Lack of proper pain treatment leads to 'over-medicalization': U of S researcher
Access to physiotherapy depends on where you live and how much money you make, according to new research.
Researchers at the University of Saskatchewan analyzed data from more than 25,000 Canadians who reported having back pain, and they identified patterns of use and potential access to care gaps.
“We found income differences between the groups,” said Brenna Bath, an associate professor at the school of rehabilitation science at the University of Saskatchewan, who co-lead the research.
“People with progressively higher and higher incomes were more likely to report seeking care with a physiotherapist, as well as chiropractors. We saw the complete reversal of that trend with family physicians only."
The data also showed those who lived in rural or remote areas were less likely to seek care form a physiotherapist.
“In Saskatchewan, we know that’s not a surprising finding. For example, we have 30 per cent or more of our population live in rural or remote areas, whereas just over 10 per cent of physios practice in those areas,”
However, back pain is more common among those who are low income or who live in rural and remote areas, according to Bath.
“People in agriculture and mining are known to have more problems with back pain, travelling on bumpy roads — whole body vibration and even sitting for long periods of time in a car — can be a risk factor as well,” said Bath.
Lack of access leads to “over-medicalization"
There is no physiotherapist practicing in Pelican Narrows.
Dr. John-Michael Stevens is one of two physicians that rotate working in the northern community.
“The most common thing we deal with is chronic pain, and I would say the majority of those are back pain,” said Dr. Stevens.
For that community, the nearest physiotherapist is more than 120 kilometres away in Flin Flon, but is always backed up, according to Dr. Stevens. The next nearest physiotherapist is in Prince Albert, a more than 380 kilometre drive.
“To take someone with chronic back pain and put them in a car for four hours on rough roads to go to a physiotherapy appointment for an hour and then turn around and head for another four hour drive home is somewhat counterproductive and not reasonable,” said Dr. Stevens.
“If northern communities had access to physiotherapy, it would be an absolute game changer.”
Without proper access to pain treatment options, like physiotherapy, patients are often getting “inappropriate” imaging, such as CT scans, X-rays and MRIs, or are being prescribed drugs, like opioids, to mask the pain, said Bath.
“That’s a problem. It comes with high costs and it means people may go down paths of treatment or investigations that may not be needed or appropriate and can cause more problems in the long run,” said Bath.
It’s something Dr. Stevens also notices.
“And inadvertently sometimes cause patients to become dependent and addicted to medication that we prescribe, which is really the most tragic thing that can happen,” said Dr. Stevens.
One in five adult Canadians suffer from chronic back pain
Michael Linklater is a professional basketball player, who represents Saskatchewan on Team Canada.
He often suffers from back pain.
“The back pain that I suffered had to do with some of the imbalances that I had in my mechanics,” said Linklater.
He said his best line of defence is a visit to his physiotherapist at Craven Sports Services.
“Physiotherapy has been my saviour,” he said.
“For me, anytime I have an injury, I come straight to my physiotherapist here and they help me get back on track as quickly as possible."
Karen Craven is a physiotherapist and co-owner of Craven Sports Services in Saskatoon.
She said two years ago she noticed what she now refers to as a back pain “epidemic.”
“There’s a lot of people that are walking around with back pain that think, ‘This is just the way it is. I have to live with this or my uncle had it or it’s genetic.’ That’s not the case,” she said.
It’s what prompted her to start offering free back pain workshops.
“They’ve been a great success, they’re always full,” Craven said.
“Ninety per cent of back pain can be treated and handled with the proper assessment and proper treatment plan."
Craven said she’s also noticed the lack of access firsthand.
“We do have a lot of clients from out of town. They drive in. People as far as Yorkton will come to see us,” she said.
Physiotherapy services not covered
Lack of access isn’t the only prohibiting factor to accessing physiotherapy care.
Evidence has long suggested education and exercise are the best ways to treat pain, but as imaging and medication are covered under Canada’s public healthcare system, many alternative forms of pain treatment, like physiotherapy and chiropractic care, are not. If a patient doesn’t have private health coverage, physiotherapy services are out-of-pocket expenses.
“There is likely something to be said for not having access to non-drug care,” said Bath.
“If what is covered is seeing a physician and having a prescription, than that may be what happens. If you see your doctor and you can’t afford physiotherapy, they’re going to want to something for you.”
Advocates have long lobbied the government to fund physiotherapy services, Bath said.
“Back pain is really a public health issue,” she said.
“We’re hoping this draws attention to the issue, to decision-makers and funders and policy-makers that if we really are going to look at changing at least early-on prescription of opioids or use of different healthcare services that may be inappropriate like MRIs, we need to look at funding services like physiotherapy publicly and earlier on in the care continuum.”