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Doctors Increasingly Ignore Evidence In Treating Back Pain with scans, injections, narcotics.
Doctors Increasingly Ignore Evidence In Treating Back Pain with scans, injections, narcotics, #makesLBPworse

The misery of low back pain often drives people to the doctor to seek relief. But doctors are doing a pretty miserable job of treating back pain, a study finds.

Physicians are increasingly prescribing expensive scans, narcotic painkillers and other treatments that don't help in most cases, and can make things a lot worse. Since 1 in 10 of all primary care visits are for low back pain, this is no small matter.

What does help? Some ibuprofen or other over-the-counter painkiller, and maybe some physical therapy. That's the evidence-based protocol. With that regimen, most people's back pain goes away within three months.

But when researchers at Beth Israel Deaconess Medical Center in Boston looked at records of 23,918 doctor visits for simple back pain between 1999 and 2010, they found that doctors have actually been getting worse at prescribing scientifically based treatments.

Doctors were recommending NSAID pain relievers and acetaminophen less often. Instead, they were increasingly prescribing prescription opioids like OxyContin, with use rising from 19 percent of cases to 29 percent. Over-the-counter painkiller use declined from 37 percent to 25 percent. Other studies have found that opioids help only slightly with acute back pain and are worthless for treating chronic back pain.

"That's a big public health issue," says Dr. John Mafi, chief medical resident and a fellow at Beth Israel Deaconess. Mafi was the lead author of the , which was published online in JAMA Internal Medicine. In the 1990s doctors were criticized for ignoring patients' pain, Mafi says. Some of that criticism was valid, but doctors have overreacted. "What magic bullet better than a very powerful pain medication?"

Doctors should be cut a little slack, a journal accompanying this study says, because guidelines have been conflicted on back pain treatment until recently, and it takes 17 years, on average, for new treatment standards to be widely adopted. But creating checklist-type guidelines for doctors would help speed that process, the commentary says. So would requiring patients to pay more of the cost of expensive imaging, and providing payment incentives for doctors who do the right thing.

"For the majority of new-onset back pain [cases], it gets better within three months," Mafi says. "Unfortunately, we don't have fancy treatments that cure it." Time, some ibuprofen and gentle exercise aren't sexy. But they most often do the trick.

Read more: http://www.npr.org/blogs/health/2013/07/30/206910829/doctors-increasingly-ignore-evidence-in-treating-back-pain?utm_source=npr&utm_medium=facebook&utm_campaign=20130730
NEWS Update || APA welcomes UK independent prescribing rights - 20 August 2013
NEWS Update || APA welcomes UK independent prescribing rights
- 20 August 2013

The Australian Physiotherapy Association (APA) has applauded todays changes to medicines legislation in the UK that allow physiotherapists independent prescribing rights. The APA has called on Australian governments to consider this prescribing model.

The change allows physiotherapists to prescribe any licensed medicine and to also mix medicines prior to administration. This means physiotherapists in the UK will have similar prescribing responsibilities to those of other non-medical prescribing professionals in Britain, such as nurses and pharmacists.

In Australia, the APA has worked with Health Workforce Australia (HWA) to develop a model prescribing pathway for non-medical health professions under the National Registration and Accreditation Scheme. The project aims to enable non-medical health professionals, such as physiotherapists, the ability to prescribe medicines consistent with their scope of practice. It will examine suitable models for education, training, accreditation, credentialing, and monitoring of quality and safety associated with pharmaceutical prescription. HWA states on its website that a final report will be presented to the Australian Health Ministers Advisory Council before the end of 2013.

The APA welcomes the introduction of independent prescribing rights for physiotherapists in the UK, APA CEO Cris Massis said. Physiotherapists are highly skilled healthcare providers. We support similar prescribing rights in Australia as this will allow physiotherapists to improve care for their patients, reduce the burden on doctors, and decrease inefficiencies in the public health system.

The APA firmly believes that proper education and training, credentialing, and strict adherence to parameters and procedures will ensure patient safety and the best quality care, he added.

Source: http://bit.ly/16rmblC

Why Dont Physicians (and Patients) Consistently Follow Clinical Practice Guidelines?

Comment on Worsening Trends in the Management and Treatment of Back Pain

In this issue of JAMA Internal Medicine, Mafi and colleagues1 effectively describe national trends in the management of neck and back pain between 1999 and 2010.

Using a large representative sample of patient encounters associated with International Classification of Diseases, Ninth Revision (ICD-9) codes for the chief symptoms of acute back and neck pain extracted from the National Hospital Ambulatory Medical Care Survey, the authors describe patterns of care that seem discordant with well-established clinical practice guidelines for these conditions.

Whereas these guidelines promote use of nonopioid analgesics, avoidance of imaging tests, use of physical therapybased exercises, and primary care for this population,2 the results of this analysis demonstrate recent significant decreases for these recommendations. So, in the words of Saturday Night Live character DeAndre Cole played by Kenan Thompson, Whats up with that?

Source: http://archinte.jamanetwork.com/article.aspx?articleid=1722504

FULL: http://archinte.jamanetwork.com/data/Journals/INTEMED/0/iic130046.pdf.gif

Dr Evil Classic and Karoo 2 Coast

September 19-22, 2013

This week wil see the superbly organised Dr Evil Classic and Karoo 2 Coast mountain bike events taking place

around Knysna. The Dr Evil Classic is a 3 day stage race taking riders around the scenic areas of Wittedrift,

whilst the Karoo 2 Coast starts in Uniondale and finishes at the Knysna High School sport fields in

Waterfront Drive, Knysna.

Phillo Beukes Physiotherapy Practice will once again be on hand with their expertise in Orthopedics and

Sports Injuries to diagnose and treat possible injuries sutained during these mountain bike races.



Dr Evil Classic


Foot bone marrow edema after a 10 - wk transition to minimalist running shoes

SMU 2013 Vol 6 (1)

In a randomised clinical trial of starting to run with minimalist shoes for 10 weeks compared with conventional running shoes, the incidence of bone stress injury in the feet (bone marrow oedema on MRI) was significantly greater in runners with minimalist shoes

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