The Low Back Pain Injury: Treatment and financial considerations with acupuncture and herbal therapy

Low back pain is the second most common cause of missed workdays due to illness and the most common cause of disability in the US. Most episodes of back pain are self-limited, but 5%-10% of cases become chronic. Chronic conditions account for 90% of healthcare expenditures for back pain and amount to approximately $50 to $80 billion dollars annually.[4] Acupuncture and herbal therapy has an extensive history of successfully managing low back pain and reducing overall costs associated with chronic cases, and should be considered as an initial treatment option.

Lumbar disk herniation usually occurs from degenerative disk disease (dessication of the annulus fibrosis) in patients between 30- and 50-year-olds. The L5/S1 disk is affected in 90% of the cases. Compression of neural structures, such as sciatic nerve, causes radicular pain. The most common activity leading to herniation is usually bending or heavy loading (such as lifting) with back in flexion, which leads to a herniation or extrusion of the disk contents.[1] [2] [3]

The key symptoms for diagnosis include:

 
· Pain with back flexion or prolonged sitting.
· Radicular pain with compression of spinal structures.
· Lower leg numbness.
· Lower leg weakness.

Many patients mistakenly attribute the onset of their back pain to a specific injury, however, the actual injury from activity such as bending over, twisting, or lifting, is often trivial. Much of the time, low back pain is from the culmination of chronic injury and cumulative trauma relative to the person’s general health. Physically active and energetically healthy people have a lower incidence of back pain than those who lead an imbalanced and sedentary lifestyle.[4]

From the perspective of East Asian Medicine, Kidney Qi manages the strength of the low back. When the Kidney Qi is strong, the low back is strong; when Kidney Qi is weak, the low back is weak. The poor posture plus the following factors can lead to low back pain: Weak Kidney Qi combined with invasion of Cold and Dampness, plus Stagnation of Qi and Blood.[4]

Treatment methods vary between East and West. From the Western allopathic perspective, bed rest for up to 48 hours is appropriate for acute exacerbation of symptoms followed by first-line treatments of: activity modification; NSAIDS, physical therapy, core stabilization exercises and McKenzie exercises.[1] [2] [3] The incidence of low back pain recurrence after one year of nonsurgical treatments is at least 40%.[1] [2] [3] Corticosteroid injections can be beneficial, especially when used to relieve acute pain, but the results tend to only last three months. Surgery is usually suggested after all other conservative measures have failed. [1] [2] [3]

From the Eastern perspective, a combination of acupuncture, herbs, TuiNa (medical massage) and QiGong (movement exercises) can help the body reduce pain, improve flexibility, increase mobility and enable the patient return to their activities of daily living. Patients in my private practice regularly report that within 6-8 weeks of weekly acupuncture treatments and herbs, they are 90% recovered with very few—if any—pain recurrences. The benefits of using an acupuncture and herbal approach is that often the pain levels can be reduced to the point where the patient rarely requires surgery or additional drug therapies (corticosteroid injections) that have long-lasting, adverse side effects.

The cost effectiveness of non-operative treatments, such as acupuncture, is an important consideration point:
· Surgical discectomy w/ fusion (no complications/with comp.)  $41,363/$55,575
· Repeat surgical procedure (often required multiple times):       $28,019
· Lost productivity (work, caregiver, housework):                      $59.71/hour
                                                                                            _______________
Surgical and lost productivity total:                                         $69,441.71[5]

An average acupuncture treatment costs $75/session. A conservative treatment plan would require weekly treatments for six months. Herbs cost an average of $85/month for six months. The total cost for treatment with acupuncture and herbs for six months is approximately: $2,310.00. Most modest insurance plans have high deductibles between $2500 and $5000. Therefore, a patient must often spend between $2500 and $5000 before surgery is covered. While acupuncture and herbal therapies are not always the correct solution for patients with low back pain, it is clear that an initial expenditure of $2,310.00 in an effort to potentially save $69,44.71 in surgical expenses makes good financial sense. The added benefit of acupuncture therapy is that complications from surgery can often be averted if acupuncture and herbal therapy is effective, which also helps reduce overall costs.

Acupuncture and herbal therapy is an excellent choice for the patient who wishes to save money, prevent surgical complications and is interested in a holistic approach to healing.


ABOUT THE AUTHOR:

Nathan J. Heide, M.S., L.Ac.

Mr. Heide is founder and CEO of Anjuna Medicine, LLC in Eugene, Oregon. Anjuna Medicine (www.AnjunaMedicine.com) is a private practice, focusing on integrative pain management solutions for chronic and recalcitrant diseases by using traditional East-Asian medical techniques. Mr. Heide is a graduate of Pacific College of Oriental Medicine (San Diego) and a current doctoral fellow at Oregon College of Oriental Medicine in Portland, Oregon.


