News
Lifestyle and Back Pain
The BackLetter Vol 36, No 3, March 2021
“Researchers have looked at many factors in the development and persistence of chronic pain–unhealthy diet, exercise, sleep, negative stresses, socioeconomic disadvantage, etc–and they all correlate individually with the development and/or persistence of chronic pain to some degree.”
“A 2013 review by Oliver van Hecke and colleagues listed all the modifiable factors that have been associated with chronic pain: mental health problems, other comorbidities, smoking, alcohol consumption, obesity, physical activity/exercise, sleep, nutrition, employment status, and occupation factors.”
Beware Biased Decisions
The BackLetter Vol 36, No 2, Feb 2021
“Some biases that often come into play in medical decisions include optimism bias (i.e. unrealistic optimism), confirmation bias (in which information is interpreted to fit preexisting beliefs), preference for certainty, ambiguity aversion, loss aversion, and the ‘focusing illusion.’ The latter highlights the basic truth that ‘nothing in life seems as important as you think it is when you are thinking about it.'”
“…to practice medicine competently, healthcare providers need to acknowledge that they themselves are subject to many of the same biases and need to be aware of those.”
“…[patients] should be aware that most spine care providers will be biased, some in unpredictable ways. For example, patients seeking back care for nonspecific chronic back pain would encounter substantially different biases if they consulted a surgeon, a pain specialist, a primary care physician, a physical therapist, a chiropractor, an acupuncturist, or a clinical psychologist. Patients will encounter markedly different views of back pain causation, diagnostic techniques, and radically different treatment approaches. And bias creeps into a lot of these issues.”
Physicians and Patients Dramatically Underestimate Spinal Radiation Exposure
The BackLetter Vol 36, No 1, Jan 2021
“A 2007 study in the New England Journal of Medicine concluded that radiation related to CT scanning alone may account for up to 2% of all cancers in the United States.”
“Unfortunately, a substantial minority of spinal imaging is unnecessary. Guidelines have recommended moving away from routine use of x-rays and early use of advanced imaging. Yet imaging continues to be employed without adequate indications, in the routine screening of patients and in defensive medicine.”
“A recent study in Spine by Michelle Scott, MD, et al. found…For lumbar x-rays, patients and surgeons underestimated radiation exposure by five-fold and seven-fold, respectively. For CT imaging of the cervical spine, patients and surgeons underestimated radiation exposure 18-fold. For lumbar CT scanning, they collectively underestimated radiation exposure by 31-fold.”