Cost/Benefit of Non-Operative Treatment in Adults

[txmarinemom]

I suspect the reason has to do with justifying the cost of surgery - so they can say to insurers "Yes, we're expensive, but, over the years, you'll spend the same amount on these conservative therapies."

I'm not sure that's it either. I would HOPE if that were the point, someone would have documented things more clearly.

Then again, as we all know, insurance companies aren't all that bright.

Just thinking back to what I spent on pain management in the 10-15 years before surgery ... and I'm going to have to try to put a dollar figure to it.

Easily, off the top of my head, I can tally about $40K from a period that ran '98 to maybe '01. It included an MRI series (or two ... I'd started protruding at C5/C6-C6/C7), several facet joint injections, multiple rhizotomies, Botox injections into knotted/spastic areas ... and I can't even calculate meds.

We almost went to a Baclofen pump, but my history of resistance (to the protocols at that time) indicated it wouldn't be helpful.

I'm pretty sure I'm glad I was able to skip that little bit of fun.

[jrnyc]

wow...alot of talk & back & forth...but, just from me, and i will state the obvious and say i have no science/medicine/research training (beyond having to take research & statistics each time i went for a graduate degree )...i know quite well that my particular choice of "alternative tx" , i.e. pain management injections of various sorts, is buying me time to see whether certain surgical techniques change in the near future...it is also helping me until i can make a huge, life changing decision...(one that i am struggling with, as is obvious, i guess) but i am under no delusions about what works & what i need! my graduate degrees are in education, administration, & social work....they dont help me to understand some of the intricate scientific discussions you guys are having...but they do help me to understand myself & others....behavior and such, etc etc

my own opinion, & only my own..nothing will work except for surgery...everything else is a stopgap..if it helps reduce my pain for awhile, thank goodness for that...but i know quite well that the pain will come back...always does, darn it!!

so debate on...it amazes me the energy you guys have! i get exhausted reading it go back & forth, & back & forth...& envy the energy some of you guys seem to have...boy, do i wish my pain would let me have just a fraction!

best regards to all of you...some of you amaze me with your knowledge, skills, & quality of reasoning!

jess

[hdugger]

Jess,

You're in the category of people (large curve with pain) for whom surgery is absolutely the best route. Nothing else has shown much promise. I think even those of use who look at conservative methods don't think they're appropriate once you're in alot of pain.

[jrnyc]

hi hdugger
i know.. i know... i know...sigh.....heavy sigh!
i know...i am only HALF in denial!

i am just not ready to do something so extremely permanently fused to my body without considering more surgery options...& do the pain managment to buy time...of course, by now, i have been buying time for a while...and the clock is ticking louder!

thanks for your reply...really appreciated it

jess

[hdugger]

Oh, I totally get the denial part! I'm just willing my son's curve to be in the low 40s so we don't have to think about surgery in the near-term.

I don't know if US hospitals have a similar program (or if you've tried them already), but in the British hospitals there's a "Functional Restoration Program" for people in pain which seems to decrease the level of disability significantly. Here's the link to Claire's thread about it on the Scoliosis Support forum - http://www.scoliosis-support.org/showthread.php?t=8758. It won't resolve the curve, but, at least for Claire, it substantially improved her ability to get around and made her more comfortable while she waits for her surgery.

[jrnyc]

thanks for the interesting link..i think everyone would enjoy reading it...as far as in the U.S., we have physical therapy & we have pain management, which is, in my experience, injections & oral pain meds...i have not seen the 2 combined, but that has just been my experience in NYC & CT...so elsewhere in the states it could be different...

i never got any help from P.T., cause they told me there "isnt much we can do for such a structural problem"...

best regrds
jess

[dailystrength]

I agree the funds should be invested in more promising approaches.

To date, that list includes only surgical methods.

Continuing to fund anything in the current panoply of alternative approaches that show almost no promise after decades just because surgery has a high fear factor and high ick factor among some is not a wise use of limited monies in my opinion. Evidence, rather than emotion, should drive research funding.

Now if there are new alternative approaches that look promising, I think those should possibly be funded.

AMEN!!! My SURGEON recommended alternative treatments: PT and massage. Now, if he sends me to massage, and I have to pay like I'm just out to pamper myself, something is amiss. I am also going to look into coverage for Schroth.