[1] Jacobs W et al. Total Disc replacement for chronic back pain in the presence of disc degeneration. Cochrane Database Syst Rev. 2012 Sep 12;9:CD008326
[2] Rihn JA et al. Duration of symptoms resulting from lumbar disc herniation: effect on treatment outcomes: analysis of Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg Am. 2011 Oct 19;93(20):1906-14.
[3] Suri P et al. Recurrence of radicular pain or back pain after nonsurgical treatment of symptomatic lumbar disk herniation. Arch Phys Med Rehabil. 2012 Apr;93(4);690-5.
[4] Callison M. Treatment of Orthopedic Disorders: A Class Manual. 2nd Ed. 2007 AcuSport Seminar Series LLC:114-157.
[5] Tosteson AN et al. The Cost Effectiveness of Surgical Versus Nonoperative
Treatment for Lumbar Disc Herniation Over Two Years Evidence From the Spine Patient Outcomes Research Trial (SPORT) SPINE. 2008 33;19: pp 2108–2115

9 Things Successful Patients Won’t Do

Recently, Dr. Travis Bradberry, Ph.D., wrote a great blog on LinkedIn called, “9 Things Successful People Won't Do” and in it he featured tips that can be directly applied to health management.

When patients first enter my clinic in Eugene, many arrive because they are suffering from some form of pain or medical condition that has not previously responded well to allopathic medicine and/or conventional medical therapies. Many patients are frustrated and upset by their condition, and are—understandably—nearing the end of their patience with medical professionals. Often the initial conversation between a patient and myself is one that revolves around frustrations of previous, often unsuccessful, medical care and the disenchantment around the lack of results produced by current healthcare system at large. While these are all important topics to discuss and I would like to continue to provide my office as a safe space to explore such conversations, it is helpful to enlist Dr. Bradberry’s tips to help improve acupuncture therapy. Successful patients—patients who achieve their healing goals with their healthcare practitioner— do the following:

They Won’t Let Anyone Limit Their Joy

Therapy satisfaction and healing are derived from many different areas: the body’s current health state, the medications one is on, nature and history of the illness, genetics, and most importantly the mental state of a patient. A success patient knows that their healing is primarily derived from the way in which they view their disease and the current situation—that is to say, they stay positive about the direction of their therapy, even if it seems to be taking longer than expected. Successful patients don’t compare themselves to other people, or to other times in their lives. Healing is a unique process that is always tied to the unique circumstances of that particular day and injury. While it is often initially satisfying to ask others how their treatments went and what results they received, the successful patient knows that only opinions that really matter are their own and the feelings associated with it. The joy of a successful treatment is a powerful healing tool and should not be limited by any other outside entity.

They Won’t Forget

Successful patients are quick to forgive themselves (and their bodies) of past injuries. Dr. Bradberry states, “Forgiveness requires letting go of what’s happened so that you can move on.” This process of forgiving and moving onward releases the emotional shackles that often prevent patients from truly healing. Successful patients are unwilling to be controlled by their own feelings of mistakes that might have lead to an illness. Rather, the successful patient lets mistakes go quickly, learns from those mistakes, and becomes assertive in protecting themselves from future harm.

They Won’t Die in the Fight

Successful patients know how important it is to live to fight another day. In the progress of illness, unchecked emotion makes you dig your heels in and fight the kind of battle that can leave you severely damaged. Unchecked emotions place unnecessary stress on the immune system and prevent the deeper healing that often needs to take place when working with chronic, recalcitrant conditions. The successful patient manages their emotions in such a way that they are able to choose healthcare battles wisely and only fight when the time is right. This is not to say that successful patients do not fight for the healing process—they do, in fact, fight very hard to heal. However, by being selective and aware of when to exert maximum fighting energy and when to calm down and allow the body to heal without emotional stress is the critical difference which often makes the largest difference between those patients who have profound healing responses and those who become stuck and don’t heal.

They Won’t Prioritize Perfection

Successful patients won’t set perfection as their target goal because they know it doesn’t exist. All patients are fallible, and when perfection is the goal, one is always left with a nagging sense of failure; Patients end up spending time lamenting what healing failed to accomplish instead of enjoying what healing did occur. Taking a step back from the larger goal of ‘complete, painless recover’ and breaking down the process into smaller steps to complete recovery will often reveal just how much healing is actually happening. The successful patient knows how to observe the small progress waypoints, rather than becoming fixated on the end result and being disappointed when they don’t arrive at the end immediately. 

They Won’t Live in the Past

Past medical conditions erodes self-confidence and makes it hard to believe a better outcome is possible in the future. In most cases, perceived therapy failure results from taking risks and trying to achieve something that isn’t easy. However, successful patients know that success lies in their ability to rise in the face of failure, and they can’t do this when they’re living in the shadows of their past medical history. Any significant medical milestone worth achieving is going to require one to take some risks, and one can’t allow failure to stop a person from believing in the ability to heal. When a patient lives in the shadows of their medical past, that is exactly what happens; the past medical history becomes the present, preventing future healing The successful patient does not allow the shadows of past medical conditions to prevent future healing successes.

They Won’t Dwell on Problems

The focal point of attention determines emotional state. When a patient fixates on the problems, this creates prolonged, negative emotions and stress, which inhibits the healing process. Successful patients know that when focus is placed on actions to better the circumstances, they create a sense of personal power that produces positive emotions and improves the healing response. Successful patients won’t dwell on problems because they know the most powerful healing response comes from a focal point on solutions and positivity instead of negativity and problems.

