• Skip to main content
  • Skip to primary sidebar
  • Skip to footer
  • About Us
    • Our Attorneys
    • Our Staff
      • Sheila Chavez
      • Marin Gorman
    • Mission Statement
    • Community Service
    • Charities We Support
    • Secret Settlements – Our Stand
    • Patrick Malone & Associates Offers Scholarship to Law Students for Representing Real People
  • Attorneys
    • Patrick Malone
    • Daniel C. Scialpi
    • Alfred Clarke
    • Heather J. Kelly
    • Aaron M. Levine, Of Counsel
    • Peter R. Masciola, Of Counsel
  • Focus Areas
    • Medical Malpractice
      • Hospital Errors
      • Cancer Misdiagnosis
      • Diabetes
      • Kaiser HMO Malpractice
      • Military Malpractice
      • Hospital Security Misconduct
    • Brain and Spinal Cord Injuries
      • Brain Injuries From Medical Care
      • Lead Poisoning
      • Traumatic Brain Injury (TBI)
      • TBI Long-Term Care & Rehabilitation
    • Baby & Child Injuries
      • Birth Injuries
      • Infant/Child Brain Injuries
      • Shaken Baby Syndrome
      • Pediatric Anesthesia Errors
      • Jaundice/Kernicterus
      • Bacterial Meningitis
    • Sex Abuse of Children and Youths
      • Sexual Abuse Claims in Washington D.C.
    • Auto, Truck, and Motorcycle Accidents
      • Car Accidents
        • Maryland Car Accidents
        • Virginia Car Accidents
      • Truck Accidents
      • Motorcycle Accidents
      • Pedestrian Accidents
      • Bicycle Accidents
      • Train Accidents
    • Defective & Dangerous Products
    • Dangerous Drugs
      • Carbon Monoxide Poisoning
    • Nursing Home Neglect and Abuse
    • Consumer Rights
    • Accounting and Legal Malpractice
      • How To Sue Your Lawyer For Malpractice
      • Common Legal Malpractice Claims
      • Damages For Legal Malpractice
      • Missing The Deadline For A Lawsuit
  • Success
    • Verdicts & Settlements
    • What Our Clients Say
    • True Stories
  • Publications
  • Resources
    • Frequently Asked Questions
    • Steps in the Legal Process
    • The Jury Trial System
    • Legal Deadlines for Filing Your Personal Injury Lawsuit
    • Better Health Care Newsletter from Patrick Malone
    • Sign Up for Our Free Newsletter on Getting Better Health Care
    • Free Fact Kit for Injury Victims
    • Tips for Patient Safety and Better Health Care
    • Health Care Advocates’ Power Kit
    • For Attorneys
    • More Legal Resources
    • Fellow Inner Circle Members
    • DC Hospital Ratings Map
    • Motor Vehicle Accident Blog
    • Washington D.C. Bike Map
    • Commute Risk Calculator
  • Patient Safety Blog
    • ProtectPatientsBlog.com
  • Malpractice A-Z
  • Contact Us

Patrick Malone Law

Medical Malpractice & Personal Injury Law Firm | Patrick Malone Law

CALL US TODAY:

202-742-1500
888-625-6635

Are You A Lawyer Seeking Co-Counsel ?
  • About Us
    • Our Attorneys
    • Our Staff
      • Sheila Chavez
      • Marin Gorman
    • Mission Statement
    • Community Service
    • Charities We Support
    • Secret Settlements – Our Stand
    • Patrick Malone & Associates Offers Scholarship to Law Students for Representing Real People
  • Attorneys
    • Patrick Malone
    • Daniel C. Scialpi
    • Alfred Clarke
    • Heather J. Kelly
    • Aaron M. Levine, Of Counsel
    • Peter R. Masciola, Of Counsel
  • Focus Areas
    • Medical Malpractice
      • Hospital Errors
      • Cancer Misdiagnosis
      • Diabetes
      • Kaiser HMO Malpractice
      • Military Malpractice
      • Hospital Security Misconduct
    • Brain and Spinal Cord Injuries
      • Brain Injuries From Medical Care
      • Lead Poisoning
      • Traumatic Brain Injury (TBI)
      • TBI Long-Term Care & Rehabilitation
    • Baby & Child Injuries
      • Birth Injuries
      • Infant/Child Brain Injuries
      • Shaken Baby Syndrome
      • Pediatric Anesthesia Errors
      • Jaundice/Kernicterus
      • Bacterial Meningitis
    • Sex Abuse of Children and Youths
      • Sexual Abuse Claims in Washington D.C.
    • Auto, Truck, and Motorcycle Accidents
      • Car Accidents
        • Maryland Car Accidents
        • Virginia Car Accidents
      • Truck Accidents
      • Motorcycle Accidents
      • Pedestrian Accidents
      • Bicycle Accidents
      • Train Accidents
    • Defective & Dangerous Products
    • Dangerous Drugs
      • Carbon Monoxide Poisoning
    • Nursing Home Neglect and Abuse
    • Consumer Rights
    • Accounting and Legal Malpractice
      • How To Sue Your Lawyer For Malpractice
      • Common Legal Malpractice Claims
      • Damages For Legal Malpractice
      • Missing The Deadline For A Lawsuit
  • Success
    • Verdicts & Settlements
    • What Our Clients Say
    • True Stories
  • Publications
  • Resources
    • Frequently Asked Questions
    • Steps in the Legal Process
    • The Jury Trial System
    • Legal Deadlines for Filing Your Personal Injury Lawsuit
    • Better Health Care Newsletter from Patrick Malone
    • Sign Up for Our Free Newsletter on Getting Better Health Care
    • Free Fact Kit for Injury Victims
    • Tips for Patient Safety and Better Health Care
    • Health Care Advocates’ Power Kit
    • For Attorneys
    • More Legal Resources
    • Fellow Inner Circle Members
    • DC Hospital Ratings Map
    • Motor Vehicle Accident Blog
    • Washington D.C. Bike Map
    • Commute Risk Calculator
  • Patient Safety Blog
    • ProtectPatientsBlog.com
  • Malpractice A-Z
  • Contact Us
Call
Contact
Blog

