Muscloskeletal Pain? Primary Care Docs Not Giving Good Advice

Sciatica.  Knee osteoarthritis symptoms.  While these two conditions seem a world apart, there is something they have in common:  Bad advice.

Both of these conditions have solid research on things that you should and should not be doing to help you recover.  The “should” category involves exercise and moving around.  Almost always with musculoskeletal pain, moving around is better and staying sedentary is a very bad idea.  While my opinion is clearly biased on this one, the acceptable medication approach to most musculoskeletal complaints involves the use of NSAIDs like ibuprofen.  Strong pain medication like opioids (Vicodin, Percocet) should not be used, especially initially, and fall into the “should not” category.

In the “should not” category is also imaging.  While plain X-rays may be appropriate to evaluate for osteoarthritis symptoms, advanced imaging like MRI and CT scan should not be ordered unless certain red flags are present.

All of this is well supported by the medical research over the past 10 years or so.  But one of my continued frustrations with all branches of medicine is just how rare it is for doctors to actually crack open medical journals.  The research itself suggests that doctors are, in general, about 19 years behind the medical literature.  That means that this particular article, looking at just how well primary care doctors understand the current recommendations for sciatica and osteoarthritis symptoms, won’t grace the typical doctor’s eyes for two more decades.

Basically, they won’t know that they don’t know until around 2033.

Just in case you think I’m being a little too facetious, let’s look at what researchers found in the study:

  1. Despite the clear benefit, less than 1/3 of physicians would give exercise advice (30.2% for osteoarthritis, 32.8% for sciatica).
  2. Overall, though, at least newer docs were more likely to give advice on exercise (39.6% of newer physicians versus 26.0% of older docs for sciatica / 20.8% for osteoarthritis).
  3. Newer physicians were less likely to order tests like CBC or CMP (9.4% vs 21.9%) or a urinalysis (4.2% vs 16.7%).
  4. For osteoarthritis, X-rays were more often ordered by newer physicians (85.4% vs 69.8%).

Overall, these numbers reflect poorly on the typical primary care doctors’ ability to handle common musculoskeletal complaints.  For my entire chiropractic practice life I have been confronted with patients and people in the community that ask whether they should see his or her primary care doctor or a chiropractor first.  The evidence is very clear–seeing a chiropractic physician first is the best option that will be more likely to lead you down a path with the best and most efficient outcomes.

But clearly I’m biased.

James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.