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"Am I part of the disease?

Or am I part of the cure?"

‘Clocks’ by Coldplay, 2002.

OK, I’ll admit it.  I love Coldplay.  I know they’re not a cool band to like and I know it reflects me being in my 40s, but tough.  Coldplay at the Etihad Stadium in 2012 was the best gig I’ve ever been to (closely followed by Pavement at the Brixton Academy in 2010 – see, I am cool.  Most people have never heard of Pavement).

(Edit - the best gig I've been to since writing this is again Coldplay at the Millenium Stadium in 2017 - it were marvellous)

Anyway, that quote.  It rattles round my brain every single day in clinic whenever I’m talking to patients about their need to continue treatment, or their need to have ever started treatment in the first place.  It becomes especially relevant when I’m talking to a new patient who has been through the wringer of other (probably well-meaning but ultimately careless) health care professionals.  The quote is an easy way to open the door to discussing what’s known as ‘iatrogenic disability’.

Iatrogenic is defined as being ‘illness or disability caused by medical examination or intervention’.  In other words, the problem didn’t exist until it was looked for or treated.  A fascinating case of this occurring is in normal, healthy individuals who during routine medical examination are found to have raised blood pressure despite having no symptoms.  They are then placed on blood pressure medication, and then start to notice health issues that they had never experienced before.  These are then further investigated and the patient notices a steady decline in their health and well-being. 

In the case of back pain and spine related disorders this is a huge problem.  This is probably down in no small part to the huge variation of health care practitioners out there who claim to know what they’re talking about when it comes to back problems and the enormous variety of treatments that can be offered to treat the same thing.  This leaves us with a big messy lump of confused and confusing information about back pain that is leaving millions of people stuck with no idea of how to get their back pain sorted. 

To imagine how ridiculous this situation is, imagine you wake up one morning with toothache and there is no such thing as a dentist.  Instead you have around a hundred people in your town who claim to treat toothache.  Some have no formal qualifications or insurance.  All of them claim they know the real cause of toothache and have all the answers.  Lots of them are critical of anyone else who claims to treat toothache.  Some of them really do know what they’re doing.  This situation doesn’t exist because a bunch of professionals got their act together and decided to work out what was the best treatment for the most common dental problems.  They're called dentists!  (Simple eh?  You’d think ‘we’ as professionals trying to treat back problems could do the same, but we are WAAAAAY off that situation).

To further use the dental analogy:  imagine it was commonplace for most of these toothache healers (and even bona fide dentists) to scare the hell out of you for no reason whatsoever before, during and even after treating your actually straightforward toothache.  Imagine an office full of grotesque pictures of decaying teeth, exposed nerves and bleeding gums.  Imagine being told you needed complicated scans of your teeth that made you stressed out of your head because you thought this meant you must have something dreadfully wrong growing in your skull.  Imagine being told that you had better keep coming back for the rest of your life otherwise all your teeth would fall out.  Imagine being told that you had better only ever eat mashed up food for the rest of your life because your teeth were as soft as marshmallows.  Imagine being told something as ridiculous as you had better give up talking as the movement of your jaw was causing your teeth to come lose.  Imagine then finding out that there was absolutely no evidence for any of it.

That would never happen would it?  Not in the dental profession it wouldn’t.  Why? Well because a bunch of professionals got their act together and decided to work out what was the best treatment for the most common dental problems.

But this kind of stuff happens every single minute of every single day in every single town in every single country all across the world when it comes to back pain.  I know because I’m seeing it every day.  I know because I’ve probably made the same mistakes in the past and inadvertently scared the b’jeebuz out of someone just by doing something simple as ordering and MRI scan for a back ache that we probably didn’t need (a bittersweet story actually – the poor guy I'm actually thinking of here wept with relief when I told him his scan was fine, It didn’t occur to me how worried he was about what might show up).  Normal healthy active people are having their lives affected detrimentally by practitioners who aren’t really thinking about what they’re doing and why they’re doing it.  Often the practitioner is clumsy or ignorant.  Sometimes the practitioner is using marketing tactics to get as many visits out of you as possible.  Sometimes it’s a blend of the two (“Say a lie often enough and some will believe you” – Stephen M. Perle DC).

I’ll finish off with a short example of a patient I have seen in the past couple of weeks. 

Healthy, very active, into fitness and outdoor pursuits and has a physical job.  Develops a relatively straight forward acute case of back pain that would never require anything more than a thorough examination, maybe some treatment and definitely some reassurance, home exercises and encouragement to keep active, stay at work and get back into exercise as soon as was comfortable. 

But no…

Books in to a no doubt very flashy clinic (i.e. definitely not mine!) Straight off; totally unnecessary full spine X-rays ordered, shown to the now seriously worried patient covered in loads of unnecessary show-offy measurements and lines and angles and markings proving what a bad state their spine was in (“I nearly fainted when I saw that”).  Scare-mongering then ensued (“The chiro was not happy at all with my spine”) and a whole bunch of unnecessary treatments prescribed and a whole bunch of unhelpful advice dolloped on top.  All ramping up the fear factor (and those who are able to instil the most fear in are usually the ones who are the gate-keepers to the all the so-called solutions which can be drip fed to you…at a price).  Every follow up visit entailed being hauled in for as many treatments as possible in as short a time as possible – usually a handful over a couple of weeks (bearing in mind this is a case where one or two visits would have sufficed) with no goal being set as to at what point treatment could be stopped.  Oh, had I mentioned that the acute pain had all but disappeared quite soon after the first visit?  

My approach was a damn good examination, a dose of reassurance and encouragement to get back to leading a normal and active life.  One visit. 

Follow up visit a few days later went something like this:

Me: How’s it going?

Patient: Absolutely great, I feel liberated.

So, in this case:

X-rays, scans, bloods: Zero

Fear mongering: Zero

Reassurance: Tonnes

Spinal adjustments: Zero

Perception adjustments: Gazillions

Visits: 2

Patient: Happy

Or

 “Effective reassurance is a bloody good painkiller” – Louis Gifford 1953-2014

 Thanks for reading.

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Clinig Corff Ystwyth,
Park Avenue,
Aberystwyth, Wales
SY23 1PB. 

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