Your Doctors Still Aren't Working Together
Amarillo medical clinic aims to provide the solution
There is new research showing that many primary care providers (family doctors) are still slow to adopt new recommendations for treating low back pain.
The days of your doctors actually working are coming. But, to be blunt, those days are taking their sweet time to get here. In 2017, the American College of Physicians (ACP) shook the medical and pharmaceutical worlds to their core when they updated their guidelines for the treatment of acute and chronic back pain(1).
Basically, one of the largest organizations in American medicine, the ACP, told physicians that the best FIRST-LINE options for acute low back pain are as follows:
- Should select nonpharmacologic treatment
- Spinal manipulative therapy
- Acupuncture, or
- If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants
These are Grade I, strong recommendations according to the ACP. Acute pain is pain that has lasted less than 3 months for the most part.
The ACP did not stop there though. They included recommendations for treating chronic back pain as well. Their FIRST-LINE treatment recommendations for chronic back pain are as follows:
- Should initially select nonpharmacologic treatment with exercise
- Spinal manipulation
- Multidisciplinary rehabilitation,
- Mindfulness-based stress reduction
- Tai chi,
- Motor control exercise,
- Progressive relaxation,
- Electromyography biofeedback,
- Low-level laser therapy (cold laser),
- Cognitive behavioral therapy,
Once again, these are Grade I, strong recommendations coming from the American College of Physicians. Chronic pain is defined differently by different entities and organizations. Some say chronic pain is pain that lasts 3 months or more. The National Pain Strategy defines it as pain that is experienced at least every other day for 6 months or more. Either way, I explain it to my patients as pain that is long-lasting and lingering.
If a person is astute and really pays attention to these recommendations, they require a combination of practitioners to provide all of, or some of, the recommended treatments. This is referred to as a 'multimodal approach'. Several different therapies from different providers.
For example, a medical provider can provide non-steroidal anti-inflammatory drugs or skeletal muscle relaxants. but neuromusculoskeletal pain is not typically a medical provider's specialty. Research is clear that providers cannot be expected to know everything about everything. This is why we have different types of specialists. Beyond the pharmaceutical aspect, chiropractors offer spinal manipulative therapy, some chiropractors offer acupuncture, heat, and soft tissue massage treatments. Chiropractors and physical therapists both offer targeted exercise recommendations.
As you can probably sense, a trip to a medical provider alone is not typically going to take care of back pain. At least not as comprehensively and a trip to a healthcare provider could take care of it.
In addition, there is new research showing very clearly that medical providers are not typically adhering to the ACP guidelines we just discussed(2). Four years after the ACP's recommendation came out, the researchers interviewed 72 primary care providers from 3 community-based outpatient clinics about their familiarity with the ACP guidelines and how they initially manage patients with acute and chronic low back pain. They were also asked about their comfort level in referring patients to nonpharmacologic treatment providers.
IT turns out that a little over 3/4 of the providers were familiar with the ACP guidelines but for acute back pain, the primary care providers were still just telling patients to stay active while giving them nonsteroidal anti-inflammatories rather than following the guidelines more thoroughly. For chronic back pain, the primary care providers were more likely to recommend nonpharmacologi c treatments. Which was nice to hear.
The researchers summed it up by saying, "While most primary care providers indicated they were familiar with the ACP guideline for low back pain, nonpharmacologic treatments were not recommended for patients with acute symptoms. Further dissemination and implementation of the ACP guideline are needed.” Meaning, primary care providers could become more familiar with the new ways of treating back pain. Chiropractors saw about 21% of the primary care referrals in this paper. For evidence-based, patient-centered, and specialized chiropractors, 21% of the referrals is a starting point but must be improved on. Here at Creek Stone, well over 74% of our patients report that their conditions have resolved at the 30-day mark. Can you imagine the impact we could make if we saw more of those suffering back pain?
My last point on this brand new research is that of the nonpharmacologic treatments recommended, the most common was physical therapy at 78%, again, chiropractic saw 21%, massage therapy at 18%, and acupuncture at 17%.
What if, however, ALL OF THESE PROVIDERS WERE IN ONE PLACE? What if all of this recommended care were under one roof in a truly integrated setting? Well, now they are. Creek Stone Integrated Care has hired a medical director/doctor, we have hired an Advanced Nurse Practioner, and we are bringing medical services into our clinic. We are re-branding to Creek Stone Integrated Medical and will now have providers of all kinds: medical, chiropractic, exercise/rehab, massage, and acupuncture all under one roof.
Creek Stone Integrated Medical is now your one-stop healthcare clinic for EVERYTHING just short of surgery. Spread the good news because something special is about to happen for those in our community suffering from pain and disability.
You now have a place to come to that understands the most recent treatment guidelines and can offer a truly integrated and multimodal approach to knocking out your pain.
1. Qaseem A, Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med, 2017. 4(166): p. 514-530.
2. Roseen EJ, C.F., Atlas SJ, Mehta DH,, Initial Management of Acute and Chronic Low Back Pain: Responses from Brief Interviews of Primary Care Providers. J Altern Complement Med, 2021. 27(S1): p. S106-S114.
Dr. Jeff Williams, DC, FIANM is a Fellowship-trained Neuromusculoskeletal specialist, Orthopedic specialist, and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast (https://www.chiropracticforward.com). Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected] Learn more about Dr. Williams and his practice at https://www.amarillochiropractor.com.
Dr. Williams was voted Best Chiropractor In Amarillo in the Best of Amarillo 2020. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Care at 3501 SW 45th St., Ste. T, Amarillo, TX 79109. If you are searching for a chiropractor near me, Dr. Williams is your Amarillo Chiropractor.