September 2013

Back Pain: Good and Bad Paths to Relief – Better Care for Your Aching Back

The Facts About Drug Therapy Spinal Injections Don’t Measure Up
Surgery as a Last Resort Watchful Waiting Can Be Your Friend

Greetings!

Back pain is the fifth most common complaint people bring to a primary care doctor. At some point, almost everyone experiences low back pain, and those who deal with it regularly can fall victim to a host of misguided treatments.

I’ve written before in my patient safety blog about the dangers of spinal laser surgery and premature imaging for low back pain.

Now, new studies confirm that caregivers routinely ignore best practices for treating back pain. A study published in JAMA Internal Medicine showed that doctors prescribe powerful, addictive narcotics instead of other recommended painkillers, and recommend unwarranted diagnostic imagery. Another study in the Journal of the American Medical Association about spinal injection therapy didn’t yield the widespread positive outcomes hoped for.

Knowing how back pain is routinely treated incorrectly can help you find the right treatment when and if your back demands attention.

Getting the Facts About Drug Therapy

Here’s just one of the prominent problems in getting correct treatment for back pain: the chance you’ll be prescribed dangerous addictive drugs that are no more effective in pain relief than other drugs.

As reported by the Los Angeles Times, doctor referrals for physical therapy remained steady during the study period of 1999 to 2010, but prescriptions for narcotic painkillers increased by half as prescriptions for nonopiate drugs fell by the same amount.

Somehow, doctors aren’t getting–or are choosing to ignore–the message. The study’s authors referred to a 2007 analysis that narcotics provided little to no benefit in cases of acute back pain and that they weren’t effective in cases of chronic back pain.

The researchers also called the increased use of diagnostic imaging for back pain “inappropriate,” and said that the radiation exposure could cause cancer. Medical guidelines recommend avoiding early imaging or other aggressive treatments, except in rare cases, but the use of computed tomography (CT) or magnetic resonance imaging (MRI) had increased by 57%.

The study from 2007 projected 1,200 additional future cancers would be created by the 2.2 million lumbar CTs performed in the U.S., according to the authors.

Be Wary of Spinal Injections

The recent report on spinal injection research was described by Dr. John Mandrola on KevinMd.com as “a shocker.” He identified five important points in the article:

1. Injection use varies substantially. Just as some doctors are notorious for overprescribing some kinds of drugs, relatively few doctors are responsible for a disproportionately high percentage of injections. Critically, there are no data to show that higher use rates associate with better outcomes.

2. Injections are not equal. Different parts of the back anatomy can be injection targets, and different drugs (local anesthetics, steroids, pain meds, etc.) can be injected. Injections are given at different stages of disease-acute, subacute and chronic. So many variables make profound review of the topic difficult at best.

3. Evaluating the benefits of a treatment is best accomplished through a systematic review of all scientific literature. Sometimes called meta analysis, these comprehensive reviews yield the best information for making clinical decisions. The Cochrane Collaboration conducted such a review for spinal injections in 2008 and found that only 6 of 18 trials showed significant results for at least one outcome in favor of the injection. No clear pattern of benefit emerged. The researchers concluded: “There is insufficient evidence to support the use of injection therapy in subacute and chronic low-back pain. However, it cannot be ruled out that specific subgroups of patients may respond to a specific type of injection.”

4. A more recent meta analysis studied epidural injections for sciatica.The Annals of Internal Medicine report  found a very small improvement in the short-term-6 points on a 100-point scale. No long-term benefit was noted for sciatica, a broad diagnosis for various kinds of pain affecting the hip, back and/or leg caused by compression of the sciatic nerve. These researchers concluded: “The small size of the treatment effects raises questions about the utility of this procedure in the target population.”

5. Only one country-Belgium-recommends spinal injections. Clinical guidelines in the U.S., U.K. and Europe do not recommend injection therapy for low back pain. In general, they prefer pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen and aspirin, muscle-strengthening exercises, behavioral therapy, spinal manipulation and, if necessary, opioid pain killers.

