Physical therapy as the first treatment for low back pain stops the use of opiates: vaccines



The patients in the study had "significantly lower out-of-pocket costs, on average, $ 500, when they first visited a physiotherapist," says Bianca Frogner, a health economist at the University of Washington.

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The patients in the study had "significantly lower out-of-pocket costs, on average, $ 500, when they first visited a physiotherapist," says Bianca Frogner, a health economist at the University of Washington.

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Although Americans spend between $ 80 billion and $ 100 billion each year hoping to relieve their back pain, there is growing evidence that many costly standard treatments, including surgery and spinal injections, are often ineffective and they can even worsen and prolong the problem. .

A study published on Wednesday in the journal Health Services Research suggests first trying physiotherapy at least to alleviate the stress in the patient's wallet in the long term, and also to curb the dependence on opioid badgesics, who carry their risks.

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Researchers, from the University of Washington in Seattle and George Washington University in Washington, DC, badyzed more than 150,000 commercial health insurance claims filed between 2009 and 2013 in six northwestern states. They reviewed the records of patients who had a new diagnosis of low back pain, comparing insurance claims of people who had received physical therapy before seeing their GP or a specialist with people who received PT at a later date or not. . everybody.

The study was not designed to directly observe how well physical therapy improves pain. Instead, the researchers wanted to see if physical therapy reduced the overall costs of medical care and the patient's expense related to back pain, including the number of opioid prescriptions and the number of advanced imaging tests such as MRIs and CT scans. , as well as hospitalizations and visits to the emergency room.

It turned out that patients who saw a physiotherapist before trying other treatments had an 89 percent lower chance of finally needing an opioid prescription, a 28 percent lower chance of having advanced imaging services and a 15 percent chance of having One hundred percent lower probability of making one or more emergency visits.

In general, patients saw "significantly lower out-of-pocket costs, on average, $ 500, when they first visited a physical therapist," says Bianca Frogner, a health economist at the University of Washington, and lead author of the study.

"People who are trained in physical therapy have a very specialized knowledge of pain management," he says, "especially with the skeletal muscle system, which could actually understand this pain better than the average family doctor."

It is also worth noting, he says, that some patients who could benefit from physical therapy do not get it, due to health insurance restrictions.

Kenneth Harwood, co-author of the study and physiotherapist who directs the program as a medical care provider at George Washington University, says that PT can decrease the patient's pain by physically moving the joints of the back, knee or hip through of a full range of motion, thus decreasing the rigidity and immobility that patients can feel.

Therapists can also guide patients through exercise regimens that strengthen muscles and help patients develop control over movements, including posture.

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The study found an unexplained 19 percent higher likelihood of final hospitalization among patients who received physical therapy before others did medical care The researchers did not have the cause of each hospitalization in their data set But Frogner says it may have been, in many cases, the result of other comorbid conditions badociated with low back pain, such as obesity or diabetes.

It could also be that the physiotherapist was able to identify more serious problems at the first visit and refer patients to more specialized care, "he says.

Among the first ones whose treatment was physical therapy, scientists found a dramatic decrease in the ability to prescribe opioids for pain.

In an era of generalized opioid prescriptions, Frogner says it is worth considering all that can be done to reduce the number of opioids in circulation.

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"We need to look for better ways to help patients control their current pain and prevent it from coming back in the future," says Frogner, adding that physiotherapists "are fine "Positioned to provide ideas about exercises, movements and ways of life to prevent the pain from worsening and, hopefully, return, once it is no longer East ".

Pain specialist Dr. Mark Bicket of the Johns Hopkins University School of Medicine, who was not affiliated with the study, says the findings align with American Pain Society guidelines on the treatment of low back pain . The guidelines recommend non-pharmacological treatments, including physiotherapy, as the first line of defense.


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