of standard musculoskeletal treatment. Incorporating this type of provider would alleviate the burden of musculoskeletal complaints from primary care practices allowing medical doctors to focus on infectious disease and serious pathology, conditions they ARE TRAINED FOR.  

The desire for this integration became evident to us upon receiving a letter from Excellus Blue Cross/Blue Shield of Rochester dated 29 December 2014. In this letter they outlined a “Waived Copayment Pilot Program” whose purpose is to “help drive care to spine pathway trained practitioners so that the program’s value can be measured and compared to other modalities of treatment for back and neck pain”. This program will extend until 31 December 2015 and only include Excellus employees and their covered family members but underlines the fact that a major health insurer believes PSPs are credible portal of entry providers for patients who present with musculoskeletal conditions.

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[1] Association of American Medical Colleges. Medical School Objectives Project. Contemporary issues in medicine: musculoskeletal medicine education. Report VII. 2005.

[2] DiCaprio MR, Covey A, Bernstein J. Curricular requirements for musculoskeletal medicine in American medical schools. J Bone Joint Surg Am. 2003 Mar;85(3):565-7.FREE Full Text

[3] Pinney SJ, Regan WD. Educating medical students about musculoskeletal problems. Are community needs reflected in the curricula of Canadian medical schools? J Bone Joint Surg Am. 2001 Sep;83(9):1317-20.Abstract/FREE Full Text

[4] Sneiderman C. Orthopedic practice and training of family physicians: a survey of 302 North Carolina practitioners. J Fam Pract. 1977 Feb;4(2):267-50.Medline

[5] DiGiovann, Benedict F., , MD, Richard D. Southgate, , MD, Christopher J. Mooney, , MA, MPH, Jennifer Y. Chu, , MD, David R. Lambert, , MD, and Regis J. O’Keefe, , MD, PhD. "Factors Impacting Musculoskeletal Knowledge and Clinical Confidence in Graduating Medical Students."The Journal of Bone and Joint Surgery E185 96.21 (2014): n. pag. The Journal of Bone and Joint Surgery, Inc. The Journal of Bone and Joint Surgery, Inc.; STRIATUS Orthopaedic Communications, 05 Nov. 2014. Web. 17 Jan. 2015. <http://jbjs.org/content/96/21/e185>. 

Investigation performed at the Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, New York

[6] Process of organizing several patients for treatment. The process of deciding which people in a hospital department should get medical treatment first, according to how serious their condition is..

Link to the full article:

https://plus.google.com/114651765255995665833/posts/4PEFAr1kaDQ

Unlock Your Healing Potential with Chiropractic Care

Patient centered and evidence-based chiropractic clinic that assists patients in overcoming their back pain, neck pain, extremity pain or headaches. We educate, motivate, and empower patients via cost effective and clinically effective active care plans that induce high patient satisfaction.