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A New Prescription for Back Pain
Advanced Back and Neck Care • Sep 18, 2020

Excellus BCBS is using an evidence-based approach to treat back pain. Instead of sending patients to the ER for imaging and surgery, they are sending them to chiropractors and physical therapists. The result: better outcomes and dramatically lower costs.

As an experienced chiropractor, Dr. Lindsay Rae is trained to heal pain using manual therapy. But when a new patient came to her reporting chronic and debilitating low back pain several years ago, she spent their first session talking and listening, without laying her hands on him at all.

For years, this patient had avoided most movement and all exercise following a spinal surgery. “He was told he shouldn’t do any physical activity post-surgery,” says Rae. “More than likely, the surgeon meant ‘No activity while you recover,’ but that’s not what he heard.” What followed was weakened muscles and very little spinal movement. He was now bound to a wheelchair and lived in extreme pain.

Though manual therapy wouldn’t necessarily have been the wrong approach, notes Rae, she knew what this patient needed was help managing his condition long-term. So she engaged him in his own recovery. This meant listening compassionately, using the right words to explain his condition and making a personal connection—all of which would have a longer impact than manual therapies alone. She talked to her patient about the importance of exercise, addressed his fear of movement and taught him self-management strategies.

Rae credits her effectiveness in managing these types of cases to training she received from Excellus BlueCross Blue Shield (Excellus BCBS).

The supermarket approach to back pain

Experts estimate that up to 80% of Americans will experience back pain at some point in their lives.* But where do you go for care when back pain hits?
You might choose your primary care provider (PCP), the chiropractor or physical therapist. If the pain was very bad, you might go to the ER. “It’s really the supermarket approach to back pain,” says Rae. “There are too many options, which can be very confusing to the patient looking for guidance on how to manage their condition.”

The problem with all these options? The care you receive might be more dependent on where you go than what you truly need. Your PCP might prescribe you pain medicine; the chiropractor might manipulate your spine to relieve the pain; the physical therapist might teach you how to stretch and strengthen your back muscles; the ER doctor might perform an MRI and recommend surgery.

“Although all of these options are appropriate for the right patient,” notes Excellus BCBS Medical Director and chiropractor, Dr. Brian Justice, “the challenge is in decreasing variation in care delivery among various providers and helping patients find the right care.”

Fewer surgeries, better outcomes

To solve for the “supermarket approach,” Excellus BCBS is training its network of chiropractors, physical therapists and PCPs to follow an evidence-based clinical pathway, or standard operating procedure, developed by Justice and Spine Care Partners, LLC, after years of research.

In a 2011 study published in the Journal of Manipulative and Physiological Therapeutics, Justice and his coauthors laid out a spine care pathway that categorized and triaged spine-related pain supported by the current best evidence and focused on the patient. The pathway is a conservative approach to spine condition management, focused on the right treatment for the right patient at the right time. Ultimately, it reduces unnecessary MRIs, surgeries and opioids. The result is better outcomes, higher patient satisfaction and much lower costs.

A four-year study published this year in the Journal of General Internal Medicine, co-authored by Justice, corroborated these findings: “Conservative spine care…is associated with reduced healthcare expenditures…[and] reduced opioid utilization.”

In addition to teaching providers this conservative approach to care, Excellus BCBS guides trainees on how to speak to patients with back pain—especially if it’s their first time getting care. Making sure patients aren’t scared of or overly focused on their pain is one of the most impactful ways to improve their outcomes. X-ray and MRI reports that read “degenerative,” “spondylosis,” or “disease” can be scary to patients. Justice says results like this are often part of the normal aging process, though, “like grey hair of the spine.” Misunderstanding these terms can set patients up to think their pain is causing further damage and they may avoid the very movement needed to speed healing as a result.

To date, roughly one thousand PCPs, chiropractors and physical therapists have taken Excellus BCBS’ spine care training. Their patients are now receiving significantly fewer surgeries, imaging services and other, sometimes unnecessary, downstream services as other patients. Their average cost of care is about 40% less.

Rae, one of the first practitioners to pilot this training, attests: “This pathway taught me that just changing the way I said something could make more of an impact on a patient’s health than trying to heal the pain myself.”

Gamifying back pain

Excellus BCBS now has online training available for primary care physicians, chiropractors and physical therapists. Urgent care and emergency room physician training will be rolled out in the fourth quarter of this year. It will also be beta testing a gamified patient app in September that helps members make educated decisions at each step of their care journey.

“As members of the healthcare industry, we’re all under-spending on prevention and education,” says Justice. “The good news is that those things are very low cost, and we can do a lot to change the behavior of our patients and members.”