[dailystrength]

The danger I see in a study like this is that it leads to discussions like the one I'm seeing here, where people use the study to make claims which this design absolutely cannot support - as an indictment of a specific form of treatment. This study says *nothing whatsoever* about that. It can't. There are simply too few people spread across too many treatments with absolutely no specifics about the protocols of the treatments.

I think the study is not making any claims yet, but hooray for the Doctors involved (one of which is mine!) for being open to other options. If a certain treatment is recommended for pain management, then it needs to be funded. Surgery is funded 100% in my health plan but I pay a whopping co-pay for therapies that alleviate my pain, and there is no break for massage, even if Doctor recommended-- $80 is out of reach and I don't really want to see a chiropractor. Perhaps this study might help here. Scoliosis needs to be recognized, and any pain management techniques that work, paid for.

[dailystrength]

Anyway - why are we doing this?

Coming late to the scene here but I agree! I don't know why either there needs to be such concern over the legitimizing of alternative treatments... each case is so unique. How wonderful that some can benefit from conservative treatment, if it is working! And also good that some can get surgically corrected if need be. Most of all we need to be supportive each other as we are all dealing with the same constant issue.

[dailystrength]

The research would test these treatments as a *pain reduction* alternative, and not as a *treatment* alternative. Unlike scoliosis progression, pain is simple and non-invasive to measure, and you can do a simple comparison of pain before treatment and pain after treatment in the same patients.

If my hypothesis is correct, this *pain reduction* will also slow progression. But, even without that, the conservative treatments are legitimized and patients have a safe method to use to treat pain.

Good comments! Pain management is the key, and it is indeed measurable. I would love to hear your hypothesis about pain reduction effecting curve progression as I missed it somewhere. Also, as surgery is done on patients at all ages, it is always a future consideration I presume, so no harm in trying alternatives.

[jrnyc]

hmmmmm...i definitely missed something big! cause i WISH my pain management reduced my curves...or progression...or anything about them, besides some...often just a tiny bit for a tiny amount of time....of the pain!

oh, how i wish!!

jess

[hdugger]

sorry, I wrote that badly. What I meant is that I've been tracking cases (I think I'm up to 8 or 10) where some kind of exercise treatment reduced a curve. So, if those exercise treatments were prescribed for pain management (since they're also effective for that), then in some number of cases they would also reduce the curve (unlikely) or halt or slow progression (more likely).

[dailystrength]

sorry, I wrote that badly. What I meant is that I've been tracking cases (I think I'm up to 8 or 10) where some kind of exercise treatment reduced a curve. So, if those exercise treatments were prescribed for pain management (since they're also effective for that), then in some number of cases they would also reduce the curve (unlikely) or halt or slow progression (more likely).

Would you share your findings - your list of 8-10 effective cases - and what type of exercise was used? I am looking into Schroth. I have heard good things about that. Yes, it needs to be in-network (insurance)- the rigamarole to find out if I'm covered at all is a mountain to get over!

[jrnyc]

insurance companies just LOVE to label things as not covered...the latest surgery is "experimental"...so they can refuse to cover something like dr anand's surgery...massage is "elective" or un-needed or such...they love the word "alternative" cause everything they can give that label to they can then refuse to cover! it is just their usual M.O.!! i fear it will take a looooong time to change it..even as the President tries to get "pre-existing conditions" eliminated from their excuse making machine of refusal!!


jess

[hdugger]

It's been a little bit since I gathered them together. I *think* it's

1 for yoga (Elisa Miller)
1 for some kind of unspecified exercise/massage (Martha Hawes)
1 - 3 for SEAS (exercise clinic in Italy)
1 for Schroth (someone on this board)
2 or 3 for torso rotation (although, with very short follow-up)

I'd have to look through my posts to remember. My criteria was any study with more then a temporary (i.e, it didn't just go away after a few hours) decrease of at least 10 degrees in a substantial curve (above 35 degrees) in an adolescent or adults.

The thing to remember with exercise, though, is that you have to continue exercising to get the benefit. Also, although I'm noting reductions, I'm really just using them to indicate a method that could stabilize a curve or slow progression.