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Patient Goals vs. Doctor Goals in Managing Low Back Pain

low back pain - patient education

In a recent paper published in Patient Education and Counseling, these authors looked at how a doctor’s goal lined up with the patient’s goal in the management of low back pain.

Low back pain is the leading cause for disability worldwide, with a lifetime incidence of 80%.

What the authors of the research titled: “Patient led goal setting in chronic low back pain—What goals are important to the patient and are they aligned to what we measure? ” looked at was how the goals of a doctor was different to a patient’s goals.

The use of standardized outcomes for back pain often utilizes pain scales, range of motion, especially the act of bending forward without pain. Pain scales are perhaps important to the doctor but the goals of the patient includes a return to normal activity prior to injury.

Using bending forward as an outcome for function is well off the mark for outcomes as flexion stress in the disc often promotes inflammation and granulation tissue within the disc itself. Encouraging patients to ‘touch their toes’ as an outcome misinforms the discogenic pain patient (which is large percentage of back pain patients) of the movements that indicate outcomes.

Flexion stress on the spine compresses intervertebral discs that often leads to ongoing back pain in the long run. It may provide temporary relief from facet related pain, but disc height loss is inevitable if the spine is continuously flexed in this direction.

In Patient Education and Counseling, the authors looked at what was important to patients in goal setting of chronic low back pain. What they found was a patients’ goals were idiosyncratic and were not in line with therapists goals that usually include commonly used clinical measures.

Interpretation of the research:

The quirkiness of a patient’s goal often is governed by the education a patient receives about ‘why they hurt’. Chronic pain patients often struggle with understanding their own pain generators because of the plethora of mis-information about their diagnosis and solutions related to their problems. Giving a patient the understanding of their own dynamic spinal anatomy is one of the most powerful tools a therapist, doctor, spine surgeon, or chiropractor can do to help in the management of their symptoms. Teaching them something as simple as flexion and extension and how it relates to load is at the foundation of spine education.

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Anatomical Spine Models – Attention to detail

Anatomical Spine Modes - Dynamic Disc Designs

Dynamic Disc Designs looks to provide the provider the best anatomical spine models.

Some of the attention to detail includes a dynamic disc to allow complete visualization of the intervertebral disc.

The foundation in the development of any of the lumbar or cervical models begins with Dr. Jerome Fryer carefully understanding the anatomy involved in pain generation. The selection of the appropriate materials and key anatomical features is at a focus with the busy doctor in mind. Saving precious clinical time is critical in patient care. To have access to effective spine education in arms reach helps the spine professional relay important patient education details.

Anatomical Spine Models - Attention to Detail

Using elastomeric materials to show a dynamic look into the tissues, careful hand-painting of delicate nerves are showcased in the outer annulus of the Professional LxH Model, for example. Other details include scattered particles within the nucleus pulposus to allow visualization of the migration patterns through vertebral lens. Disc herniation is visualized by hands-on compression through an annular fissure and abuts the descending nerve root dynamically.

Flexion movement causes posterior annular stress. This is an important concept to convey when patients have pain with bending forward activities. Driving the point across to motivate the patient to avoid flexion loads is important in improving outcomes for back pain. Dynamic disc models can quickly teach patients neutral and flexion load. When patients see, they believe, and when they believe, they comply.

Often compliance to treatment plans governs outcomes for spine professionals. When a patient truly understands the pain source in back pain, they will work to avoid activities that generate further inflammation. Having accurate spine models, that are dynamic in nature, allows patients a clear look into why they got injured to begin with while the doctor crafts a treatment plan.

 

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Dynamic Disc Model – Educate to Motivate

Chronic Pain Patients

How about a little history on the conception of the company : ddd ?

First off, ddd’s name was chosen because of three main reasons:

1. Degenerative Disc Disease (DDD) is a common spinal finding and the models are hoped to inspire mechanical based regenerative medicine.

2. ddd represents 3d — inspired by Frank Netter and his drawings.

