The MedRisk Blog
Fear that spine issues can quickly escalate into a chronic problem or even a disability often leads patients to a make decisions based on panic, resulting in an overreliance on expensive treatments such as injections, surgeries and medications as a first line of defense. However, research is showing the outcomes for many spine issues from the simple through even the complex are just as good with a much more conservative approach to diagnosis and management.
“Back pain is less the catastrophe people think it is and more a painful inconvenience that can be managed,” said Dr. Donald Murphy, DC, chiropractor, research scientist and MedRisk advisory board member.
Dr. Murphy is pioneering a wholesale change in how the medical community views and manages spine issues and it begins at first report of injury or issue. The key: primary spine practitioners.
“People typically look to their primary care physician to diagnose and treat back pain. But this can be a challenge for the general practitioner who doesn’t have specialized knowledge to deliver the most efficient and effective treatment,” Murphy said. “It leaves the patient faced with a laundry list of interventions, services and devices they can’t really navigate on their own.”
Just as a general dentist is the first professional patients see for issues related to their teeth and gums, a primary spine practitioner would lead the initial diagnosis and recommendations for further treatment for people with back and neck issues. It is essentially primary care specifically for patients with spine problems and Dr. Murphy calls this new approach Primary Spine Care.
One of the guiding principles for Dr. Murphy’s Primary Spine Practitioners is to help patients understand the reality of their back pain–what it is and what it isn’t–and to focus on education and self-care as both part of the treatment plan as well as a way to prevent re-injury.
Dr. Murphy has completed several clinical studies focused on the outcome of primary spine care on specific patient populations from those suffering from cervical radiculopathy or spinal stenosis to pregnancy related back pain, and has published research on the wider potential impact primary spine care could have on patients, the healthcare system and society as a whole. The studies, which are informed by evidence-based spine management research, suggest that primary spine care could improve patient outcomes both immediately and in the long term.
“Spine care as it stands now is a mess–a lot of treatments and procedures don’t have very good evidence of efficacy despite costing quite a bit of money. We’ve incentivized doing as much stuff to people as possible rather than finding a solution,” Dr. Murphy said. “Primary Spine Care provides incredible value because it begins with the treatment path that is both most effective and has the fewest consequences–the best possible healthcare at the best possible cost.”
Primary Spine Care relies on practitioners trained to discover, diagnose and treat the majority of spinal issues, as well as develop a fully informed triage strategy should the patient require a specialist consultation or more intensive intervention. The training and certification process, however, is still in development.
Dr. Murphy is working with the University of Pittsburgh to formalize the certification process and testing procedures, establish the core competencies and prerequisites, and fully develop the curriculum.
One of the foundational textbooks, Clinical Reasoning in Spine Pain Volume 1, is already available and covers the principles of Primary Spine Care with a focus on lower back pain. Volume 2 is scheduled to be released early next year and will cover applying the Primary Spine Care methodology to cervical problems as well as a section devoted to case studies. Dr. Murphy says the two-volume book set was designed to be the operations manual for the primary spine practitioner and expects they will be a keystone of the curriculum when it becomes available.
“I’m very excited about having such a reputable and experienced academic partner in the University of Pittsburgh,” Dr. Murphy said. “And I look forward to the day when primary spine care is considered a common best practice throughout the medical community.”
Murphy, D.R., Hurwitz, E.L. “Application of a Diagnosis-Based Clinical Decision Guide in Patients with Low Back Pain”. Chiropractic & Manual Therapies 19 (2011):26. BioMed Central. Web. 25 Nov. 2015.
Murphy, D.R., Hurwitz, E.L. “Application of a Diagnosis-Based Clinical Decision Guide in Patients with Neck Pain”. Chiropractic & Manual Therapies 19 (2011): 19. BioMed Central. Web. 25 Nov. 2015.
Murphy, Donald R et al. “The Establishment of a Primary Spine Care Practitioner and Its Benefits to Health Care Reform in the United States.” Chiropractic & Manual Therapies 19 (2011): 17. PMC. Web. 25 Nov. 2015.
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