What causes acute low back pain to become chronic? That's the question explored in a new study suggesting acute LBP patients shouldn't be going to primary care medical doctors for their pain. Here's why.
The study evaluated the care provided to 5,233 patients with acute LBP in 77 primary care practices. Among the potential factors leading to chronicity, the authors considered "nonconcordant" care, or care not consistent with established guidelines. Surprisingly, almost half (48%) of patients received at least one form of nonconcordant care.
The authors note: "[N]onconcordant care can lead to direct and indirect harm, given that it has been linked with medicalization and unnecessary health care utilization."
Nonconcordant care was divided into three categories: pharmacologic, diagnostic and medical subspecialty referral. Almost 50% of patients received at least one form of nonconcordant care within the first 21 days– many for non-guideline-recommended medications such as opioids.
Patients were stratified based upon their likelihood of transitioning to chronic LBP: low, medium or high risk. Overall, about a third (32% unadjusted) transitioned from acute to chronic: approximately one fifth of low-risk patients, a third of medium-risk patients and almost half of high-risk patients.
A patient whose medical primary care medical doctor provided two or more forms of nonconcordant care was more likely to transition to chronic than a patient stratified in the medium-risk category. The nonconcordant actions of the MD effectively moved the patient from low risk (one in five chance of becoming chronic) to medium risk (one in three chance) or almost high risk (even chance). Overall, exposure to one, two or three forms of nonconcordant care increased the odds of transitioning to chronicity incrementally.
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The luo vessels are important in the treatment of mental health issues. They are conduits of “ying qi”: blood and fluids. We believe that the shen is “housed” in the heart and circulated through the blood, making a channel system that “conducts” ying qi ideal for treatment of the mind and emotions.
As our health care ecosystem continues to evolve, I’ve found an increased emphasis being placed on an integrative approach to patient care. As an acupuncturist, you are an essential part of this collaborative system and health care team, cooperating with a range of other professionals including medical doctors, chiropractors, massage therapists, and others.
