Professional Athletes And Back Surgery: A Teachable Moment On Overuse In Health Care?
After four back surgeries, Tiger Woods still is not back on the golf course. Steve Kerr, the coach of the Golden State Warriors, missed most of last season and even much of this year’s playoffs with headaches and recurrent pain after back surgery. These two high-profile patients, and their very public surgery results, should encourage us all to ask whether “more is always better” in health care.
The Institute of Medicine National Roundtable on Health Care Quality coined the term “overuse” to describe the provision of health care services for which potential harms outweigh potential benefits. Overuse in health car...
Source: Health Affairs Blog - August 1, 2017 Category: Health Management Authors: William Shrank, Donna Keyser and Anthony Delitto Tags: Costs and Spending Featured Payment Policy Quality chronic pain Source Type: blogs
Great expectations – and low back pain
Have you ever wondered why there are so many treatments for low back pain? Like there are actually hundreds of different ways to “treat” back pain… yet the truth is, none of them work for everyone. Actually, most of them seem to help pass the time until low back pain settles of its own accord. Until it’s back again (no pun intended!).
This post is prompted after reading a string of general news articles discussing the common non-specific low back pain – under various guises of “dead butt syndrome“, “Dr Tom: Ouch I’ve hurt my back” and the like – I think it&#...
Source: HealthSkills Weblog - July 30, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Back pain Chronic pain Clinical reasoning Research Health healthcare Low back pain rehabilitation Resilience Therapeutic approaches Source Type: blogs
Primary pain disorders
In a move likely to create some havoc in compensation systems around the world (well, at least in my corner of the world!), the International Association for the Study of Pain has worked with the World Health Organisation to develop a way to classify and thus record persistent pain conditions in the new (draft) ICD-11. While primary headache disorder has been in the classification for some years, other forms of persistent pain have not. Recording the presence of a pain disorder is incredibly important step forward for recognising and (fingers crossed) funding research and treatment into the problem of persistent pain. As t...
Source: HealthSkills Weblog - July 23, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Clinical reasoning Health Research biopsychosocial healthcare Source Type: blogs
Taming the pain of sciatica: For most people, time heals and less is more
Despite being a less common cause of low back pain, sciatica is still something I regularly see as a general internist. Primary care doctors can and should manage sciatica, because for most individuals the body can fix the problem. My job is to help manage the pain while the body does its job. When a person’s symptoms don’t improve, I discuss the role of surgery or an injection to speed things up.
What is sciatica?
Sciatica refers to pain caused by the sciatic nerve that carries messages from the brain down the spinal cord to the legs. The pain of sciatica typically radiates down one side from the lower back into the l...
Source: Harvard Health Blog - July 12, 2017 Category: Consumer Health News Authors: Steven J. Atlas, MD, MPH Tags: Back Pain Health Pain Management Source Type: blogs
Here ’s something completely different for low back pain
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It’s a question that has challenged generations of patients and their doctors. The answer has changed over the years. When I was in medical school in the early 1980s, bedrest for a week or more was often recommended for severe back pain. This sometimes included hospital admission. Then, research demonstrated that prolonged bedrest was actually a bad idea. It was no better (and often worse) than taking it easy for a day or two followed by slowly increasing activity, including stretching and strengthening the back.
Medications, including pain relievers, non-steroidal anti-inflammatory dru...
Source: Harvard Health Blog - July 6, 2017 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Back Pain Complementary and alternative medicine Health Injuries Pain Management Source Type: blogs
Everyday hassles of fibromyalgia
This post has been on my mind for a while now. I live with fibromyalgia (FM) and want to share some of the everyday hassles I face. This isn’t a “oh woe is me” kind of post, it’s more of a “if you’re a clinician working with someone who has fibromyalgia, these are some things to ponder”.
Diagnosis
I worked in chronic pain management for almost 20 years before I recognised that the pains I’d been experiencing most of my adult life actually added up to “…a syndrome of diffuse body pain with associations of fatigue, sleep disturbance, cognitive changes, mood disturba...
Source: HealthSkills Weblog - July 2, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Clinical reasoning Coping strategies Health Pain conditions Professional topics Research Resilience/Health biopsychosocial fibromyalgia pain management Source Type: blogs
Exercise? Who me? Yoga or physiotherapy or education …
This study is a “non-inferiority” study, looking to establish whether yoga or physiotherapy, or indeed education, can help people living with chronic low back pain. Now I’m not going to do a blow-by-blow analysis of the study, that’s for you to do. What I am going to do is look at what the yoga consisted of – and see why, perhaps, yoga is getting so much research interest. BTW, yoga was found to be non-inferior to physiotherapy, and both yoga and PT were more likely than education to have a clinically meaningful response, although neither yoga nor PT were superior to education.
This is the bas...
Source: HealthSkills Weblog - June 25, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Back pain Chronic pain Coping strategies Motivation Pain conditions Professional topics Research Science in practice biopsychosocial function Health Therapeutic approaches Source Type: blogs
Lifestyle change: “I know what to do, I just need to do it…but how?”
I hear this nearly every day in my primary care clinic. Many of my patients are overweight or obese, which mirrors the national trend: two out of three adults in the US are overweight or obese. Many of these folks suffer from medical issues such as low back, hip, knee, and foot pain; asthma; obstructive sleep apnea; fatty liver; type 2 diabetes; high blood pressure; high cholesterol; or depression. We know that these conditions often improve with weight loss. So, I often recommend weight loss as a first step in treatment, and the usual approach is through lifestyle change.
