To help, do we need to diagnose first?

For years, chiropractors (as well as most other CAM providers) have debated the need — or even the wisdom — of diagnosing diseases before we adjust patients.

One contingent in the alternative health care field feels it’s important to make a differential diagnosis and put a name on the specific disease or condition presented.

The other contingent believes the aim of non-medical care is to help the human body achieve homeostasis so it can heal itself, and that for what we do (whether it’s adjust the spine to remove interference from the neurologic pathways or use acupuncture needles to balance chi) we don’t need to label the disease.

Apparently, even the medical profession is beginning to realize the wisdom of the latter approach. According to a new Johns Hopkins-led research study, slavishly following long-held guidelines for diagnosing the cause of arthritis-related back pain is resulting in excessive tests, delays in pain relief, and wasteful spending of as much as $10,000 per patient.

While arthritis is a common cause of back pain, experts say it’s difficult to diagnose precisely because of the poor correlation between a finding of arthritis on an X-ray or MRI and the degree of a patient’s back pain. That has routinely led to a series of temporary diagnostic nerve blocks to prove the arthritis connection before doctors will recommend radiofrequency denervation, which is a relatively safe, noninvasive procedure that interrupts nerve-pain signals from arthritic joints.

The new study, published in the August issue of the journal Anesthesiology, says the wiser course is to skip the diagnostic nerve blocks altogether and move straight to treatment when arthritis is the suspected cause of back pain.

“The whole way we’re doing this is wrong,” says study leader Steven P. Cohen, MD, an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. “If we just do the radiofrequency procedure first, we’re going to help more people and we’re going to save a lot of money. Our goal is to get people feeling better,” he says. “When you do two blocks, you may be wrongly weeding out many people who would actually benefit from radiofrequency denervation.”

I wonder how many times CAM providers “weed out” people because they feel they need to come up with a specific diagnosis before they can reach out and help that person. If they can’t label the condition, they send them to a medical doctor, who injects them with pain killers and far too often scares them into unnecessary surgery (usually with the best of intentions, but based on their limited understanding of wellness and the body’s innate ability to heal itself).

Dr. Cohen, who is also a colonel in the US Army Reserves and director of chronic pain research at Walter Reed Army Medical Center, says the idea to do without diagnostic blocks came from his experience treating active-duty soldiers who complain of debilitating back pain. Deployed military doctors are under time pressure because soldiers who can’t be sent back to their posts quickly are likely to be evacuated out of a war zone with the likelihood they won’t return.

In the civilian world, he says, patients also should be treated as quickly and safely as possible. Going straight to treatment typically means that those patients can also return to work and their normal lives in a shorter period of time.

I think that’s a good policy for chiropractors and other wellness providers to adapt. Go straight to “treatment” and help as many patients as possible lead healthier lives. Adjust their subluxations so they have an improved neurological function and musculoskeletal condition!

SOURCE: “Multicenter, Randomized, Comparative Cost-effectiveness Study Comparing 0, 1, and 2 Diagnostic Medial Branch (Facet Joint Nerve) Block Treatment Paradigms before Lumbar Facet Radiofrequency Denervation” by Steven Cohen, MD, et. al. Anesthesiology. 113(2):395-405, August 2010, doi: 10.1097/ALN.0b013e3181e33ae5. Online

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Comments

I agree with that! Good to hear more about what is going on in the military and chiropractic front.

Thank you for sending it out. Merry Christmas.

Carrie Burdick-Roldan

I agree, if you know what you are doing will cause no harm, but will create some good, why wait to have a label before you start

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