We were reading through “Diagnostic Testing and Treatment of Low Back Pain in United States Emergency Departments: A National Perspective” on MedScape and were struck by a couple items.

“Diagnostic testing was performed in nearly 1 of every 2 patients with low back pain and opioids were administered to nearly two-thirds of the sample.” http://www.medscape.com/viewarticle/732744_4

Most low back pain can be evaluated clinically and manually without imaging studies. A clinician familiar with back problems is usually able to determine the etiology (root cause) of the back pain, and then decide on an appropriate course of action. For example, in physical therapy graduate programs, neurological testing — sensation, reflexes, strength, etc. — is recommended (required really) when there are symptoms past the gluteal fold into the thigh or leg. If no loss of strength and function is present, then treatment and education may proceed.

Then the question of opioids comes in. While a physical therapist cannot prescribe medication, all treatment interventions are considered in the context of desired results. Pain control is a laudable goal, but healing, resolution, self management education, and return to function might be considered more desirable in the long, and even near, term.

“Savings may be realized if visits can be shifted to primary care settings, where typical charges and propensity for diagnostic testing may be less.”

We’d like to see people offered a solution to their problem, not simply more tests and treatment to mask the symptoms. What do you think?

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