How Successful Is Chiropractic Care: A Patient's Point of View
A recent study published in the Journal of Manipulative and Physiological Therapeutics (JMPT) compared chiropractic management of low back pain with medical management.1 While there has been at least one other study on patient satisfaction,2 this paper came to an important conclusion:
"After controlling for these variables simultaneously in a stratified analysis, chiropractic patients were still almost twice as likely to perceive their treatment to be successful after three months compared to medical patients."The study compared 146 chiropractic patients with 279 medical patients with some interesting results:
"... the 3-month risk of improvement was 13% greater for chiropractic care than medical care."References"... the 3-month risk of worsening was 40% less for chiropractic care than for medical care."
The medical patients were "more likely to have been hospitalized for low back pain and to have had low back surgery."
The May 29, 1993 issue of the well respected medical research journal, Lancet, contained an interesting letter to the editor that began like a confession:
"Spinal fusion for low back pain is one of the 80% of procedures untested by clinical trials. We know from epidemiological data that the frequency of spinal surgery is closely correlated with the number of orthopaedic and neurosurgeons per head of population and that spinal fusion may be associated with an increased number of complications and has questionable benefits."
While the letter goes on to urge needed controlled trials, the obvious question is, "How many spinal fusions should there be based on clinical efficacy, rather than surgical greed?" Something to think about, the next time an MD tries to recommend spinal fusion for a patient of yours.
Spinal Fusion, Take II
Elderly patients undergoing back surgery suffer twice as many complications, and nearly twice as many die, when their surgery includes spinal fusion.1 Further, spinal fusion results in nearly six times as many blood transfusions, about two times greater nursing home placement, and one and one-half times higher hospital charges than spinal surgery without fusion, according to the AHCPR-funded Back Pain PORT. The mean hospital stay for Medicare patients who underwent fusion in 1985 was almost 20 percent longer, and their mean hospital charges (not including professional fees) were almost 50 percent higher.
Regardless of diagnosis, prior surgery, coexisting conditions, age, sex, or race, the likelihood of complications, death, or nursing home placement was twice as high for patients undergoing fusions than those undergoing spinal surgery without fusion.
Reference:
1. Deyo, RA, Ciol, Cherkin, et al. Lumbar spinal fusion: A cohort study of complications, reoperations, and resource use in the Medicare population. Spine 18(11):14673-1470, 1993.
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
