Friday, May 21, 2010

Iatrogenic Disability and Narcotics Addiction After Lumbar Fusion in a Worker's Compensation Claimant

-This tragic case study is a prime example of some of the dangers that accompany back surgery and routine follow up with narcotic medication. Chiropractic is a drug less, non-surgical healing art that has been shown over decades to help those injured at work and those involved in motor vehicle collisions. All of the worker's compensation and whiplash patients that are seen in my chiropractic clinic in Takoma Park/Silver Spring, MD are closely monitored by top medical doctors if they are taking any form of medication.
-PT


Spine: 20 May 2010 - Volume 35 - Issue 12 - pp E549-E552

Parks, Philip D. MD, MPH, MOccH; Pransky, Glenn S. MD, MOccH; Kales, Stefanos N. MD, MPH

Objective. Describe a case of chronic occupational low back pain with various treatments of questionable efficacy, leading to prolonged disability, iatrogenic narcotic addiction, and opioid-induced hyperalgesia.

Summary of Background Data. Concerns about narcotics and other questionable treatments for chronic low back pain are increasing, especially in those with work-related conditions.

Methods. Medical record review.

Results. The patient had significant, persistent low back symptoms, but good function at work and home. He underwent lumbar fusion to address persistent pain, and subsequently developed failed back surgery syndrome. He was prescribed increasing amounts of opioid analgesics and was recommended for an intrathecal morphine pump, without evaluation of the safety or efficacy of his current regimen. Subsequently, he was hospitalized for opioid detoxification and substance abuse treatment.

Conclusion. Patients with chronic low back pain are at risk for receiving ineffective and potentially harmful treatment. A focus on restoring function instead of complete pain relief may lead to better outcomes in these patients.

Dr. Paul S. Tetro
Chiropractor
Takoma Park/Silver Spring, MD

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