A Quiet Crisis In Pain Management Within The NHS?

The British public is a fairly stoic bunch on the whole.  When it comes to chronic back pain, while there are still paths to be directed along, pain sufferers will go from one appointment to another without too much fuss.  But can more be done for back pain patients in limbo?

Any professional discussion about back pain invariably begins with the churning out of familiar back pain facts. Delve a little deeper and very different stats come to light showing that current services are not meeting the needs of patients.

One third of back pain patients presenting to a GP come with a recurring problem suffered in the previous year.  A further third of back pain patients will be coming with a persistent disabling problem.

These figures illustrate the extent to which back pain consumes the NHS. But what happens to patients next?

After seeing their GP, chronic back pain patients can be referred to a pain clinic.  But according to a patient survey by the National Pain Audit 2013, over 50% of respondents report little or no help from current NHS pain services.  The National Pain Audit 2010-2012 records that “It appears that pain clinics are being commissioned (or are providing) care almost exclusively for people with back pain.

Combining the two commentaries, we might reasonably infer that 50% of back pain patients referred to an NHS Pain Clinic feel that current pain services provide little or no benefit.

Pain clinics provide a range of services including manual therapy (physiotherapy), counselling services, pain management (medication) and spinal injections.  From there the next step would be surgery for certain patients.

There is no single cure for back pain and there are many different back pain conditions.  But common to many sufferers is a lack of mobility and spinal compression: sometimes in association with a disc-related problem.

The IDD Therapy Disc Programme takes a structured conservative approach. Rather than manage pain with medication or provide a short term pain relief window with injections, the IDD Therapy programme   decompresses targeted spinal segments, restores mobility and helps patients to rehabilitate where current methods fall short.

It takes time to bring about change but The IDD Therapy Disc Clinic Network is demonstrating a shift in conservative care and there is growing interest in certain influential corridors about the potential for IDD Therapy within the national Pain Clinic infrastructure.  Watch this space.

AVAILABILITY: At the time of writing, the IDD Therapy Disc Programme is not available on the NHS.  It is available privately in physiotherapy, osteopathic and chiropractic clinics.  To find your nearest clinic, look at the Clinic Finder

Using Wireless Movement Sensors With IDD Therapy For The First Time

When it comes to IDD Therapy Disc Treatment, it’s about relieving pain of course, but the main aim of the programme is to restore functional movement.

You might be interested to see something very few clinics do.  This is my back and you might be thinking, yes, sensors.  But unless you have seen these, trust me, you do not know what they do.

Stephen Small with movement sensors 4 idd therpy

Clinical Director Sally Lansdale applying sensors to Stephen Small

These are wireless movement sensors with EMG and I’ll tell you why they are super cool.  As co-owner of Spinex Disc Clinic in London our main focus is to help disc patients who need more than manual therapy and who do not want or are not candidates for surgery.  We use IDD Therapy programmes extensively.

We introduced the gyroscopic sensors because they allow us to measure and record movements and function as well as capture objective data.  A simple thing we do is to measure flexion, extension and side bending and we get a graphic and measurement to the nearest degree.

This helps us with the evaluation and it helps the patient see their problem.  That is stage 1.

Thus, in order to prove our treatments beyond VAS and Oswestry, we can measure before during and after IDD Therapy to demonstrate change in movement – to the nearest degree.

So what?  Well as an example, Vitality Insurance recently provided for 10 IDD treatments for a difficult patient.  The patient needed additional treatments to complete the programme and because we were able to show the changes in movement, they funded an additional ten sessions straight away. (Aviva Insurance already reimburse IDD Therapy)

Ok, but this is basic stuff.

Next step is functional movement.  We are expanding this with all our patients because we can put patients through a set of standard functional movements and show them precisely where they have asymmetries and dysfunction.

At the same time, the EMG lets us look at muscle firing activity – which with chronic back pain tends to be dysfunctional.

Thus the patient can really see hard data to support their condition AND this helps them understand our programmes and goals.

Stage 2 is treatment with IDD Therapy and rehab.  My view is that academics love measurements, but the key issue is they don’t have the tools to bring about the changes we want to measure.  This is what gets patients (and us!) excited.

