facetguy

10+ Year Member
7+ Year Member
Jan 10, 2008
3,581
9
151
Status
My distorted view remains that you have yet to illucidate specific treatment algorithms for disc, facet, and based low back pain, leaving me to conclude that all low back pain is evaluated radiographically (if the patient's insurance will pay for it), random line-drawing on said x-rays (www.ncbi.nlm.nih.gov/pubmed/14970809), discussion about the terrible findings on said x-rays, and then treated indefinitely with the same adjustments, discussion of good posture, and conversation regarding nutrition.
There have been a number of algorithms published over the years. The Mercy Guidelines were published in the early 1990s:
http://www.chiro.org/documentation/FULL/Mercy_Recommendations.shtml
You are probably interested in "Section VIII: Frequency and Duration of Care".

Additional algorithms and guidelines have been published since then, most recently I think by the Council on Chiropractic Guidelines and Practice Parameters (CCGPP). These things also show up in various textbooks. Of course guidelines exist.

As to the random line drawing on xrays, there have been over the years a number of so-called assessment methods that some chiros have promoted, so I can't really argue much there. I don't know how much of this still goes on, but as I said long ago, we as a profession are improving all the time. The lines I learned in school are the standards that anyone would use, e.g., George's line, Cobb Angle, canal-body ratio, etc.

I don't see anything wrong with a discussion about good posture. And I don't see much wrong with giving a patient some diet advice (gee, Americans don't need any of that, do they?). So, we are in agreement there.:)


No, I want to you prove to me that what YOU DO (chiropractic care, not spinal manipulation, which includes what D.O.s do) works better that a placebo (not PT, or massage, just a placebo) in a prospective, double-blind, placebo-controlled trial for specific indications (not non-specific chronic low back pain). Until your field can measure up to the same demands we in medicine hold ourselves to, then yes, I will indeed consider it voodoo. Not because of any medicine vs chiropractic dialectic, but rather because that is the standard all of medicine is held to.
Back in the day, there was no literature available regarding chiropractic care of anything. So, little by little, researchers began to do this study. But you know as well as I that it is more feasible to design a study with a narrow focus so as to avoid any number of errors. It's not surprising, then, that it was spinal manipulation that got looked at the most; it's something virtually all chiropractors do, and it lends itself to specific study. That's why so many of these references are for "spinal manipulation" and not "chiropractic care". Some of them don't involve chiropractors, so that's another reason for the generic label of "spinal manipulation". (This isn't really that hard to understand)

But when you expand the parameters out to "chiropractic care", now it gets tougher to say exactly what that included. There are many ways to manipulate a body, and many ways to utilize modalities, and many ways to exercise a patient. So, for study purposes, it gets a little hazy. But, nonetheless, there are some studies that examined "chiropractic treatment" specifically:
http://www.ncbi.nlm.nih.gov/pubmed/20004804

http://www.ncbi.nlm.nih.gov/pubmed/16517383

That second study does address a specific source of low back pain, so you might like that one. But, as I've said several times now, most of the literature has examined "low back pain" or "neck pain". That's because in many cases, the true source of the patients pain is never 100% confirmed. But they get better, so everyone should be happy. SleepIsGood wants all chiropractors to use fluoro on their patients before and during treatment; sounds real practical to me. You guys do the fluoro stuff; we don't. It's widely known throughout healthcare that the true source of neck and back pain is elusive sometimes. And most times, a working dx after history and exam leads us in the right direction and we get the patient better.

Yup, I will wonder what disease entities you might have missed, and look forward to the day a judge in a malpractice suit holds you to the standard of an ordinary and reasonable physician when your attempts to practice medicine go awry.
Off the deep end again here. And, since it is your position that chiropractors routinely practice medicine without a license, why aren't we all getting sued and losing our licenses? There are lots of lawyers out there, so why are chiropractors still able to endanger patients' lives with such reckless abandon, as you would contend?
 