They Won’t Hang Around Negative People

Complainers are bad for the healing process because they wallow in their conditions and fail to focus on healthcare solutions. Unsuccessful patients want people to join their melancholic mental so that they can feel better about themselves and lack of progress. Dr. Bradberry states, “people often feel pressure to listen to complainers because they don’t want to be seen as callous or rude, but there’s a fine line between lending a sympathetic ear and getting sucked into their negative emotional spiral. You can avoid getting drawn in only by setting limits and distancing yourself when necessary. Think of it this way: if a person were smoking, would you sit there all afternoon inhaling the second-hand smoke? You’d distance yourself, and you should do the same with complainers. A great way to set limits is to ask complainers how they intend to fix a problem. The complainer will then either quiet down or redirect the conversation in a productive direction.” Successful patients are determined to surround themselves with individuals that are positive and engaged in the healing process.

They Won’t Hold Grudges

Successful patients learn that holding grudges against themselves or their healthcare providers only compounds the challenging healing situation. Again from Dr. Bradberry, “the negative emotions that come with holding onto a grudge are actually a stress response. Just thinking about the event involved sends your body into fight-or-flight mode. When a threat is imminent, this reaction is essential to your survival, but when a threat is ancient history, holding onto that stress wreaks havoc on your body and can have devastating health consequences over time. In fact, researchers at Emory University have shown that holding onto stress contributes to high blood pressure and heart disease. Holding onto a grudge means you’re holding onto stress, and [successful patients] know to avoid this at all costs. Learning to let go of a grudge will not only make you feel better now but can also improve your health.” 

They Won’t Say Yes Unless They Really Want To

According Dr. Bradberry, “research conducted at the University of California in San Francisco shows that the more difficulty that you have saying no, the more likely you are to experience stress, burnout, and even depression. Saying no is indeed a major challenge for most people. ‘No’ is a powerful word that you should not be afraid to wield.” Successful patients are very much engaged with their own healthcare, and the ability to have a positive conversation with a healthcare provider about the wishes and desires of treatment empowers successful patients and establishes a pathway for repeated future healing and healthcare successes. Saying ‘No’ to healthcare recommendations, when the recommendations do not seem appropriate to the patient, can be an avenue for gaining personal power that will lead to a greater sense of direction in the healing process.

ABOUT THE AUTHOR: Nathan J. Heide, M.S., L.Ac.

Mr. Heide is founder and CEO of Anjuna Medicine, LLC in Eugene, Oregon. Anjuna Medicine (www.AnjunaMedicine.com) is a private practice, focusing on integrative pain management solutions for chronic and recalcitrant diseases by using traditional East-Asian medical techniques. Mr. Heide is currently a graduate of Pacific College of Oriental Medicine (San Diego) and a current doctoral fellow at Oregon College of Oriental Medicine in Portland, Oregon.

Reference: 9 Things Successful People Won’t Do. Travis Bradberry, Ph.D. Retrieved from www.LinkedIn.com, 18AUG14.

Handwashing for Better Health

Anjuna Medicine Blog, August 13, 2014. Nathan J. Heide, M.S., L.Ac.

“Antimicrobial chemicals are so ubiquitous that a recent study found them in pregnant mothers' urine and newborns' cord blood. Research shows that their risks may outweigh their benefits.” The Atlantic Online. Julie Beck, Aug 12, 2014.

Recently, many scientists have discussed the potential benefits and risks of reducing the volume of antibiotic material used in the US and around the globe. As more antibiotic resistant bacteria develop and challenge the growing global population, it is important to find ways to maintain proper sanitation and hygiene without relying exclusively upon chemical solutions. One solution is to recall the basic principles of handwashing with regular soap and warm water.

According to the Centers for Disease Control, “Handwashing is like a "do-it-yourself" vaccine—it involves five simple and effective steps (think Wet, Lather, Scrub, Rinse, Dry) you can take to reduce the spread of diarrheal and respiratory illness so you can stay healthy. Regular handwashing, particularly before and after certain activities, is one of the best ways to remove germs, avoid getting sick, and prevent the spread of germs to others.”

When is the best time to wash hands? Follow these easy guidelines to help prevent the spread of germs:*

·       Before, during, and after preparing food

·       Before eating food

·       Before and after caring for someone who is sick

·       Before and after treating a cut or wound

·       After using the toilet

·       After changing diapers or cleaning up a child who has used the toilet

·       After blowing your nose, coughing, or sneezing

·       After touching an animal, animal feed, or animal waste

·       After handling pet food or pet treats

·       After touching garbage

How should you wash your hands? Follow these easy directions for the best results:*

      ·       Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.

        ·       Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.

        ·       Scrub your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice.

        ·       Rinse your hands well under clean, running water.

        ·       Dry your hands using a clean towel or air dry them.

*http://www.cdc.gov/handwashing/when-how-handwashing.html, Retrieved 13AUG14.