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Back and neck pain happen commonly, and if you haven’t had an episode yet, it’s likely there is one in your future. The bad news is it can hurt a lot; the good news is that fewer than 1 out of 100 people with new-onset back pain has a serious condition such as infection, fracture, or cancer. Also, human backs have the capacity to heal themselves. Even if a disc is herniated, studies have shown that the condition tends to regress over time, with partial to complete resolution after six months in two-thirds of people.
To give CHP members improved treatment options for back and neck pain, early in 2008 we opened the network to include the Back and Neck Program through the Center for Orthopedics and Sports Physical Therapy (COSPT). We are receiving positive feedback from members and physicians regarding the success of this exercise program, which reduces pain, improves function, and teaches patients how to strengthen their backs to avoid future episodes of pain.
The January and November 2008 issues of HealthLine, posted here, have more details. If you and your PCP feel that the Back and Neck Program may be appropriate for you, you can make an appointment by calling
Another tool in the tool box for back pain is Health Coaching. Excellent DVDs from the Foundation for Informed Decision Making are available at no additional charge, explaining what research shows about acute (recent onset) and chronic low back pain. In addition, the Health Coaching Dialog Center web site, accessible via www.capitalhealth.com, has a “health crossroads” module under the Health Information tab, providing great information about how to get better. CHP wants you to be able to choose the course of action most likely to lead to healing. Specifically, we want you to participate in informed decision making to better understand the risks and benefits of available choices. You can obtain the DVDs on back pain and other conditions by calling a Health Coach at (850) 383-3400. On a national level, increasing numbers of patients are discovering that education, support, and conservative therapy provide relief from painful symptoms, while reducing the need for habit-forming pain medication and surgery. Several groups, such as the American College of Physicians and the American Pain Society, have produced evidence-based clinical guidelines that encourage patients to seek conservative care from their physicians, keep active, and take over-the-counter pain medication.
Unless serious symptoms are also present, such as incontinence or fever, imaging studies are not recommended unless, after six weeks, the pain is still severe and not improving with active participation in conservative care. The reason is that 65 out of 100 middle-aged to older adults with no back pain show abnormalities such as bulging discs and arthritis on imaging studies. The older you are, the greater the chances that your back x-ray or MRI is already abnormal even though you have no symptoms. The take home point is that you do not want to undergo procedures directed to a problem that isn’t the cause of your pain.
In order to facilitate evidence-based care for neck and back pain, requests for outpatient MRIs of the cervical and lumbar spine will require precertification by Capital Health Plan. This will be phased in starting February 16, 2009. The most important test for back pain is evaluation: taking a history and performing an appropriate physical exam. These will be required elements prior to imaging.
If you are suffering with sudden onset or persistent back or neck pain, you should contact your primary care physician for evaluation and management. After evaluation, your PCP may elect to help you manage your pain in a number of ways, including referral to the Back and Neck Program at the Center for Orthopedic and Sports Physical Therapy and to a Health Coach.