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

Stephen Small with movement sensors 4 idd therpy

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)

Is Entrepreneurship Compatible With Healthcare?

Money is a tricky subject in healthcare.  The moment money comes into any discussion the spectre of “conflict of interest” immediately casts its shadow and raises ugly suspicions.

Anyone in business is, by definition, an entrepreneur.  That includes all private clinicians where income is a function of the volume and type of care provided.

Of all the clinicians I know, I can’t think of any who went into healthcare to “make money”.  It’s not what the healthcare profession is about.  One clinician I know describes himself as an “accidental entrepreneur” and that is a wholly accurate title for most clinicians.  Or for others it might be more a case of “reluctant entrepreneur”!

The moment a clinician leaves the NHS and works privately (not applicable for many who go directly to private practice), they are in the healthcare business.  A sole practitioner working from their spare room is an “entrepreneur”.

When we think of entrepreneur, I suspect 99% of us think Richard Branson.

If we were asked to name another 10 entrepreneurs, in the UK we would probably reel off Alan Sugar, before moving to Dragons Den characters like Peter Jones, Deborah Meaden, Theo Paphitis or we might think abroad and think Steve Jobs and up until recently we might have allowed ourselves to say Donald T!

So, are these well known people just megalomaniacs sitting stroking their white cat?  Well, one might be but on the whole, not really.

Whether we think of these iconic entrepreneurs or a local builder, printing company, solicitor or manual therapist, the most successful invariably just work really hard to meet the needs of their customer (better than the competition).

That can be the best service, the best products, the ease of doing business with them (because they have an efficient operation), the nicest staff (well trained) and usually they are effective in letting people know about their services so they get to serve and help more people.

Within healthcare, amongst some other factors, my observation is that the most successful clinics provide a better than average level of care (note – not always the best) where the focus is on providing the best service possible and experience for the patient.

Of course there are some clinicians who, like Alex the Lion in the film Madagascar, view every patient as fresh meat or a walking £ sign, but I think that is the exception rather than the rule.

A successful clinician might enjoy material rewards but I believe the material rewards are a function of how well you care for your patients and how many people you reach out to care for.

We live in a capitalist society and therefore financial goals are a requirement for individuals, including clinicians, because our futures and retirement standard of living depend on it (unless we plan to go and live in the woods).

Realising a financial goal requires a strategy and tactics to get there.  But returning to the title, the two need not be mutually exclusive.

Successful entrepreneurship requires providing the best possible product, service and experience to the customer, which will help achieve a given set of goals – personal or financial.

So when it comes to healthcare, I believe it is compatible with entrepreneurship albeit that in practically all cases the two come together accidentally!  And at the end of the day it’s not complicated; the patient must come first, always.

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)

General Election Clinic Lessons – Decision, Change and The New Order

This morning the UK political landscape sees some significant change.

During the five years since the last election, individual voters have had very little power to point the country in a given direction.

And then we have a General Election and a vote.

A vote is a choice.  We choose and that simple act of making a choice can have far reaching implications for the future.

I am not here to comment on politics but a couple of lessons stand out for clinics:

1/ One minute you can be here and the next minute you can be gone (Liberal Democrats)
2/ One minute you are in the background, the next minute you have taken over a country (SNP)

I have been visiting clinics this past month.  A common theme has been the concern that more and more clinics are entering the market.

With a swathe of new graduates entering the market each year, most will find it difficult to get jobs in established clinics.  The new graduates will thus set up shop by themselves, rent a room somewhere and slowly build themselves up.

Some of these will have clearer purpose, ambition and charisma than others (SNP) and these are the clinics that pose the biggest threat to the old guard (Scottish Labour).

 

Of the others, whether new or old, those who dawdle along and don’t stand up for anything clear or just aren’t heard will find it difficult to be seen and will fade from view (Lib Dems).

I was not particularly interested in the political debate but what struck me was the frenetic activity of the last few months.

With an election coming up, suddenly I knew who the candidates were (lots of leaflets) and it seemed there was much greater clarity with some firm new promises to win voters.  Activity and decision lead to change.

Today is no different from yesterday but in 5 years time, we may look back at some significant changes in the UK political/ economic landscape because of the choices made last night.

Here are my General Election takeaways for clinics:

* Decide what sort of clinic you want to have in 5 years time and start work on it now.
* If you do have a vision of a clinic, stay visible and make it clear to your public what you are offering. 
* If what you offer is good, patients will give you their vote of confidence.

And remember if you aren’t building it, someone else is.

By Stephen Small
Director Steadfast Clinics & IDD Therapy Services Tel: 01279 602030 (Intl +44 1279 602030)
Steadfast Clinics supports a network of IDD Therapy Disc Clinics.  To find out more about becoming a centre of excellence in conservative spinal care, get more information at www.iddtherapy.co.uk