We’ve said it before, but it bears repeating: low back pain (LBP) is at epidemic levels in Canada. Over 80% of Canadians can expect to suffer an episode of LBP in their lifetime, and it is a leading cause of disability and prolonged work absences.

Chronic and recurrent low back pain is also responsible for the majority of MSK-related healthcare costs – an estimated $12 billion yearly – and that figure does not even include the economic impact to Canadian society resulting from lost productivity, absences and disability payments. Considering that by 2027, one in three Canadians will be over 55 years old and facing increased risk of developing MSK issues, it is vital to devise a comprehensive MSK strategy and ensure access to appropriate care sooner rather than later.

Low Back Pain: Medical Intervention

According to Statistics Canada, those in chronic pain are most likely to seek professional care from doctors, nurses, physiotherapists, and psychologists. Many patients are managed primarily through pharmaceutical options, diagnostic imaging and surgical referrals. But, is this the most appropriate care?

There is evidence that medical treatment of LBP in Canada, the US and England has very high healthcare costs, with limited patient outcomes. In Alberta, a 2009 review of the suitability of ordering MRI scans revealed that one-third of MRI requisitions were ordered to determine whether or not patients suffering from low back pain needed surgery. Researchers found that only 44% of the tests were deemed appropriate and that less than 1% of cases were, in fact, candidates for surgery.

The Overuse of Diagnostic Imaging and Opioids

Within 10 years in Ontario, MRIs increased by 619% and CT scans increased by 199%, although data suggests that clinical assessments made by MSK experts decrease the overuse of MRIs. This not only results in significant healthcare savings, but spares patients from the stress and risks of undergoing unnecessary diagnostic imaging.

Similarly, those coping with chronic pain who seek medical intervention are likely to be prescribed opioids. Alarmingly, Canadians are the world’s second largest (per capita) consumers of prescription opioids. In 2012, approximately 410,000 Canadians self-reported abuse of psychoactive drugs. In Ontario alone, over 60% of drug-related deaths were related to prescription opioids. It is conceivable that some of these cases could have been managed with appropriate and conservative care.

What is “Appropriate” Care?

Appropriate care is based on valid evidence, and the benefits of care need to exceed potential harm. Appropriate care is also cost effective and consistent with ethical principles that reflect individual preferences and show clear benefits to a community. Conversely, inappropriate care can complicate care or even have a detrimental impact on Canadians’ health.

For many Canadians, access to appropriate non-pharmaceutical options may help relieve pain but also manage the complexity of comorbidities and decrease the likelihood of opioid addiction. Early chiropractic intervention of MSK injuries and disorders addresses problems before they become chronic and helps patients effectively manage pain and other disorders that increasingly plague the Canadian workforce.

References:

1. Canadian Chiropractic Association
2. Dionne CE, et al. Does back pain prevalence really decrease with increasing age? Age Ageing 2006.
3. CADTH. Costs and outcomes of chiropractic treatment for low back pain. (Verified Link).
4. The Work Foundation. Fit For Work? Musculoskeletal Disorders and the Canadian Labour Market.
5. Statistics Canada. Canadian Community Health Survey, Health Reports.
6. Emery D, et al. Management of MRI Wait Lists in Canada.
7. International Narcotics Control Board. Narcotics Drugs: Estimated World Requirements.
8. Parliament of Canada (HESA). Evidence, 6 November 2013.
9. Parliament of Canada (HESA). Evidence, 20 November 2013.