In the most recent edition of the journal Practical Pain Management (volume 11, Issue 1 Jan/Feb, 2011, Pages 33-42), Gatchel, et al, published a paper entitled “Back Surgery That Does Not Relieve Pain.”
In that paper, they posted the following statistics and numbers that coincide with our prior comments regarding Muscle Pattern Recognition (MPR), the proprietary technology from iTech Medical (OTCBB:IMSU) :
85% of people in the Unites States will experience low back pain sometime in their lives.
28% of adults will experience Low Back Pain within the last 3 months.
The prevalence of chronic LBP has risen substantially over a 14-year period with 10.2% of individuals now reporting Chronic LPB at any one time.
LBP results in 31 million office visits and 2.6 million emergency room visits each year.
LBP is the second most common pain condition causing lost time from work.
From 1997-2005, the costs for treating adults with spinal disorders increased by 65%.
In 2007, $30.3 billion was spent on LBPO treatments.
35% of patients with LBP will recover within 1 month; 85% will recover with 3 months, and 95% will recover within 6 months.
Over 10 million American adults between 21-64 years of age report spine problems as their cause for disability.
Published: Tuesday, February 15, 2011 at 3:30 a.m.
Many doctors order imaging scans when patients complain of lower back pain, but they are unnecessary in most cases and may do more harm than good, the American College of Physicians stated in new practice guidelines.
Routinely ordering X-rays and CT or M.R.I. scans drives up health care costs, and does not help resolve the problem, the college’s “best practice advice” guidelines say.
On the contrary, the guidelines suggest, the scans may pick up unrelated abnormalities, leading to additional tests or procedures that are of no benefit, and some scans expose patients to high levels of radiation. The recommendations are the first in a series of papers aimed at helping doctors and patients identify misused medical treatments.
Most lower back pain is caused by strain on bones, muscles and ligaments. It can be treated with over-the-counter painkillers and usually abates within a few days, said an author of the practice guidelines, Dr. Amir Qaseem, director of clinical policy in medical education at the American College of Physicians.
“Something like that can be identified by the physician taking a good plain old medical history,” he said, adding that an X-ray or scan “should be reserved for selective high-risk patients who have serious symptoms.”
Patients complaining of lower back pain are first suggested to undergo a series of tests as a pre-requisite of every hospital before the doctors can
Xrays & Radiation?
diagnose or prescribe treatment. The routine tests include x-rays, CT scans and MRIs.
According to the American College of Physicians, those tests are unnecessary.
Aside from the increased cost it would bring to the patient’s bill, those tests may also harm the patient.
Causes of lower back pain may include strain or sprain on the musculoskeletal system within the body. Some may stem on the bones, ligaments, and joints. The pain may arise when the back is being overused or has been overworked physically. This can be treated with over-the-counter pain killer drugs and rest. It will usually subside after just a few days.
While patients with chronic back pain may not notice the quick benefits of simple OTC medicine and rest, additional treatment may be required, but in many cases, high-radiation scans are unnecessary.
Dr. Alan Goldman, neurologist, discusses Muscle Pattern Recognition (MPR) Technology.
The MPR System is a non-invasive clinical assessment tool being developed to assist in the evaluation and treatment of back and neck pain, one of the most common chronic conditions in the industrialized world. Click on the image to see the HD Video interview with Dr. Alan Goldman on YouTube.com.
On December 13, 2010, the Company reported that it had received Health Canada approval to begin sales and marketing of the MPR System in Canada. “The achievement of the CE Mark for our MPR System represents another critical milestone in the history of iTech Medical,” said Wayne Cockburn, President & CEO at iTech Medical.
It is estimated that 80% of the European population will suffer back painat some time in their lives and in excess of one third of the European workforce suffer from low back pain. Although many cases resolve within 2-4 weeks, many patients will have recurring pain within 1 year following the first episode of back pain.
“Back and neck pain cases are one of the greatest health problems in the European Union, with direct and indirect treatment costs in excess of 100 billion Euros a year,” said Mr. Cockburn.
