Back Pain Epidemic
By Eric Kaplan, DC, FIAMA
Perry Bard, DC
Jason Kaplan, DC
After being in practice for over 40 years, it’s amazing to have seen how far chiropractic has come. Early in my career, we were called quacks, but today, we are some of the leaders in treating back pain, if not the leader in the world. With failed back pain syndrome now reaching epidemic proportions and companies like Medtronic under investigation, now is the time to take our place as leaders in the back care industry.
In a damning new study in the Journal of the American Medical Association, health policy researchers at the University of Washington reported the estimated cost of treating back pain by using data from an annual federal survey of 23,000 people. Unlike previous studies that examined specific treatments, such as surgery or painkillers, the new study took a broad-brush approach to examine whether overall spending on back treatments is making us feel better.
Treating back pain has become a multibillion-dollar business. The number of lumbar fusion operations tripled from 1990 to 2001. Other studies have reported increased rates of spine imaging and various spinal injections.
The JAMA study found that people with spine problems in 2005 spent $2,500 more in medical expenses than those without such problems, which is up from $2,000 more in 1997. Overall costs of treating back pain rose 65% from 1997 to 2005 to an estimated $85.9 billion nationally. One of the biggest drivers of spending was the increased use of expensive painkillers. Spending on narcotic drugs for back pain soared an astonishing 423% during the study’s period.
Researchers then looked at whether spending made patients feel any better based on self-reported measures of disability and pain. They found no improvement over the eight-year period. On some measures, such as limitations in physical function, people actually got slightly worse during the period.
“We are putting a lot more money into this problem and not seeing any improvement in health,” said University of Washington health policy expert Brook Martin, who led the study. Coauthor Richard Deyo of Oregon Health and Science University added, “The bottom line is we are spending a lot and not getting a lot of value.”
Deyo called the finding “an indictment of the whole broad approach to treating back pain.” It suggests that there may be “lots of treatments” being overused with no benefit to patients. He added, “There are going to be a lot of people who are going to be unhappy with this result.”
Another great article in the Wall Street Journal found that some doctors performing the controversial fusion surgery happen to be receiving huge fees from Medtronic, the manufacturer of gear used in the operation. The article proves what everyone had always suspected; there is a huge correlation between who gets industry payments and how often the operation is performed.
Norton Hospital in Louisville, Kentucky, may not be a household name nationally, but five senior spine surgeons have helped put it on the map in at least one category. From 2004 to 2008, Norton performed the third-most spinal fusions on Medicare patients in the country.
Those five spine surgeons are also among the largest recipients nationwide of payments from Medtronic. In the first nine months of 2023, the surgeons — Steven Glassman, Mitchell Campbell, John Johnson, John Dimar, and Rolando Puno — received more than $7 million from the company.
Dr. Lali Sekhon, MD, PhD, stated, “I was taught there was no surgery done for it, and surgery generally did not do well for back pain. In my residency, we were just starting to put in plates and screws. I went on and did some advanced training in spine surgery at the Mayo Clinic and in Toronto and learned more about fixing spine problems. I started out in academic neurosurgery. I was salaried, and we basically did things because they needed to be done, not because we got paid more for them. When I started out, we fixed broken necks with pieces of wire that you could buy at Home Depot for two bucks. At one time, I was a pioneer on artificial disc surgery and published a lot. I sat — and still sit— on a lot of editorial boards and saw a lot of what has come and gone. Most was fluff. Most of it you would not read about a year later. I rode the wave of spine care.”
Research states that if you have a fusion of 10% to 25%, people wear it out within 10 years and need another surgery. Even 10% of older folks who just get “unpinched” need more surgery. If you blow a disc out, then 10% to 15% will blow another. Some reasons are genetic, but we don’t exactly understand how and why. If you are obese or smoke, part of it is lifestyle. Some of it is bad luck. Tall people have more back issues. Golf is a killer. Many golfers are older, not in great shape, and the violent bending and twisting unmasks arthritic back problems. Look at Tiger Woods; he is built like a battleship and already had several back surgeries.
As a golfer, spinal decompression has kept my back healthy and helped me avoid surgery and live a normal, active life. I joke to my friends that I am not only the president of the hair club for men; I am a user. I have even had the opportunity to speak with President Donald Trump about nonsurgical spinal decompression and how we can avoid back surgery. This is not a political article, an article against the medical profession, or an article for Republicans or Democrats. This article is for all people who have had back pain and for all doctors who have ever treated back pain to know there is a possible solution.
Study after study — McClure study, Eyerman study, Shealy study, Leslie study — show an 86% to 92% success rate for nonsurgical spinal decompression (NSSD). Many table manufacturers promote their equipment; some equipment is better than others. However, the Ramos and Martin study showed that you need to create negative pressure to, in turn, create an event of spinal decompression. That is why inversion does not work; it creates positive disc pressure. To learn more about negative pressure, look up the Nachemson study.
In many ways, a spine surgeon is similar to a car mechanic fixing old cars with no spare parts. Usually, he will get the car on the road. Sometimes, the car gets on the road, goes around the block, and comes back because a wheel fell off it.
If you can grasp that analogy, you will grasp the essence of spine surgery. Even artificial discs are not 100% like our real discs. Most are metal and plastic, and they don’t squish. They are “cartoon character” versions of the real thing. This may shock you, but you have to remember one thing. The main reason you have a car is to get from point A to B (i.e., from birth to death). That’s it. Drive it carefully, and it will get you there.
For many years, chiropractic was called alternative care. However, chiropractic should be the first choice, and surgery should be the alternative. You cannot take care of your back by strengthening your core with exercise. Renowned orthopedic surgeon Dr. Timothy Kremcheck discusses how he had surgery but still suffers to this day. He recommends NSSD before even having an epidural or any invasive procedure.
The world is now aware of the seriousness of back pain. Today, as chiropractors look around and wonder how to get new patients, they just need to be the best doctors they can be. The D in doctor stands for detective. Doctors at Disc Centers of America work to be great diagnosticians, train to be nationally certified, and continue to represent our profession at the highest level. We try to take our doctors from good to great. Just because we have “Dr.” in front of our name doesn’t mean we have to stop studying and working. As my father said to me, “The road to success is always under construction.”
Now is the time for us to stand up, stand tall, and bring our profession to the next level. There has never been a better time to be a chiropractor. Embrace it and enjoy it.
Dr. Eric Kaplan and Dr. Perry Bard, are business partners of over 32 years. They have developed Disc Centers of America & Concierge Coaches, now in the eleventh year, as well as the first and largest National Certification Program for Non-Surgical Spinal Decompression. Currently, they have over 150 clinics using their Disc Centers of America brand and lead ongoing success training events throughout the year. For more information on coaching, spinal decompression, or seminars, visit www.thechiroevent.com or www.decompressioncertified. org, or call the Chiropractic Q&A Hotline at 888-990-9660.
Dr. Jason Kaplan is a graduate of Parker University. Along with his wife Dr. Stephanie Kaplan, they practice in Wellington Florida. Jason is an Instructor for Disc Centers of America, one of the Nation’s largest collection of doctors specializing in Disc Injuries. He has been recognized and honored by the International Disc Education Association and serves on the Medical Advisory Board for Non-Surgical Spinal Decompression. He teaches technique at the National Certification Program at Life University and is considered a Master on Non Surgical Spinal Decompression. www.wellingtondisccenter.com.
