Doctors often overlook whole patient treatment

Recently I switched doctors to get help for my chronic back pain and it’s the best decision I’ve ever made. My prior doctor recommended rest, a series of injections and pain medication, none of which helped much. My new doctor prescribed supervised exercise, counseling, acupuncture and dietary help from a dietician. Why the dramatic difference in guidance? Isn’t medical training consistent? — Erica (Tigard)

Professional training provides a basic framework to practice medicine. It does not predict the manner in which a health care provider practices. The majority of professional school programs overlook exercise, biomechanics and nutrition, which some experts believe is largely responsible for the U.S. health care system being in crisis.

Your first doctor seems to believe in a model that seeks a “magic bullet” based on specific disease. This is also coined as a “victim” approach to health care, where the focus is on reducing symptoms as opposed to addressing potential causes. As a result, the most common treatments include drugs and/or medical procedures (e.g., injection, surgery).by: SUBMITTED PHOTO - Getting moving - Any exercise is better than none and should include strengthening, stretching and             endurance activities, with strengthening arguably being the most important. The aid of a competent physical therapist or athletic trainer can speed things along.

Your new doctor appears to support a model where the “whole” patient is the treatment focus as opposed to the disease. This is a comprehensive approach using multiple disciplines that addresses both physical and emotional factors (especially stress). Hippocrates, often referred to as the “Father of Medicine,” believed “it is far more important to know what person the disease has than the disease the person has.”

Dr. Nels Carlson, a Portland physiatrist who practices at Oregon Health and Sciences University, said, “While there are many ways to address chronic pain, exercise is a mainstay of conser­vative treatment for mus­cle-joint related conditions. Any exercise is bet­ter than none and should include strengthening, stretching and endurance activities, with strengthening arguably being the most important. Of course, using effective long-term adherence strategies are also crucial, which may include workout partners, peer support and doing enjoyable activities.”

Generally, this approach focuses more on managing pain than “curing,” which means physicians use treatments other than pain medication, injections and/or surgery. Research heavily supports this “multidisciplinary” approach more con­sistently than single modality interventions. For example, people with chronic pain who incorporate exercise therapy and professional counseling demonstrate greater improvement and use up to 300 percent less health care services than those who only use injection as a primary treatment. This isn’t surprising, as chronic pain has a huge psychological component.

Programs based on the multidisciplinary approach increased 400 percent from 1970 to 1998, with more than 200 United States programs accredited. However, due to changes in reimbursement and pain management training programs, more than 50 percent of these programs closed by 2004 due to emphasis on injection for treatment.

People suffering from chronic pain tend to feel helpless and fear movement the longer it persists, so learning how to gradually incorporate healthy behavior is essential to regaining hope and function. Of course, this takes time and effort, which isn’t a sexy sell in medicine but crucial if health care costs are to be controlled.

Colin Hoobler is a licensed physical therapist, hosts a live health segment on KGW Channel 8 and has written two books on exercise as treatment for disease and injury

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