3. Dynamic Disc Designs speaks accurately about the company’s focus. Designs around a dynamic disc is at the core of this company.

Jerome Fryer, chiropractor, founder and chief innovations officer of Dynamic Disc Designs Corp. (ddd) knew there was something missing in the marketplace. In 2006 he decided to purchase the best lumbar spine model on the market. At the same time, he was doing research using upright MRI that lead to “Magnetic resonance imaging and stadiometric assessment of the lumbar discs after sitting and chair-care decompression exercise: a pilot study“.

Immediately Jerome knew there was something not quite right with the model he ordered. It was static and did not move. Even though it was the best on the market at the time, it was a static model. Pain (and structures related to pain) are often load sensitive. We all know this.

And so, Dr. Fryer embarked on designing something different to help him explain what he knew about spine to his own patients — a dynamic disc model that would match up to what the literature currently knows about back pain. He had recently moved to Nanaimo, BC, Canada for better opportunities and was in the process of building a new practice from the bottom up. With his time, he dedicated himself to building a model that would be durable and representative of the real tissue. The models he had used in the past would consistently break and would need repair frequently because he would bend them so frequently–he was fed up with this. He also knew the intervertebral disc was often the culprit in back pain. It, itself, is often the pain generator (and related to pain generators like the facet). He also wanted to show the innervation of the disc to inform patients of their pain and how to avoid certain postures to help improve outcomes.

Empowering patients with hands-on dynamic spine models ensures they understand.
-Jerome Fryer

After several years of development, the Professional LxH Model was launched. The model’s features are numerous. Dr. Jerome packed as much anatomical detail into a reasonably priced product always keeping perspective of what spine doctors need to be equipped with when patients need to know their pain generators. The Professional LxH Model continues to remain the best seller and will likely remain for decades to come. This dynamic disc model is the first of its kind and Dynamic Disc Designs is proud to be the leader in spine modeling.

Connecting with patients quickly and effectively is at the hallmark of any good physician. Common conditions of the spine include disc herniation, intradiscal disc herniation with annular fissures, facet pain and stenosis. If doctors can effectively show these conditions in a convincing (and timely) way to the patient, they can move on to therapeutic solutions. Saving precious clinical time is key for all doctors.

Educate to motivate patients. Anything to facilitate the #patientdoctorteam to improve outcomes.

Published by: Dynamic Disc Designs

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Bulging Disc Model – Helping Patients Understand Spine

Bulging-Disc-Model - Dynamic Disc Designs

Using a bulging disc model that can show these lesions can be very helpful in getting patients to understand the differences with the different types of disc problems.

Interverterbal discs can bulge and can cause pain. Many people think a bulge and a herniation is the same but that is not true.

According to a recent paper published in The Spine Journal, a disc bulge is defined by the presence of disc tissue extending beyond the edges of the endplates of the vertebrae throughout the full circumference. See Figure 3

On the other hand, a disc herniation is a general term to explain both a focal or localized displacement of disc material which can include the nucleus pulposus, annulus fibrosus and/or the endplate. See Figure 4

Herniation can be further classified into:

  • protrusion
  • extrusion
  • sequestration

This is the amount the material is sticking out. Migration is a term to explain the traveling of extruded material.

Intravertebral disc herniations, or Schmorl nodes, are perforations of the endplate into the vertebral body. This can be a superior or inferior lesion. See Figure 7

Educating patients about the differences is important. Using a bulging disc model that can show these lesions can be very helpful in getting patients to understand the differences with the different types of disc problems.

bulging disc model - Dynamic Disc Designs

Accurate modeling engagement reassures the patient about the painful anatomy and helps in the plan of management moving forward.

We invite you to explore our roster of anatomical spine models to help speed up and facilitate doctor-patient communication of spine pathologies.

One of the biggest challenges I have had with my patients is helping them understand what is happening to their spine…..I recommend these models to all the docs I know!  Keep up the good work!
-Dr. Raymond Uhlmansiek, D.C.