By Ronald Grisanti D.C., D.A.B.C.O., DACBN, MS, CFMP 13 Mar, 2024
https://www.functionalmedicineuniversity.com/public/2000.cfm ** Feel free to use this article on your website. Compliments from Functional Medicine University . ** Read my past articles: http://www.functionalmedicineuniversity.com/public/department88.cfm ===================== View Rick Bramos Fitness YouTube Channel https://www.youtube.com/channel/UC_x4I27Z0DfYkfcroXxAhcA/videos Here is Rick's New Video of the Week: https://www.youtube.com/watch?v=W__EwtXJkyY Rick is now offering phone consultations for those wanting to lose weight or simply to improve their fitness. Rick can be reached at 2days2fitness@gmail.com for more details. ===================== ATTENTION DOCTORS AND ALL HEALTHCARE PRACTITIONERS Tell your friends and colleagues about Clinical Rounds. This is a great introduction to the field of functional medicine. Here is the webpage to subscribe: http://www.clinicalrounds.com Take care, Ron P.S. Please visit our facebook page and "Like It" Of course if you really like it. :) http://www.facebook.com/pages/Functional-Medicine-University/161486170671332
13 Mar, 2024
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Ronald Grisanti D.C., D.A.B.C.O., DACBN, MS, CFMP Alzheimer's is the most common form of dementia. Its symptoms vary but may start with mild memory loss or difficulty remembering words or names. As it progresses, Alzheimer's causes worsening confusion and memory loss, changes in personality, the inability to perform everyday tasks and more. Alzheimer's is caused by a slow build-up of protein plaques and tangles in the brain that eventually cause brain cells to stop working properly. This build-up usually starts years before a person experiences symptoms. Alzheimer's-related memory loss is caused by brain cells working improperly and dying-a process known as neurodegeneration. Alzheimer's is estimated to account for about 60% of dementia cases. Diagnosing Alzheimer's Until recently, it has been difficult to identify the biological changes that indicate Alzheimer's. The typical evaluation, which includes physical exam, blood and urine tests and cognitive testing may provide ambiguous or conflicting answers, which can result in delayed referrals until symptoms become clearer. That has changed with new technology and testing. Labcorp has developed a new test called the Amyloid-Tau-Neurodegeneration (ATN) Profile ( ATN Profile) to help doctors detect evidence of biological changes consistent with Alzheimer's. These tests are the first objective tools that doctors have to help evaluate Alzheimer's, meaning that with a simple blood test , doctors and other health professionals allowed to order labs can get a clearer answers on Alzheimer's and its progression and get patients on a care plan earlier. This will in fact give physicians a simple, objective test for Alzheimer's disease pathology that can help shorten the time to diagnosis. Labcorp is the first company to make a fully blood-based ATN Profile commercially available. What is ATN? The ATN framework establishes a means for classifying biomarkers based on the biological evidence of Alzheimer's disease that each marker provides These markers are divided into three categories to reflect the three primary biological changes associated with Alzheimer's: A for amyloid plaques: Accumulations of beta-amyloid 42 proteins begin to form plaques in the brain years before initial symptom onset T for tau tangles: The beta-amyloid 42 accumulation causes misfolding of tau proteins, which tangle into knots and disrupt normal brain cell function N for neurodegeneratio : Brain cell functional impairment causes the cells to die, which exacerbates the characteristic cognitive impairment symptoms observed in Alzheimer's patients
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Ronald Grisanti D.C., D.A.B.C.O., DACBN, MS, CFMP Medical literature is very clear that oral dental health plays a significant role in your cardiovascular health. As odd as it sounds, regularly brushing and flossing your teeth could be what stands between you and a future heart attack. Research has linked bacteria from the Streptococcus genus to fatty plaque buildup in heart arteries. A new study published in the journal Circulation has pinpointed two specific oral microorganisms that play a role in whether we develop atherosclerosis (clogged arteries). In all people there should be a healthy balance of good and bad bacteria in our mouth (teeth). However when this balance is upset, it kicks off a chain of events that makes atherosclerosis far more likely to occur. The researchers used advanced technology for the study to reexamine the gut and oral bacteria assessments and cardiac imaging from 8,973 volunteers in the earlier SCAPIS study. Search in the medical literature has actually identified three bacteria associated with atherosclerosis when they were found in large numbers in the mouth. They include: Streptococcus anginosus Streptococcus oralis Streptococcus mutans The scientists who have published their research have two theories about why these bacteria might be a contributing factor for atherosclerosis. 1:These bacteria (streptococcus species) set off systemic low-grade inflammation that leads to plaque accumulation in heart arteries. 2: In an attempt to evade our immune system, the bacteria in our mouth enter our bloodstream and set up shop in our arteries. Steps to take to decrease the potential of Streptococcus genus compromising our cardiovascular health include: Regularly brushing your teeth Flossing Consider using a waterpik water flosser (this is my dentist strongest recommendations to clean out bacteria deep in the back molars.) This oral health appliance provides a stream of pulsating water to floss between your teeth and below the gumline. Don't forget the most important step of ideal dental health and that is regular dental cleanings. Here are some additional recommendations to be certain your oral health has the best opportunity to be bacteria free. Stop the Sugar Salt Water Rinse Tea Tree Oil and/or Oregano oil products. These essential oils have natural antibacterial qualities. If you battle gingivitis, look for mouthwash or toothpaste made with tea tree oil (never use straight oil) and/or Oregano oil. Olive Leaf Extract: Olive leaf extract is another natural antibacterial that can be used in mouthwash or toothpaste. One of my personal go to preventive measures to ensure optimal oral health is the Dentalcidin Oral Care System by Biocidin Botanicals. Clear here for more details on this dental care system. Start protecting your heart and reducing your risk of heart complications today by focusing on your oral care. You can find a qualified and certified functional medicine practitioner by going to: www.FunctionalMedicineDoctors.com References: https://www.sciencedirect.com/science/article/pii/S1882761608000045 https://www.sciencedirect.com/science/article/abs/pii/S1043276015000454 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1594668/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275337/ https://pubmed.ncbi.nlm.nih.gov/33825326/ https://journals.asm.org/doi/full/10.1128/iai.00897-19 https://pubmed.ncbi.nlm.nih.gov/37435755/ The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Grisanti and his functional medicine community. Dr. Grisanti encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional. Visit www.FunctionalMedicineUniversity.com for more information on our training in functional medicine. Look for practitioners who have successfully completed the Functional Medicine University's Certification Program (CFMP) www.functionalmedicinedoctors.com . This content may be copied in full, with copyright, contact, creation and information intact, without specific permission, when used only in a not-for-profit format. If any other use is desired, permission in writing from Dr. Grisanti is required
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