Spine-related disorders (SRDs) are extremely common and often recurring, potentially debilitating conditions that affect just about every individual at some point in the lifespan.
Spine-related disorders (SRDs) are extremely common and often recurring, potentially debilitating conditions that affect just about every individual at some point in the lifespan. In fact, low back pain (LBP) is the second most common symptomatic reason patients consult a family doctor and is now the leading cause of “days with disability” worldwide (neck pain is fourth on this list).
SRDs place a massive burden on society, industry and health-care systems around the globe. Despite a staggering rise in expenditure on advanced diagnostic imaging, specialist visits, medications and other interventions, the magnitude of improvement in patient outcomes has not been commensurate. In fact, disability resulting from SRDs is rising.
There is a pressing need for the establishment and development of a primary spine care provider (PSCP) – a clinical specialty with advanced training in spine care, in-depth awareness of the multifactorial nature of SRDs, and ability to assist in patient-centred, rational clinical decision-making. Health-care systems desperately need appropriately trained, skilled clinicians to fill the role of PSCP for the diagnosis and non-surgical management of SRDs – a primary care physician for the spine, if you will.
PSCP challenge
On the surface, the proposed role of PSCP may seem simple, yet to appropriately fulfill this responsibility, a clinician must have:
- Astute diagnostic capability, including the ability to differentiate systemic/inflammatory disease from degenerative processes as well as other causes of spinal pain
- Specialized training in SRDs and numerous forms of spine care (including manual therapy, medications, percutaneous injection options, exercise and rehabilitation)
- Familiarity with surgical interventions and their evidence-based indications and implications
- Intimate awareness of the abilities and limitations of other spine care providers and specialists who can provide necessary complementary interventions (both surgical and non-surgical)
- Evidence-based, scientifically defensible, cost-effective, clinically-relevant, collaborative, patient-centred care practices for SRDs
- Appreciation for minimalism and quality of care to minimize excess spending and the development of treatment dependency
- Understanding of the unique aspects of work-related and motor vehicle collisions-related SRDs
- Broad perspective on the public health correlations with SRDs including smoking, obesity, lack of exercise, mental health disorders
- Ability to screen for psychosocial morbidity and professionally communicate with appropriate providers of care for these conditions and other aspects of biopsychosocial rehabilitation
- An understanding of pain and chronicity from a biological and clinical research perspective, with working knowledge of the clinical implications for patient communication, establishing realistic expectations and approaching case management
- Ability to coordinate care among numerous practitioners and follow patients for a prolonged period of time if necessary
This is likely not a comprehensive list and is in no particular order, but represents a tall order for an individual clinician as it stands. In fact, the true solution to this problem likely exists in a coordinated, team-based approach. But, every team needs a leader. The PSCP would function as such a leader and represent the point of first clinical contact for patients with SRDs.
The PSCP would also function as a resource for traditional primary care providers (such as family practice physicians, general internal medicine physicians, pediatric, obstetrical/ gynecological physicians) to refer patients who present with SRDs. There is currently no single discipline or professional group that fills this important role.
Traditional primary care givers (PCGs)–family physicians–are not well trained in the differential diagnosis and management of musculoskeletal disorders, including SRDs. This is likely due to the heavy (and necessary) emphasis on internal diseases in medical school and in primary care residency programs.
There is strong body of evidence that published clinical guidelines are not well-implemented in practice. There is also evidence that even those PCGs professing to have a special interest in SRDs tend to have anachronistic beliefs about best practices for assessing and managing these disorders.
Dr. SHAWN THISTLE is the founder and president of Research Review Service, an online, subscription-based service to help busy practitioners integrate current, relevant, scientific evidence into their practice (www.researchreviewservice.com).
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