I have chosen the topic of acute and chronic back pain in adults 18 years old and above.
There are many causes of acute and chronic muscular pain such as injuries, chronic inflammation due to underlying diseases, overuse syndrome, and or as simple as a poor posture, to name a few. Back pain is the most complaint that providers in primary care, urgent care, and emergency department may encounter. Patients who present with back pain experience pain and discomfort, but can also lead to psychological problems such as comorbid stress, anxiety, and depression (Rakel, 2018).
There are numerous integrative medicine treatment for back pain. The therapy suggested for back pain and or in a combination of non-narcotics medications are exercise therapy, spinal manipulation, non-thrust manual therapy, massage, yoga, and tai chi (Rakel, 2018). Chiropractic and osteopathic physicians primarily perform spinal manipulation therapy (SMT). SMT is a high-velocity low-amplitude force applied to the spinal process and its supporting tissues. It is thought to stimulate a cascade of central and peripheral events that results in instant pain relief (Rakel, 2018.
The ethical consideration for SMT is the risk of acquiring possible harm or injuries. There are many published literature about the positive effect of SMT. Like many treatments, it is crucial for the provider to educate the risk and benefits of any treatment to the patient. Although reports of injuries following a chiropractic treatment is rare, it does happen. In a case study by Skappak & Saude (2018), A healthy 66-year-old man acquired multiple compression fractures after only three sessions of SMT by a chiropractor. Before the visit with a chiropractor, the patient was evaluated by his PMD and had obtained x-rays of his back with negative findings. The patient was re-evaluated by his PMD after his three sessions with the chiropractor and obtained more radiographic test. The radiographic analysis revealed undiagnosed multiple myeloma. Unbeknown to the chiropractor of patients undiagnosed multiple myeloma, the spinal manipulation he performed caused the multiple compression fractures.
As future clinicians, it is imperative to assess the patient thoroughly. When suggesting alternative treatment such as SMT, the clinician needs to evaluate if the treatment is appropriate for the patient to reduce harm or further injuries.
Reference
Rakel, D. (2018). Integrative medicine (4th Ed.). Elsevier Saunders: Philadelphia.
Skappak, C., & Saude, E. J. (2018). Back pain in the emergency department: Pathological fracture following spinal manipulation. CJEM: Canadian Journal of Emergency Medicine, 20(2), 307–312. https://doi-org.ezproxy.csusm.edu/10.1017/cem.2017.19