Thus we are going to be doing functional movement assessments before, during and after the IDD Therapy programme using the system.

I know there are people who say we don’t need machines and gizmos.  Fair enough.  But if you are reading this on a smartphone, you will hopefully not be immune to a little irony 🙂  It’s all about the right tool for the right job.  Interestingly when I asked our team to look at the sensors, they were reticent at first but they have embraced it because they see what it can do for the patients in the programme and how it helps them as clinicians.

Spinex was the first IDD Therapy clinic to adopt this and the first osteopathy clinic in the UK with the technology.  Four other IDD Therapy providers are now using these wireless, gyroscopic movement sensors with the IDD Therapy.  My job is to standardise the way they do it so we can collate meaningful data across the IDD Therapy Disc Clinic network.  In the meantime, we just crack on and help the patients!

I look for the positives, at the same time, I expect we will also get patterns of when IDD isn’t bringing about change.  That will help patient selection and manage expectations about when to expect changes.

EXPERIMENT

During a training last week, we were looking at the elements I describe here and I asked, has anyone used these DURING the IDD Therapy?  Er, no. So, me being me I got rigged up and went on the IDD Therapy machine.

The results were really interesting.  The muscles were not firing during decompression which was great and the sensors picked up the oscillation and the cyclic extension flexion, ranging from between 2 and 3 degrees.

When you get close to IDD Therapy, you will appreciate the significance of that.  Of course, you don’t need to measure during treatment, that’s my job, it just shows the effect of the treatment.

Some other things we do with the sensors – we have patients wear them for 24 hours “24 hour monitoring”.  The data shows us their entire movements, from how long they sit, whether they are in good posture of slumped, how much activity they do.  We can show patients precisely how their daily lifestyle is often squashing the life out of their discs!  And when they see the data, they are more likely to make changes.

We did this experiment off the cuff so it is a bit raw, but, nobody else is doing this.  Hopefully by the time of the third IDD Therapy Provider Conference this year, we will have things nailed down for roll out.  I recorded some videos and will post in due course.

I hope this is food for thought, we are changing conservative spine care.

Author: Stephen Small – Steadfast Clinics, IDD Therapy and Spinex Disc Clinic
Connect on linkedin www.linkedin.com/in/stephen-small-0b404718
Twitter: www.twitter.com/iddtherapyeuro (I follow back)

Acting as a human guinea pig to experience advanced spinal mobilisation capability of IDD Therapy

IDD Therapy is the fastest growing conservative spinal treatment.  Thoughts about the application of spinal mobilisation got me thinking about how we might make use of the parameters of treatment for different therapeutic objectives.  

In this video I act as a human guinea pig to set a treatment with an increased level of spinal mobilisation and extended duration of distraction.  That sounds more dramatic than it was since treatment is very safe, although I was slightly nervous!

IDD Therapy is a programme of treatment involving a series of one minute distraction and mobilisation cycles to decompress targeted spinal segments.

Part of the mobilisation is a patented oscillation capability at the point when the joint is distracted. Typically, this oscillation force is set at 10lbs and applied for one minute at a moderate frequency.

The computer software in IDD Therapy gives clinicians the unique ability to adjust the oscillation in line with principles of manual therapy, whether Maitland, Harmonics etc.

Oscillation Frequency & Amplitude

Differing frequency and amplitude of oscillation/mobilisation (60 seconds)                                                               Low Freq’cy      Moderate Freq’cy          High freq’cy               10lbs oscillation            20lbs oscillation

In this video, I explore what a higher oscillation force feels like by increasing the oscillation force from 10lbs to 20lbs (amplitude) at the point when the joint is distracted under tension.

Since the oscillation force has a bigger distance to travel between high tension and low tension, it is necessary to decrease the frequency, ie the number of cycles, to allow time for the distraction force to go up and down within the range of the oscillation.

This reduces the number of cycles of oscillation in a 60 second high distraction. Therefore the duration of the oscillation at the high distraction is increased from one minute to 90 seconds.

Thus the joint is opened for longer and at the same time, the joint and surrounding soft tissues are exposed to more significant distraction and mobilisation forces.