“Our device has the potential to benefit a large number of patients that suffer from neck and back pain while at the same time reducing the costs related to diagnosing and treating this condition. We are extremely pleased with this approval and we look forward to introducing the MPR System in the European Community in 2011.”
The Company stated that it is currently evaluating its marketing and distribution strategy options, including strategic partners.
About iTech Medical – (OTCBB:IMSU – News) iTech Medical is engaged in the research and commercial development of healthcare information systems and technologies. To date, the Company has focused on developing a proprietary platform called Muscle Pattern Recognition (MPR), a unique clinical tool for the analysis of muscle function. iTech Medical is ISO 13485:2003 certified for the production and sale of surface electromyography (sEMG) diagnostic devices for clinical use.
This news release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 as contained in Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934 that reflect management’s current views and estimates regarding future market conditions, company performance and financial results, business prospects, new strategies, the competitive environment and other events. You can identify these statements by the fact that they use words such as “anticipate,” “believe,” “estimate,” “expect,” “intend,” “project,” “plan,” “outlook,” and other words and terms of similar meaning.
These statements involve a number of risks and uncertainties that could cause actual results to materially differ from the potential results discussed in the forward-looking statements. Among the factors that could cause actual results and outcomes to differ materially from those contained in such forward-looking statements are the following: general economic conditions, acquisitions and development of new businesses, divestitures, product availability, sales volumes, pricing actions and promotional activities of our competitors, profit margins, weather, changes in law or regulations, foreign currency fluctuation, availability of suitable real estate locations, our ability to react to a disaster recovery situation, and the impact of labor markets and new product introductions on our overall profitability.
A further list and description of these risks, uncertainties and other matters can be found in the company’s annual report and other reports filed from time to time with the Securities and Exchange Commission, including, but not limited to, iTech Medical’s Annual Report on Form 10-K filed with the SEC on April 15, 2010. iTech Medical cautions that the foregoing list of important factors is not complete and assumes no obligation to update any forward-looking statements that it may make.
January 31, 2011 — Routine imaging for low back pain with radiography or advanced imaging methods, such as computed tomography (CT) scanning or magnetic resonance imaging (MRI), does not improve patient health, according to recommendations issued by the Clinical Guidelines Committee of the American College of Physicians (ACP) regarding high-value healthcare for diagnostic imaging for low back pain.
Imaging scan of lower back
The new guidelines, which are first in a series to help physicians and patients identify misused medical treatments and to practice high-value healthcare, are published in the February 1 issue of Annals of Internal Medicine. The recommendations target internists, family physicians, and other clinicians treating adults with low back pain.
“Low back pain is one of the most common reasons for a patient to see a physician and many patients with low back pain receive routine imaging that is not beneficial and may even be harmful,” said second author Amir Qaseem, MD, PhD, MHA, director of clinical policy for ACP, in a news release. “Unnecessary imaging can lead to a series of unnecessary additional tests, interventions, follow ups, and referrals that do not improve patient outcomes.”
The new recommendations are based on a systematic review and meta-analysis conducted for the diagnosis and treatment of low back pain joint clinical practice guideline from ACP and the American Pain Society. Available imaging modalities for the low back include radiography, CT, and MRI.
Specific Recommendations Specific recommendations include the following:
Diagnostic imaging is indicated for patients with low back pain only if they have severe progressive neurologic impairments or signs or symptoms indicating a serious or specific underlying condition, or if they are candidates for invasive interventions. Routine imaging is not associated with clinically meaningful benefits in other patients and can lead to harms.
Immediate imaging is recommended for patients with acute low back pain who have major risk factors for cancer, risk factors for spinal infection, risk factors for or signs of the cauda equina syndrome, or severe or progressive neurologic deficits.
Imaging after a trial of treatment is recommended for patients who have minor risk factors for cancer, risk factors for inflammatory back disease, risk factors for vertebral compression fracture, signs or symptoms of radiculopathy, or risk factors for or symptoms of symptomatic spinal stenosis.
Decisions for subsequent imaging should be guided by development of new symptoms or changes in current symptoms, with repeated imaging recommended only in patients with new or changed low back symptoms.
