It's Drugs, Surgery, or Us

A great post from Evidence In Motion below. Would love to hear your thoughts.........

Ever get the feeling that the more things change the more they stay the same? The links below to two recent medical headlines remind me of the fact that despite our health care system being bro ken (and the Affordable Health Care for America Act has not and will not fix it), the following tune within the culture seems to only grow stronger: a. More surgery (at ever younger ages, more extensive procedures, and for increasingly “elective” reasons and b. More drugs.

In the first case, total joint replacement and resurfacing procedures have transitioned from being the last intervention option after all other means of relief have been exhausted to becoming a primary option for getting folks back to kite-boarding and basketball (make sure to view the video link on that page to hear a real expert interpret and explain things for us). In the second case, what could be better than a drug (Cymbalta) that works for not only one condition (depression in this case) but for two!! Everyone loves a two’fer, right? (in this case, make sure to read the important safety information posted at the top……does that apply when taking this for chronic MSK pain or only when I am taking it for depression?).

No question that total joint replacements and medication for selected conditions have their place, but when it comes to musculoskeletal pain should surgery and drugs be the primary interventions of choice? The answer to that rhetorical question is an obvious “NO”, but too few seem to be getting it or getting that message out. Besides common and fiscal sense, there has been a voluminous increase in the volume and quality of evidence that non-operative interventions provided by physical therapists can reduce pain, disability, and increase function. Oh yea, there is also evidence that these same non-operative interventions (a combination of education, manual therapies, and exercise in most cases) can also reduce depression, anxiety and fear in patients suffering from these conditions (the article by Main and George is a good place to begin with getting up to speed with what has been termed “psychologically informed practice”).

It’s been said before and I will say it again. When broken down into the simplest terms, a patient’s basic intervention choices when suffering from musculoskeletal conditions are: Drugs, Surgery or Us. We need more than evidence at this point to stop the Madness that has, in many cases, become what we know as health care. I am not sure what those “somethings” are (no silver bullet for sure), but it will involve a change in behavior of all parties involved, including the consumer.