I have received many IDD Therapy treatments and observed that the combination of longer distraction at high tension and greater degree of oscillation results in a greater feeling of decompression.

The treatment feels more powerful and remains comfortable. The next day after treatment, I could feel greater range of movement, improved posture and less stiffness in the lower back.

Whilst IDD Therapy is typically given as a course of treatments for chronic disc-related conditions, IDD Therapy is used as a tool when clinicians need something more than hands alone to increase range of motion and soft tissue function in the lumbar spine.

Author: Stephen Small
Director Steadfast Clinics Ltd
www.steadfastclinics.co.uk  www.iddtherapy.co.uk

Spinex Disc Clinic – the new name for non-invasive disc treatment in London

All physiotherapists, osteopaths and chiropractors treat intervertebral disc problems.  And yet, pain consultants up and down the country have waiting rooms full of people with back pain and neck pain, caused by disc-related problems.

Spinex Disc Clinic

Spinex Disc Clinic – Edgware Road London

Spinex Disc Clinic, a specialist back pain clinic in London helps patients caught in the back pain no-man’s land where standard manual therapy and exercise haven’t worked, and where they need something more for their pain without resorting to injections and/or surgery,

Causes and consequences. 

When it comes to back pain, cause and consequence are quite similar.  The cause of your back pain might be a herniated or slipped disc.  However, the real cause of your herniated disc is one of a number of factors such as the compression of the disc from poor posture over a long period of time, combined with a lack of exercise and so on.

So the cause of the pain is actually the consequence of changes in the body which lead to the disc problem.

All clinicians treat the causes of pain, but first of all they treat the consequences of the causes of pain.

Where Spinex Disc Clinic and other IDD Therapy Spine Centres come in, is when the consequences of the causes of pain e.g severe compression and restricted mobility, are such that manual therapy alone is not able to address the problem.

The first things to do therefore is to take pressure off the disc and improve tissue function, then the focus can be on addressing the real causes which led to the problem.

In some ways it’s like obesity treatment.

The cause of obesity is a calorie surplus each day built up over time.  The consequence of that is excess weight/ fat.  First the person has to work hard to get rid of the excess fat and then they make lifestyle changes to ensure they stay at a healthy weight.

Now, the person will make the lifestyle changes as part of the process of losing weight but they have to work harder than normal because they need to burn more calories to cut the excess.

When it comes to disc treatment, for some patients lifestyle changes alone (improved strength, more activity, better posture etc) are not enough to undo the consequences / causes of the pain.

Spinex Disc Clinic is primarily focussed on those patients with disc problems who need something more than manual therapy.

Clinical Director Sally Lansdale is a highly experienced osteopath who finally resolved her long standing problem with a series of IDD Therapy treatments.

[youtube=http://www.youtube.com/watch?v=HYSH9JM4XBI]

Since then she has had two clinics offering IDD Therapy and now Spinex Disc Clinic is the evolution of those clinics now located in North West London, just off Edgware Road.

For more details about Spinex Disc Clinic, visit www.SpinexDiscClinic.com 

Case Study Template For Back Pain Treatment – Comments Invited

As we expand availability of IDD Therapy treatment for discs and nerve pain, we encourage all IDD Therapy provider clinics to write up case studies.

Ultimately we want to refine the patient cohort so that we get better predictability of outcomes and use the strength of the network for multi-centre data analysis.

We use subjective and outcome measures and I wanted to share the outline and structure of a case study template so that if someone had some suggestions for improvement, they could contribute.

The template has some details specifically for IDD Therapy treatment, but they can be deleted for use with other conditions, if someone wanted to.  The IDD CASE STUDY TEMPLATE is a word document you can click to open.

IDD Case Study Template doc

There are many different treatments for back pain and as the somewhat cruel saying goes, there is more than one way to skin a cat.  IDD Therapy spinal decompression is a tool used by clinicians when they want to decompress, distract and mobilise a targeted spinal segment in a manner they can’t achieve with their hands, or traditional traction.

Author: Stephen Small
Director Steadfast Clinics Ltd  www.steadfastclinics.co.uk  www.iddtherapy.co.uk 
email: stephen.small (@)steadfastclinics.co.uk

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