I often have patients who come in to see a Chiropractor after they have exhausted all other avenues and found no resolution. While I'm glad that they have come to me, I'm often troubled that it's too late for them to get the maximum effect of what I do.
Let's examine this. I have a patient come in for, let's say low back pain. They had trouble years ago, and began to treat it with pain pills; common enough solution. After years of this, maybe some steroid shots, possibly a surgery or two, they come in to see me, desperate, at their wits end, they don't know what else to do at this point. I can hopefully help them somewhat, and gladly will, but by now, what I can do has become limited. The problem here is coordination. They never had a plan for how to address the problem and the most invasive options have already been exercised. My contribution is now limited by changes in anatomy and arthritis. Let's take a step back and see what we can do to to make this situation turn out better if it can.
To begin, most people who develop an issue such as back pain don't expect this particular episode to be the beginning of a long term problem, they just want relief so that they can go back to work. Simplest solution: take some painkillers that they have laying around the house. Here is where the problem starts. Most likely, the problem is not due to a deficiency of pharmaceuticals. If it were that would be great, and the problem would be solved. It rarely is though, because our bodies do not usually require pharmaceuticals to operate properly. The problem here is in thinking that the pain is the problem. It's not, it's the messenger. If the King gets a messenger from another king stating that he is going to declare war on the first king, simply killing the messenger does not solve the problem, and our smug king will find himself on the gallows, or resting under the guillotine. Problem not solved; addressed... not solved. So what should our wise king do? It's my opinion that he should address the real threat, the other king, and not simply kill the messenger. So the pain is our messenger, and we routinely take care of the pain and go on our way. But the other king is still setting up camp outside our castle walls while we blissfully ignore him. Wouldn't it be better to address the problem before it develops and becomes stronger? In the case of musculoskeletal pain this will usually be accomplished by paying a visit to the local Chiropractor. If the problem is not musculoskeletal he will also be able to refer you to the most appropriate caregiver. But what if you would rather go to another type of doctor? Maybe you don't like chiropractors, or you think of them as sort of a last resort? Well that certainly is your right and you can do that if you like, but is it wise? The point I would like to stress here is that is a most appropriate order of what to do to address a problem and it goes in order of invasiveness. The first choice should be the least invasive, and the last choice will be the most invasive. The reason for this is simple: the more invasive a procedure is the more other options it cancels out. For example, in most cases, surgery will be the most invasive procedure anyone will pursue for a particular issue. Let's say spinal fusion for low back pain. You had low back pain, you took acetaminophen for years, now you can't stand the pain anymore and you got your back fused. Ok. I hope it worked, because now you have no more options, well almost none, you can still have ablation, which is the burning the nerve and destroying it so that you can't feel anything. Now of course, you don't have that nerve so you don't have use of anything that was driven by that nerve. You can expect muscle wasting and atrophy, total loss of tactile sensing and even paralysis. It may be worth it if the pain was bad enough, but it would be a shame if there were other avenues that could have been explored and weren't. It won't matter now though, because what's done is done. there is no "un-ablation" surgery, it's basically amputation of the nerve.
So how do you make a wise decision on the appropriate order of treatment? Well the first thing you have to do is recognize that the pain is not the problem, it's the herald of the problem. Many people will not realize this and refuse to accept this, and for them the pain IS the problem. They don't care about it any more than that. For those people, there is nothing more that I can do for them and I wish them well as pursue a life of comfort. For the rest of us, we would like to find out what is causing us to have pain, and rectify that, and therefore cure the pain. The most likely culprit, statistically, is biomechanical disfunction. The best thing to do, therefore in my opinion, is to go to a Chiropractor as a portal of entry physician to the health care arena. They will most likely be able to address the problem or refer to Physical Therapy or Allopathic (Medical) care as is appropriate. If you don't want to go to a Chiropractor for one reason or another, there is still an order of invasiveness as to what's most appropriate. It's pretty much the same for most issues, it follows as such: Least Invasive: diet and exercise > Chiropractic > Physical Therapy > medication > surgical modification > ablation/amputation > death :Most Invasive. The reason I recommend Chiropractic first is that it is the lowest level of invasiveness where your problem will be addressed by a doctor, and most Chiropractors will also be able to address diet and exercise issues as well. Now, of course I don't recommend going to a Chiropractor first for something like low back pain due to being shot in the back and needing a bullet removed. Use common sense in determining where you need to step into this model, but remember it is best to step in at the lowest level of invasiveness possible because you can always move up, but you can't always move back. If you still have low back pain after a lumbar fusion, and the fusion was performed in the correct area, there is probably not much a chiropractor can do for you now because he cant move vertebrae once they're screwed together. There is a good chance he could have helped before hand though, even if you weren't told that was an option. Do not rely on medical personnel to make appropriate referrals to chiropractors, many of them have an incomplete understanding of what chiropractic is and certainly of what it can do. They also have no legal or other obligation to refer to a Chiropractor, whereas, Chiropractors do have a legal obligation to refer to medical providers when it's appropriate. That's another reason to go to a chiropractor first, you will get a medical referral if it's appropriate whereas if you go to a medical provider first you will probably not be informed of any Chiropractic options you have, even if they are better or more appropriate.
So, whether you like Chiropractic or not, the same concerns of invasiveness apply. I hope that you'll agree with the points I've tried to illuminate here. My one other suggestion would be that for your overall health care you have one main doctor, Chiropractic or Medical, that you trust, that you use to correlate and coordinate all your care so that there can be a logical flow to your care and to avoid confusion and mis-treatment in all your health care issues, and so taht you have one person who has the whole big picture of your care as the health care system we have today can be very fragmented.