Efforts to reduce routine imaging will be most effective if these efforts consider clinician behaviors, patient expectations, and financial incentives.
Patient education is needed to inform patients of current and effective standards of care and to educate them regarding the benefits and potential harms of diagnostic imaging.
Evidence that expanding imaging to patients without indications for advanced or repeated imaging does not improve outcomes includes randomized trials of routine imaging vs usual care without routine imaging in patients without indications for diagnostic imaging. Findings from these trials suggested no clinically meaningful benefits from expanded imaging on outcomes regarding pain, function, quality of life, or mental health. In addition, there is a weak correlation between most imaging findings and symptoms, acute low back pain has a favorable prognosis with or without imaging, the prevalence of serious or specific underlying conditions is low, and the impact of imaging on treatment decisions is unclear.
Potential harms of unnecessary imaging include the radiation exposure involved in lumbar radiography and CT; hypersensitivity reactions and contrast nephropathy for use of iodinated contrast with CT; and the possibility that subsequent unnecessary, invasive, and expensive procedures could be performed. In addition, knowledge of clinically irrelevant imaging findings might hinder recovery by causing patients to worry more, focus excessively on minor back symptoms, or avoid exercise or other recommended activities for fear of causing more structural damage.
Talking Points Advised
To overcome barriers to evidence-based practice regarding use of imaging for low back pain, the ACP recommends using talking points based on evidence-based guidelines to facilitate patient education. Evidence-based online or print education material to supplement face-to-face education may help overcome time constraints. Clinicians who are uncertain about the need for imaging can be reassured once they recognize the low likelihood of serious conditions in the absence of clinical risk factors and review the evidence showing no benefit associated with routine imaging. The ACP also recommends that clinician incentives be based on providing appropriate care, in addition to patient satisfaction.
“Addressing inefficiencies in diagnostic testing could minimize potential harms to patients and have a large effect on use of resources by reducing both direct and downstream costs,” the guidelines authors write. “In this area, more testing does not equate to better care. Implementing a selective approach to low back imaging, as suggested by the …ACP and American Pain Society guideline on low back pain, would provide better care to patients, improve outcomes, and reduce costs.”
Financial support for the development of this guideline came exclusively from the ACP operating budget. Some of the guidelines authors have disclosed various financial relationships with Wellpoint, Palladian Health, Consumers Union, Blue Cross Blue Shield Association, American Pain Society, ACP, and Anthem/Wellpoint. Disclosures can also be viewed at the Annals of Internal Medicine Web site.
AHRQ News and Numbers Release date: February 2, 2011
Roughly 3.4 million emergency department visits—an average of 9,400 a day—were specifically for back problems at U.S. hospitals in 2008, according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ).
In the same year, there were over 663,000 inpatient stays—a daily average of nearly 1,820—principally for back surgery or other back disorder treatments.
AHRQ also found that in 2008:
Adults ages 18 to 44 were the most likely to require emergency department care just for back pain (1,569 visits per 100,000 people) and seniors ages 65 to 84 were the least likely (1,084 visits per 100,000 people).
However, people ages 18 to 44 years were far less likely to be hospitalized while the rate of hospitalization principally for back pain was highest for seniors ages 65 to 84 (130 hospital stays per 100,000 people versus 607 per 100,000 people).
Men were less likely than women to need emergency department care or be hospitalized for back pain (1,005 visits and 209 admissions per 100,000 men versus 1,244 emergency visits and 225 admissions per 100,000 women).
The overall costs for inpatient stays principally for back problems was over $9.5 billion, making it the 9th most expensive condition treated in U.S. hospitals.
This AHRQ News and Numbers is based on data in Emergency Department Visits and Inpatient Stays Related to Back Problems, 2008 (PDF File, PDF Help). The report uses data from the agency’s 2008 Nationwide Emergency Department Sample and 2008 data from its Nationwide Inpatient Sample. For information about these two AHRQ databases, go to http://www.ahrq.gov/data/hcup/datahcup.htm.