Lifestyle change programs for weight loss have bee...
Source: Harvard Health Blog - June 23, 2017 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Behavioral Health Exercise and Fitness Healthy Eating Prevention Source Type: blogs
The opioid crisis changed how doctors think about pain - Vox
WILLIAMSON, West Virginia — This town on the eastern border of Kentucky has 3,150 residents, one hotel, one gas station, one fire station — and about 50 opiate overdoses each month.On the first weekend of each month, when public benefits like disability get paid out, the local fire chief estimates the city sees about half a million dollars in drug sales. The area is poor — 29 percent of county residents live in poverty, and, amid the retreat of the coal industry, the unemployment rate was 12.2 percent when I visited last August— and those selling pills are not always who you'd expect."Elderly folks who dep...
Source: Psychology of Pain - June 22, 2017 Category: Anesthesiology Source Type: blogs
Emergency acupuncture! (2017 edition)
For whatever reason, acupuncturists and acupuncture believers think that acupuncture can be useful in emergency situations. They even do studies purporting to show that. This is yet another of such a clinical trial, albeit larger than usual. Guess what? It doesn't really show what it's advertised to show. (Source: Respectful Insolence)
Source: Respectful Insolence - June 20, 2017 Category: Surgery Authors: Orac Tags: Clinical trials Complementary and alternative medicine Pseudoscience Quackery Skepticism/critical thinking acupuncture ankle sprain emergency room low back pain migraine quackademic medicine Source Type: blogs
Pacing, pacing, pacing – good, bad, or … ?
There’s nothing that pain peeps seem to like more than a good dispute over whether something is good, or not so good for treatment. Pacing is a perennial topic for this kind of vexed discussion. Advocates say “But look at what it does for me! I can do more without getting my pain out of control!” Those not quite as convinced say “But look at how little you’re doing, and you keep letting pain get in the way of what you really want to do!”
Defining and measuring pacing is just as vexed as deciding whether it’s a good thing or not. Pacing isn’t well-defined and there are several...
Source: HealthSkills Weblog - June 18, 2017 Category: Anesthesiology Authors: adiemusfree Tags: 'Pacing' or Quota Assessment Chronic pain Clinical reasoning Coping Skills Pain conditions Research Science in practice biopsychosocial pain management self management Therapeutic approaches Source Type: blogs
Who Receives More Wasteful Care: Medicaid Enrollees or People with Private Insurance?
Some medical services are unnecessary. Is it your first day of uncomplicated lower back pain? You don’t need an x-ray. But many patients continue to receive such services anyway, perhaps because they demand them or, perhaps, because their providers keep recommending … Continue reading →
The post Who Receives More Wasteful Care: Medicaid Enrollees or People with Private Insurance? appeared first on PeterUbel.com. (Source: blog.bioethics.net)
Source: blog.bioethics.net - May 31, 2017 Category: Medical Ethics Authors: Peter Ubel Tags: Health Care Peter Ubel syndicated Uncategorized Source Type: blogs
Targeting the people who need it most
This study provides some support for using single item questions to identify those who need more in-depth assessment, and those who don’t need this level of attention. I like that! The idea that we can triage those who probably don’t need the whole toolbox hurled at them is a great idea.
Perhaps the New Zealand politicians, as they begin the downhill towards general elections at the end of the year, could be asked to thoughtfully consider rational distribution of healthcare, and a greater emphasis on targeted use of allied health and expensive surgery.
Deyo, R. A., & Mirza, S. K. (2016). Herniated Lu...
Source: HealthSkills Weblog - May 28, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Assessment Back pain Chronic pain Coping strategies Interdisciplinary teams News Pain conditions Professional topics Research biopsychosocial disability healthcare rehabilitation self management treatment Source Type: blogs
Being mindful about mindfulness
I’m generally a supporter of mindfulness practice. It’s been a great discipline for me as I deal with everyday life and everything. I don’t admit to being incredibly disciplined about “making time for meditation” every day – that is, I don’t sit down and do the whole thing at a set time each day – but I do dip in and out of mindfulness throughout my day. While I’m brushing my teeth, slurping on a coffee, driving, sitting in the sun, looking at the leaves on the trees, cuddling my Sheba-dog I’ll bring myself to the present moment and take a couple of minutes to be ...
Source: HealthSkills Weblog - May 21, 2017 Category: Anesthesiology Authors: adiemusfree Tags: Chronic pain Clinical reasoning Pain conditions Relaxation Resilience/Health Science in practice acceptance mindfulness persistent pain willingness Source Type: blogs
To Your Health: an NLM podcast
The National Library of Medicine presents a weekly audio update that highlights consumer health news and accompanying information from MedlinePlus. Information includes such topics as revised prostate cancer screening guidelines, low back pain and the geography of cancer deaths. This consumer health oriented podcast also helps consumers use MedlinePlus to follow up on weekly topics. Each podcast is less than 7 minutes in length and are accompanied with a transcript. Listen to the podcasts. (Source: BHIC)
Source: BHIC - May 9, 2017 Category: Databases & Libraries Authors: Annette Parde-Maass Tags: General National Library of Medicine News Source Type: blogs
