Can You Waive My Copay?

Lyrica No Better Than Placebo For Low Back Pain With Sciatica

A recent study out of the New England Journal of Medicine on March 22, 2017 indicates that a widely prescribed drug used against sciatica may be no more effective than placebo. The study found that the amount of improvement that sciatica patients felt was the same whether they were given Lyrica (pregabalin) or a placebo for their back and leg pain. You can read about the study here.

In my Baltimore chiropractic clinics we routinely treat patients that have sciatica. Often these patients are being co-treated by their primary care physicians, pain management specialists, and/or orthopedists for their lower back and sciatic pain. While I am in no way suggesting that patients taking these medications discontinue their use (as Chiropractors we can not advise our patients on the use of medications), I do suggest that in light of these findings sciatic patients should discuss these findings with their medical providers and determine if the continued use of these medications is appropriate.

Sciatica refers to inflammation of the sciatic nerve – a large nerve that runs down the back of the leg. Everyone has two sciatic nerves, one of the left side and one on the right. In some instances patients with sciatica have only pain down the back of their legs. In others, they also present with numbness, tingling, or weakness down their leg in addition to pain. There are many different causes of sciatica, with the most common being irritation of the sciatic nerve such as by a bulging or herniated lower back intervertebral disc.

After studying more than 200 sciatica patients who were randomly assigned Lyrica or a placebo and were followed up over a course of up to eight weeks, the study’s author concludes “we do not recommend the use of pregabalin in people with sciatica.” Patients originally included in the study rated their sciatic pain at around a 6/10. Following the eight week study, whether participants were given Lyrica or a placebo the average pain score at the end of the study was down between 3 and 3.7 regardless of which pill was taken. It is important to note, however, that those participants that were given Lyrica did report more side effects compared with the placebo group.

These findings are interesting to me and my associate Baltimore chiropractors since we routinely treat patients with sciatica. I typically suggest that patients should try a short course of chiropractic care (2-4 weeks) followed by referral to other specialists for further evaluation and intervention. Corticosteroid injections and/or advanced imaging may be appropriate down the line if a short course of chiropractic care does not help with the sciatica.

If you are experiencing sciatica and would like to try some non-drug and non-surgical efforts to improve or eliminate your sciatic pain please call Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

NSAIDs and Ibuprofen Have No Significant Effect on Back Pain

As a Baltimore Chiropractor that spends his clinical time treating patients with headaches, neck pain, and back pain, I have nearly 9 years worth of experience treating patients with back pain. Although as a chiropractor I can not and do not recommend the use of medication to treat mechanical lower back pain, I routinely discuss with patients the alternatives to medication for their acute lower back pain. We discuss stretches, exercise, moist heat, yoga, swimming, and of course, chiropractic manipulation therapy. Baltimore is a blue collar town with lots of my patients working in construction, as police officers, or in restaurants as back of the house staff. Routinely I am told by these patients that even though chiropractic care feels great on their necks and backs, they often have to depend on NSAIDs (non-steroidal anti inflammatory drugs) such as ibuprofen to get through a shift and make it through the day.

Recent research indicates that the NSAIDs and ibuprofen that they take just to get through the day offer little, if any, clinical pain relief for these patients. Research conducted by Professor Manuel Ferreira from the University of Sydney seem to suggest that not only do these drugs offer only very limited short term relief of pain that is “arguably not of any clinical significance” but “when you factor in the side effects which are very common, it becomes clear that these drugs are not the answer to providing pain relief to the man millions who suffer from this debilitating condition every year.” You can read the article here.

In spite of this research, it will take time for clinical guidelines recommending NSAIDs to change. Currently guidelines recommend paracetamol, followed by NSAIDs, followed by opioids.

Given the risks associated with NSAID ingestion, such as stomach ulcers and bleeding, it is important to note that back pain sufferers have choices besides pills to help with back pain.

If you, or someone you know, is suffering from back pain and have been taking NSAIDs and you want to try a safer, non medicinal approach to back pain relief, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We will discuss what options are available for neck and back pain relief without the side effects. We would be happy to help!

Dr. Gulitz

I-83 Pepsi Sign Continues to Contribute to Baltimore Auto Accident Injuries

As a Baltimore Chiropractor, I spend the majority of my clinic time treating patients with headaches, neck pain, and back pain. About half of the patients that we treat have been injured in Baltimore auto accidents. Typically these patients were running errands or commuting to and from work on seemingly normal days when their lives were changed forever as a result of an auto accident.

As part of our intake process we try to determine what it is that brings a patient into the office (i.e. Baltimore auto accident, Baltimore worker’s compensation injury, sports related injury, over-exertion, etc). When we evaluate a new Baltimore auto accident injury patient, we ask more questions and we typically try to determine where the patient was driving prior to their crash. For nearly 4.5 years now I have been seeing an alarming trend where many of our patients are being injured on I-83 “near the Pepsi sign” in Hamden. Many daily commuters know that stretch of the elevated highway, where the road bends ever so slightly and speed limits are only 50 mph. Now that we are a few weeks away from opening our second clinic location in Baltimore (6810 Park Heights Avenue Suite C4, Baltimore, MD 21215) I routinely take I-83 to drive between the two clinics. Nearly each day I see either near miss crashes on this stretch of the highway, or I see an actual crash with paramedics racing to the scene to help injured parties.

