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.
Think of your most difficult patient – the one you try to motivate and work so hard with to develop a realistic treatment plan with achievable and measurable goals. Week after week, you see this patient struggle, sinking deeper into hopelessness as their health and quality of life continue to worsen. What if there was something else you could do that could change their outlook and their life? The solution is as simple as an automated program.
To paraphrase the Tao de Jing; a bowl is useful because of the empty space. Recent anatomical research uncovered evidence for previously undescribed large-scale pathways that span organs, blood vessels and other connective tissue. These pathways are defined by what is known as the interstitial space between cells. The newer research provides evidence that these interstitial spaces actually make very large-scale networks between different types of tissue.
As a practitioner, if you're wondering why your social media efforts aren't working the way you had hoped, or if you're not using social media at all, use this article to get your social media marketing strategies (back) on track.
