Why we need to get ‘Back’ to basics in healthcare
Health costs are rising inexorably across the Western World.
Causes include :
- Aging populations (the average life expectancy was around 50 at the turn of the century. It is currently around 80 years).
- The rise of unhealthy lifestyle diseases like obesity due to sedentary lifestyles and processed, sugary food (obesity rates have tripled since the 1980’s).
- An outdated health payment system that generously rewards expensive medical treatments in hospitals, while underfunding cheaper, primary care (it costs up to four times more to treat someone in an Emergency Department than it does with a General Practitioner in the community).
…Government health spending grew 74% over the past decade, far faster than GDP, which grew by 46% above CPITough choices, how to rein in Australia’s rising health bill.
The biggest and fastest growing category in the health budget is hospital spending. People are receiving more expensive and invasive medical treatments, more often. However hospital treatments are less successful than many people realise.
In this article I look at some overpriced yet ineffective hospital based treatments for back pain, and list cheaper, more effective options using modern health technology services.
What is back pain (and why is it so difficult to cure?)
Back pain is one of the most common reasons people see their doctor and take time off work. It is also a leading cause of disability around the world.
The spine is a lightweight and flexible structure. It often ends up carrying a far heavier load than it was designed for.
The human spine is composed of 30 small bones (called vertebrae) all stacked one on top of the other. These bones are separated by spongy pieces of cartilage, called discs, that act as shock absorber. With age these discs can wear, shrink, or become injured. The heavier a person is, the more pressure gets placed on this delicate spine structure.
A weakened disk can rupture, allowing the soft inner material to protrude. These leads to a herniated disc. If this material presses on a spinal nerve the pain can be like an electric shock. A herniated disc in the lower back can put pressure on a major nerve that runs down the spine, causing sciatica.
The resulting nerve pain is very different to other types (somatic and visceral pain). It is sharp, burning or stinging. People sometimes describe shooting pain like an electrical shock. Neuropathic pain does not respond to opioids the way other paid does.
Understandably people flood to Doctors seeking cures for back pain. However few realise how low the success rates of this surgery really are.
‘Failed Back Surgery Syndrome’
Back surgery rates in Western countries have skyrocketed in recent years. However academic studies show that an unacceptably large number are irrelevant, even harmful.
One study in the USA showed that over a ten year period the number of spinal surgeries quadrupled, however the failure rate was between 10% and 46%.
In 2017 another study showed that up to 74% of low back spine surgeries fail to completely relieve pain.
This makes back pain a key target for allied health and digital treatment management. Surgical intervention for chronic back pain may one day the very last treatment to be considered.
Health technology helping people with back pain
Modern health technology services view the ‘patient’ as their customer. Very few health tech products are covered by Government or Private insurance. The result is low cost, competitive and consumer focused services.
They draw on a huge range of technology, virtual reality from the gaming industry, robotics from military developers and nerve stimulation from clinical research into brain recording of pain.
Below are a few examples, sorted via the type of technology they use.
Internet of Things – connected ‘smart’ devices
Articulate labs – A ‘smart knee’ rehabilitation device that gives out electrical impulses, to increase muscle tone
Jintronix – Home based therapy using smart wearable devices and screen based feedback
Neofect – smart rehabilitation for neurological and musculoskeletal conditions
Prohab – A smart clip that attaches to tension strengthening equipment, and sends real time data to a smartphone app, that gives analytics on progress
Sword health – pairing physical therapists with home based clients, so they can make an assessment, recommend treatment then monitor progress, from wearable motion sensor trackers and digital therapy programs
Withings – Smart home monitoring devices, from wearbles to smart scales.
Tele health and off-site care
Care Connected – connecting people with health professionals via a ‘virtual health clinic’.
HingeHealth – Improving chronic back and knee pain without drugs, with app based exercise therapy, behavioural coaching and education
Health Delivered – a platform, connecting people wanting to lose weight and eat better, with an easy to use and informative interface and a qualified dietitian.
Hydrow – a home rowing machine with a screen that shows videos of rowing on water and gives feedback on performance
Mirror – A home mirror that acts as a portal to communicate with off site physiotherapists, participate in off site classes and give feedback on progress
Online physio – Allows users access off site physiotherapy conferencing, to receive individualized assessments and treatment plans
Physera – App based physiotherapy program, from teleconferencing to individual plans and ongoing monitoring
Physitrack – a platform linking physiotherapists to customers for online assessments, treatment plans and ongoing follow up
Theratrak – an app platform to allow physiotherapist to communicate digitally with their customers
Reflection Health – remote physiotherapy program
Remedy Healthcare – a post surgery rehabilitation in the home program
Worklete – a combination of on site and home based programs for help people manage and reduce the risk of workplace injuries
XR health – using Virtual Reality technology to deliver home based rehabilitation programs
Personalised ‘Digital’ care
FlintRehab – a range of rehabilitation devices sold online
Kaia health – an app offering 250 exercises that can be tailored for personalised back pain relief.
Kieser – gym equipment and physiotherapy programs designed specifically for rehabilitation and back management
Lark – personalised health and fitness program using artificial intelligence and smart devices
ThereTrak – A smartphone app that allows physiotherapists to capture meaningful data from clients and then prescribe and monitor personalised rehabilitation programs
Reminders and ‘chat bots’
Freeletics – an Artificial Intelligence coach that assesses needs and monitors progress
Physio Phebe – A free chatbot to help guide people through the first steps to manage injury
‘Non pharmaceutical’ pain relief therapy
PENS therapy – peripheral nerve stimulation via low dose electrical currents to help decrease chronic pain
Pain Matrix – A chronic pain management clinic that offers a range of blocks and nerve stimulation services
Sprint Therapeutics – a percutaneous peripheral nerve stimulation device
Shopping around for health services
BetterPT – A physical therapists directory, that shows the nearest clinics, ratings and reviews
Lyfe – a directory, booking, teleconferencing and payment platform for allied health professionals.
Take home message
- Chronic conditions like many forms of back pain, should be treated first by allied health professionals and last, by medical intervention.
- The most effective treatments may be a coordination of allied health services, from psychotherapy to pharmacy, to help people lose weight and strengthen core muscles.
- There is no ‘cure’ for getting older. It’s simply a byproduct of living longer due to better hygiene, antibiotics and medical treatments for acute conditions. We need to manage old age, not ‘treat’ it like a disease.
All About Neuropathy And Chronic Back Pain – Spine health, William Deardorff, PhD.
Causes of FBSS: Why Does Back Surgery Fail? Very Well Health 2019
Failed Back Surgery Syndrome: A Review Article – Asian spine, 2018
Healthcare costs unsustainable in advanced economies without reform – OECD 24th September 2015
Tough choices: how to rein in Australia’s rising health bill – The Conversation 2013
© Wikihospitals October 2019