RPM and the frustrating reality of back surgeries

Let’s talk about RPM. And no, it has nothing to do with your car. In the medical field, RPM stands for Responsible Pain Management — which is what we specialize in at PC Medical Centers in Cape Girardeau. Before we dive into RPM, let’s talk about examples of Irresponsible Pain Management.

Back pain and neck pain treatment is a microcosm of what’s wrong in the healthcare system today, and it is estimated to cost the United States over $100 billion each year, according to a 2016 study in JAMA. This means back and neck pain treatments cost more than diabetes and heart disease costs combined — according to the same study.

It’s likely that the costs of failed back surgery contribute to the high spending on back and neck pain. Failed back surgery has now officially received epidemic status, and actually has its own diagnosis code for patients. However, today spine surgeons’ go-to procedure is still lumbar or cervical fusion.

Back pain is one of the most frustrating medical complaints for patients and doctors. Both expect the usual paradigm of diagnosis and treatment to work. This means a history of the problem, along with examination and tests to diagnose the specific problem with the patient anatomically and physiologically. In theory, this would provide the best conservative treatment first, and viola, the patient gets better. Sadly, this routine is not usually followed when it comes to back pain.

It takes time and proper treatment for tissues to heal. But patients are usually prescribed opioids (the leading cause of death in individuals under 50 years old), injections and physical therapy. When the pain doesn’t go away, surgery is often recommended prematurely.

Research now shows that most of these back surgeries, especially fusions, were unnecessary and the success rates run between 40% to 50%. Not great odds.

Still, fusion surgeries are increasing, and the complexity of the procedure is increasing. More complex surgeries are directly linked to higher complication rates, less success and an increase in the need for follow-up surgeries.

Responsible Pain Management (or RRM) is helping these patients heal with an Integrated Medical approach alongside medical providers working together to provide the least invasive treatments first. This is our mission and job at PC Medical Centers: to educate the public that there are better, more responsible and more effective alternatives to health care.