OP
SleepIsGood

SleepIsGood

Support the ASA !
10+ Year Member
5+ Year Member
Apr 16, 2006
1,965
2
0
Status
Fellow [Any Field]
Off the deep end again here. And, since it is your position that chiropractors routinely practice medicine without a license, why aren't we all getting sued and losing our licenses? There are lots of lawyers out there, so why are chiropractors still able to endanger patients' lives with such reckless abandon, as you would contend?
Because both of you leech of off patients. It's a symbiotic relationship, why would the lawyers want to cut you guys off. The lawyers find these pts with xyz pain. The chiropractors affirm it's due to the accident or whatever injury. Lawyer gets paid. Chiropractor gets paid by the lawyer:thumbup: Simple logic. Try it.
 

facetguy

10+ Year Member
7+ Year Member
Jan 10, 2008
3,581
9
151
Status
Because both of you leech of off patients. It's a symbiotic relationship, why would the lawyers want to cut you guys off. The lawyers find these pts with xyz pain. The chiropractors affirm it's due to the accident or whatever injury. Lawyer gets paid. Chiropractor gets paid by the lawyer:thumbup: Simple logic. Try it.
Are you saying that pain management physicians don't treat patients who happen to be involved in litigation? If that is your belief, then you are indeed a newbie.
 
OP
SleepIsGood

SleepIsGood

Support the ASA !
10+ Year Member
5+ Year Member
Apr 16, 2006
1,965
2
0
Status
Fellow [Any Field]
Are you saying that pain management physicians don't treat patients who happen to be involved in litigation? If that is your belief, then you are indeed a newbie.
If I'm a 'newbie' to medicine, what does that make you? Someone without ANY medical training:cool:

Didnt say that Pain docs dont work with them. however, chiropractors and the amulance chacing lawyers are leeches. You guys prey on vulnerable pts. Big difference.
 

Tenesma

Senior Member
10+ Year Member
15+ Year Member
Jun 11, 2002
5,332
127
281
Visit site
Status
Attending Physician
chiros don't get sued because they don't have deep pockets and their malpractice coverage is usually minimal and not that interesting.... i have seen a few lawsuits where (in my opinion) the chiro missed something HUGE, but ends up getting dropped from the case as the lawyers chased the docs for settlements.
 

facetguy

10+ Year Member
7+ Year Member
Jan 10, 2008
3,581
9
151
Status
chiros don't get sued because they don't have deep pockets and their malpractice coverage is usually minimal and not that interesting.... i have seen a few lawsuits where (in my opinion) the chiro missed something HUGE, but ends up getting dropped from the case as the lawyers chased the docs for settlements.
What are your malpractice limits?
 

ampaphb

Interventional Spine
10+ Year Member
May 13, 2007
4,352
723
331
New Orleans, LA
Status
Attending Physician
What are your malpractice limits?
No physician should answer this question on the public forum, as a lawyer, reading this thread, might tailor his demand to those values.

That being said, most hospitals require a standard set of limits in order to grant privileges at their institutions. As chiropractors do not hold such privileges, it seems unlikely your coverage limits would be as high as ours.
 

facetguy

10+ Year Member
7+ Year Member
Jan 10, 2008
3,581
9
151
Status
1M/3M is pretty standard.
That's what I have too, as this is standard for chiros. The notion that chiropractors don't carry malpractice or their policies are "not interesting" to lawyers is fantasy.
 

axm397

SDN Moderator
Moderator
15+ Year Member
Aug 25, 2003
1,728
47
461
texas
Status
Attending Physician
Didnt say that Pain docs dont work with them. however, chiropractors and the amulance chacing lawyers are leeches. You guys prey on vulnerable pts. Big difference.
I did some medicolegal work in Nevada - and there are pain docs and neuroradiologists and surgeons who work with PI lawyers to specifically run up the medical bill - the patients always get an over-read MRI that sound very ominous but if u look at the images there's really not much there - then they go to the pain doc who does a series of 3 Epis, facet injections followed by MBB followed by RFA, then discogram, IDET, then off to the spine surgeon for multilevel fusion.