The older JAMA article concluded: “Patients with low back pain differ in their clinical presentation and may respond differently to treatments. Injection therapy of any kind may be beneficial in individual cases or subgroups. Nevertheless, given the weak scientific evidence base and the availability of noninvasive and more effective alternatives, physicians and policy makers should not recommend the use of injection therapy for patients with low back pain and sciatica.”

Mandrola was surprised. He thought it was logical to inject anti-inflammatory drugs directly to the source of the problem. “You would have thought comparison studies would have strongly favored local injections,” he wrote. “But that’s the thing with evidence-based medicine: Just because something makes sense, and smart doctors think it so, does not mean it is so.”

As he noted, many patients referred for spinal injections, especially older folks, also take blood-thinning drugs, such as warfarin (Coumadin), Clopidogrel (Plavix), heparin, Lovenox, etc. Interrupting that regimen, which is necessary to deliver other drugs in spinal injections, can be risky.

Surgery as a Last Resort

Back surgery has long been controversial; sometimes it results in not relieving pain, or even making it worse. Back and spine surgery risk factors include permanent nerve damage or even paralysis; spinal hematoma (collection of blood) puts pressure on nerves that also can cause paralysis.

I’ve represented several patients in malpractice cases; they walked into the hospital for their back surgery and never walked again. Check out my backgrounder on spine surgery malpractice here.

Except for acute injuries and serious conditions, other, less invasive measures such as physical therapy, weight loss and analgesics should be considered as first-line treatments, especially for what’s often promoted as new and better kinds of surgery.

Recently, so-called “breakthrough” spinal surgeries have proved significantly riskier than promised. My recent patient safety blog about a snazzy new surgery to promote bone growth instead of the more traditional bone graft illustrates the dangers of being too eager to embrace what sounds fantastic.

The product is a protein that’s implanted to encourage bone growth and fuse the gaps between vertebrae. Grafts harvest bone from another part of the body or a cadaver to encourage fusion of the vertebrae. The latter procedure doesn’t carry the risks that have been suggested might occur with the implant, including male sterility, bone growth problems, cancer and back and leg pain.

Laser spine surgery is another treatment you don’t undertake lightly. As noted in my blog, it substitutes the laser beam for electrical current. In both cases, the idea is to burn off sensitive nerve endings between the vertebrae. But with either device, pain relief can be short term because the nerve endings grow back. See also our backgrounder on laser spine surgery malpractice.

Watchful Waiting Can Be Your Friend

Any treatment that isn’t necessary is poor treatment. Disease is never 100% avoidable, Mandrola pointed out, but a healthful, balanced lifestyle reduces the risk of facing tough treatment decisions. When disease strikes, “if it is safe to wait,” he advised, “taking a conservative approach, giving the body time to heal itself, is often just as good as having a sharp object stuck into you.”

As the authors of the recent study noted, if doctors and patients follow the established treatment guidelines, routine back pain usually improves within three months.

For more information, see my backgrounder.
Here’s to a healthy 2013!

Sincerely,
  signature block

Patrick Malone
Patrick Malone & Associates

Primary Sidebar

Contact Us

Focus Areas

  • Medical Malpractice
  • Birth Injury
  • Auto, Truck & Motorcycle Accidents
  • Brain & Spinal Cord Injuries
  • Defective Products
  • Dangerous Drugs
  • Nursing Home Neglect & Abuse
  • Consumer Rights
  • Accounting & Legal Malpractice

Resources

The Lawsuit Process
  • Free Fact Kit for injury victims
  • FAQs about injuries & the legal process
  • Steps in the legal process
  • Legal deadlines for your lawsuit
  • What to expect from your “independent” medical examination
  • The jury trial system
Medical Resources
  • Patient Safety Tips
  • Health Care Advocates’ Power Kit
  • DC Hospital Rating Map
  • Patient Safety Newsletter
    from Patrick Malone
For Attorneys
  • Books for Attorneys
  • Expert Witness Resources
  • Articles
  • Briefs
  • Closing Arguments in Trial
  • Medical Society Statements on Expert Witness Testimony
  • Cross Examination Transcripts

What Our Clients Say

  • Client reviews on
  • Client reviews on
View more

Patient Safety Blog by Patrick Malone & Associates

  • Communication
  • Medical Malpractice
  • Medications
  • Hospitals
  • Preventive Care
  • Research Studies
  • Accessibility of Health Care
  • Disclosure
  • Primary Care
  • Product Safety
View More Topics

Footer

Our Location

  • PATRICK MALONE & ASSOCIATES, P.C.

    1310 L Street NW
    Suite 800
    Washington, DC 20005

  • Phone: (202) 742-1500
  • Toll Free: (888) 625-6635
  • EMAIL
  • Facebook
  • Twitter
  • Youtube
  • Linkedin

What We Do

  • Brain And Spinal Cord Injuries
  • Medical Malpractice
  • Birth Injury
  • Auto, Truck And Motorcycle Injuries
  • Defective And Dangerous Products
  • Dangerous Drugs
  • Nursing Home Neglect And Abuse
  • Consumer Rights
  • Accounting and Legal Malpractice

Directions

Get Directions

© 2023 Patrick Malone & Associates, P.C. | All Rights Reserved | Legal Notice