May 23, 2011 — The May 12, 2011 issue of the Arizona Republic reported the following: “Despite the results of a recent major clinical trial that demonstrated conclusively that good medical therapy is just as effective as balloon angioplasty or coronary artery bypass surgery for treating stable coronary disease, fewer than half of cardiologists use such therapy before subjecting their patients to the much more expensive surgical intervention, researchers said this week.”
The result is that scores of patients are being exposed to unnecessary, dangerous, and highly expensive surgeries when medical therapy would do the job.
Therefore, the Arizona Chiropractic Society (ACS) proposes informed consent. The ACS says that before a stable cardiac patient receives either an angioplasty or coronary bypass surgery, they should be required to sign an informed consent, which states that medical therapy would be equally successful without surgery.
ACS is also calling for informed consent before a patient receives an epidural injection for neck or back pain. They say these injections are an invasive and risky procedure given in a series of three at a cost of approximately $5,000 each. They are widely used in spite of the fact that the American Pain Society Clinical Practice Guideline from 2009 published in The Spine Journal reviewed 216 medical journal studies and issued this definitive finding: “Fair evidence that epidural steroid injection is moderately effective for short-term (but not long-term) symptom relief.” Research has also proven that epidurals do not decrease the rate of surgery.
According to the ACS, the informed consent would state that noninvasive chiropractic care provides at least as much short and long term pain relief. The North American Spine Society (NASS) reviewed 71 studies on spinal manipulation and low back pain and concluded: “Based on the RCTs (randomized controlled trials) reviewed, SMT (spinal manipulative therapy) appears to be effective for pain reduction in the short, intermediate, and long terms.”
The American College of Physicians and the American Pain Society issued a Joint Practice Guideline in 2007 based on a review of 131 journal articles and endorsed the use of spinal manipulation for low back pain.
Chiropractic is far safer and less expensive than epidural injection therapy and produces pain relief that is at least as effective. Before receiving an epidural injection, patients should be given an informed consent form stating that chiropractic is a safer and less expensive option.
Chiropractic often resolves the problem entirely. This is proven by the fact that when chiropractic was added to a large health plan with 700,000 members, the number of low back surgeries and hospitalizations declined by 1/3rd.
The ACS intends to ask the Legislature to pass informed consent legislation, which would apply to all stable cardiac patients before an angioplasty or coronary bypass surgery and to all patients prior to receiving an epidural injection. Having more information before making such a major decision is only a positive factor that each patient deserves. Since doctors are not providing all the information, a law is required to ensure it is done and patients know all of their choices.
Source: Arizona Chiropractic Society, www.azchiropractors.org
- Optimal Medical Therapy with or without PCI for Stable Coronary Disease, N Engl J Med 2007;356:1503-16
- Patterns and Intensity of Medical Therapy in Patients Undergoing Percutaneous Coronary Intervention, JAMA.2011;305(18):1882-1889. doi: 10.1001/jama.2011.601
- Nonsurgical Interventional Therapies for Low Back Pain: A Review of the Evidence for an American Pain Society Clinical Practice Guideline, Spine 2009;34:1078–1093
- Overtreating Chronic Back Pain: Time to Back Off? J Am Board Fam Med.2009;22(1):62-68
- Geographic Variation in Epidural Steroid Injection Use in Medicare Patients, J Bone Joint Surg Am. 2008;90:1730-7
- Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society, Ann Intern Med. 2007;147:478-491.
- Comparative Analysis of Individuals With and Without Chiropractic Coverage: Patient Characteristics, Utilization, and Costs, Arch Intern Med. 2004;164:1985-1992