I think there are definitely more chiros that do this than physicians - and the chiros advertise more - but there are practitioners that committ fraud and abuse in all fields - certainly not limited to chiros.
 

hyperalgesia

member
Lifetime Donor
7+ Year Member
Jan 9, 2010
4,844
1,538
181
Status
Attending Physician
I think there are definitely more chiros that do this than physicians - and the chiros advertise more - but there are practitioners that committ fraud and abuse in all fields - certainly not limited to chiros.
Absolutely. This type of arrangement in very common here in South Florida.
 
OP
SleepIsGood

SleepIsGood

Support the ASA !
10+ Year Member
5+ Year Member
Apr 16, 2006
1,965
2
0
Status
Fellow [Any Field]
I did some medicolegal work in Nevada - and there are pain docs and neuroradiologists and surgeons who work with PI lawyers to specifically run up the medical bill - the patients always get an over-read MRI that sound very ominous but if u look at the images there's really not much there - then they go to the pain doc who does a series of 3 Epis, facet injections followed by MBB followed by RFA, then discogram, IDET, then off to the spine surgeon for multilevel fusion.

I think there are definitely more chiros that do this than physicians - and the chiros advertise more - but there are practitioners that committ fraud and abuse in all fields - certainly not limited to chiros.
Good job man, paint that picture of your OWN profession:thumbup: :rolleyes:

Sure, there's probably a degree of exageration and such. Like you stated though, it's definitely 'over the top' with the chiropractors. Furthermore, as we've all learned in medical school and beyond it's almost never what you see on the MRI that causes the pain. As I recall something like 30% of asymptomatic patients have bulges,etc on MRIs. So if a patient IS symptomatic and it is documented and there's MRI pathology....I'm not sure how a retrospective chart review could question the physician's mode of treatment.

Of course if a pt has a foraminal stenosis at C5/6 on the left, and the patient is said to have right sided pain shooting down his right leg which requires a LESI or TFESI,etc that's a different story.
 

facetguy

10+ Year Member
7+ Year Member
Jan 10, 2008
3,581
9
151
Status
Good job man, paint that picture of your OWN profession:thumbup: :rolleyes:
Pretending it's not true or sweeping it under the rug is surely the better approach.

Sure, there's probably a degree of exageration and such.
Keep telling yourself that. This stuff happens. A lot.

Like you stated though, it's definitely 'over the top' with the chiropractors.
If it makes you feel better to believe this...

Furthermore, as we've all learned in medical school and beyond it's almost never what you see on the MRI that causes the pain. As I recall something like 30% of asymptomatic patients have bulges,etc on MRIs. So if a patient IS symptomatic and it is documented and there's MRI pathology....I'm not sure how a retrospective chart review could question the physician's mode of treatment.

Of course if a pt has a foraminal stenosis at C5/6 on the left, and the patient is said to have right sided pain shooting down his right leg which requires a LESI or TFESI,etc that's a different story.
 

Tenesma

Senior Member
10+ Year Member
15+ Year Member
Jun 11, 2002
5,332
127
281
Visit site
Status
Attending Physician
that is interesting about malpractice coverage - i wonder why the chiros get dropped from the suits despite the potential settlement the lawyers could obtain --- very odd... hmmm... food for thought
 

ampaphb

Interventional Spine
10+ Year Member
May 13, 2007
4,352
723
331
New Orleans, LA
Status
Attending Physician
i wonder why the chiros get dropped from the suits despite the potential settlement the lawyers could obtain --- very odd...
because the hypothetical chiropractor facetguy is describing is a fiction. The average chiropractor sees 50-70 medicolegal patients a day, sees them indefinitely, and drains their PIP within the requisite 45 or 90 day period by insisting they be seen 5x/week.

The thorough, intellectual chiropractor whose practices is exclusively evidence-based, remains exclusively within the chiropractic scope of practice, and provides long-lasting relief for his patients must exist in a parallel universe. I have never found such a practitioner in the communities where I have worked.
 

facetguy

10+ Year Member
7+ Year Member
Jan 10, 2008
3,581
9
151
Status
because the hypothetical chiropractor facetguy is describing is a fiction. The average chiropractor sees 50-70 medicolegal patients a day, sees them indefinitely, and drains their PIP within the requisite 45 or 90 day period by insisting they be seen 5x/week.

The thorough, intellectual chiropractor whose practices is exclusively evidence-based, remains exclusively within the chiropractic scope of practice, and provides long-lasting relief for his patients must exist in a parallel universe. I have never found such a practitioner in the communities where I have worked.
That's too bad. They are out there though. The dirtbag DCs must get all the attention in your neighborhood.
 
OP
SleepIsGood

SleepIsGood

Support the ASA !
10+ Year Member
5+ Year Member
Apr 16, 2006
1,965
2
0
Status
Fellow [Any Field]
That's too bad. They are out there though. The dirtbag DCs must get all the attention in your neighborhood.
and in mine, like I said I dont even know ampa.....coincidence or recurrent theme here ?:rolleyes:

out of luck there facetguy? Your 'attending' wantabe status doesn't hide what you and your chiropractic friends true skills/intentions are.
 

facetguy

10+ Year Member
7+ Year Member
Jan 10, 2008
3,581
9
151
Status
and in mine, like I said I dont even know ampa.....coincidence or recurrent theme here ?:rolleyes:

out of luck there facetguy? Your 'attending' wantabe status doesn't hide what you and your chiropractic friends true skills/intentions are.
Realize that it's been a long time since you've posted anything even remotely useful in this thread.:yawn:
 
OP
SleepIsGood

SleepIsGood

Support the ASA !
10+ Year Member
5+ Year Member
Apr 16, 2006
1,965
2
0
Status
Fellow [Any Field]
Realize that it's been a long time since you've posted anything even remotely useful in this thread.:yawn:
hey man, you've proved my point. so I'm good with that.
 

facetguy

10+ Year Member
7+ Year Member
Jan 10, 2008
3,581
9
151
Status
i have to hand it to facetguy for hanging in there...
I've found this to be a reasonably worthwhile exchange so far. There haven't been any surprises on my end, and there rarely are; I've heard it all. Hopefully I've shed a little light anyway on where I as a chiropractor am coming from. There is a lot of misinformation out there about chiropractors. I think at least some of the namecalling I often hear is just a reflex, repeated and perpetuated because it's easy to do so. Let's face it, we are all busy with running practices, family, recreation, etc. So it's understandable that an MD wouldn't be interested in spending time following the 'manual medicine' (and perhaps nutrition) literature, just like I'm not interested in keeping up with, say, the proctology literature. An exchange like this one perhaps offered some new info to those following along. Perhaps not.

So, if any of you need a letter of recommendation for that chiro school application you are now filling out, don't hesitate to ask.:laugh:
 

Ligament

Interventional Pain Management
Lifetime Donor
15+ Year Member
Jan 8, 2002
4,924
1,315
381
Status
Attending Physician
Mike: He starts from why you have back pain. He shows you pictures. He talks to you. A lot of the doctors I went to, they'd use big words, and I'd never understand them. So when I came up here and did the orientation, he talked step by step, explains everything clear to where we understand. It was exactly what I was going through.
 
Jan 4, 2010
7
0
0
Status
Attending Physician
D.C. are part of the multimodal pain treatment plan as exactly as PT. I regularly advise my patient to try chiro care for chronic low back pain. I advise them to avoid excessive/ long term plan exceeding few weeks and also to avoid manipulations to the neck. Who never send his patients to PT/Chiro is as ignorant/ arrogant as the one promoting the alien subluxation theory

The only time I specifically advised an Ehler Danlos patient not to go to her chiropractor when she told me, during the first visit that a chiro is manipulating her neck twice weekly to restore the atlas subluxation. This chiro, for me, is as ignorant and dangerous to both patients and the practice as the 10year plus experienced pain doc who asked during a conference that after a series of 3 "shots" +- some TPIs what should he do to help the patient with LBP, what a shame
 

facetguy

10+ Year Member
7+ Year Member
Jan 10, 2008
3,581
9
151
Status
North American Spine Society on spinal manipulation for acute LBP:
http://www.ncbi.nlm.nih.gov/pubmed/20869008

"Spine care clinicians should discuss the role of SMT as a treatment option for patients with acute LBP who do not find adequate symptomatic relief with self-care and education alone."