I read an article in the Baltimore Sun this past week that addressed the topic of auto accidents on I-83 near the Pepsi Sign. It is estimated that there are between 250-300 crashes on I-83 each year. Over the course of the year it averages out to nearly one per day. The JFX is thought to accommodate over 100,000 driver’s daily. State officials have become increasingly concerned with the number of Baltimore auto accidents that occur on this stretch of highway. As a result they have commissioned a $65,000 study to determine problem areas over the highway and to develop some solutions to these problems.

While it is thought that less than favorable geometry, tight curves and high traffic volume are thought to be the major contributors to the sheer number of crashes on the highway, no formal study has yet been conducted to conclude if these are the reasons for the crash. Further, state officials suspect that most people driving on I-83 are traveling faster than the posted speed limit of 50 mph because they are used to traveling faster on the 695 Beltway. Additionally, as I noted in previous blog posts, elevated roadways can freeze before surface roads, which leads to more icy crashes in temperatures at or near 32 degrees.

City officials are trying to have Maryland State Police extend their jurisdiction to I-83, whereas right now it falls under Baltimore City Police jurisdiction. City officials want the Baltimore city police to focus on more pressing issues such as crime and drugs and feel that the Baltimore city police are spread to thin having to responds to I-83 Baltimore auto accidents. However Maryland State Troopers reportedly oversee over 200 miles of highway and are strained as it is.

Whether you are a city resident and use I-83 for your daily commute or just someone who comes to the city on weekends for the great entertainment and night life, we all need to do our part to obey the posted speed limit of 50 mph on the JFX. The old infrastructure and winding roads lead to an abundance of Baltimore auto accidents and we all need to do our part to slow down and help our commutes move along smoothly.

If you, or someone you know, has been injured as a result of a Baltimore auto accident injury, please call Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Meet China’s TEB-1, is it a cure for road congestion and will it help to decrease auto accident injuries?

As all of my avid blog readers are aware, I am a Baltimore Chiropractor that spends the majority of my clinic time diagnosing and treating ailments of the head, neck, and back primarily. Although I am not limited to diagnosing and treating injuries just within the spine, these are the types of injuries that we typically see, especially given the high number of Baltimore auto accident injury patients that come through the doors every day. Since I focus my clinical practice on injuries associated with Baltimore car accidents, I try and stay up on news both locally and globally about how we can cut down on road congestion and how we can decrease or eliminate injuries resulting from auto accidents.

A few months ago I came across an idea out of China that I found interesting. A Chinese company created a “flying bus” in what is being called TEB-1, or Transit Elevated Bus-1. In many ways it is more like a tram than a bus, since it is affixed to a track below. The TEB-1 stands at about 16 feet tall and can straddle two entire lanes of traffic, while still clearing the roadway below by approximately seven feet. The passenger compartment is said to be roomy as it is approximately 72 feet long and 26 feet wide and capable of holding in excess of 300 passengers at a time. It has been stated that as many as 4 of these TEB-1s can be combined together almost like a train and they can hold over 1000 passengers at a time in that configuration.

While it is certainly something to behold visually, the question remains whether or not it can work in very congested cities in China. And furthermore, the question is whether or not major metropolitan areas in the U.S. would accept it as a means to decreasing road congestion and resulting injuries.

There are just a few problems remaining with the TEB-1 that need to be overcome before we can expect to see it in our neck of the woods

1. Clearance – At just over seven feet of street clearance, this device is just too short to traverse our roads with so many trucks and SUVs. It seems like an easy fix to raise it up another few feet, though.

2. Designated lanes – It would potentially be very costly to rework the framework of most major American cities to install the tram that the TEB needs to roll on. And how to we designate which lanes the TEB will operate in and where motorists can drive in or out of the lanes? That, in addition to the fact that it allegedly can not make 90 degree turns makes this bus seem more like a distant possibility than a short term reality.

3. Power – The TEB is an electric vehicle. While great for the world given its small hydrocarbon footprint, there will be some problems surrounding how to keep it charged enough to make its rounds each day. There has been some discussion about whether or not outfitting the TEB with solar panels will help ease its electricity demand, but some engineers suspect that it will have to be recharged at each stop in order to make all of its rounds on a given day. Who knows, maybe Elon Musk can engineer its batteries?

4. Cost – The estimated cost to construct at TEB is approximately 4.5 million dollars. That’s considered pretty expensive given that its approaching the cost of 11 emissions free buses that can ride around off of a designated track. That is, it may be a solution that is not currently better than what we are already accustomed to using.

I, for one, enjoy engineering marvels and I hope that we can see improvements in mass transit in major cities such as Baltimore. I would support any technological development that decreases road congestion and the likelihood of Baltimore auto accident injuries.

If you want to see some videos of the TEB in action click here or here.

In the meanwhile, if you, or someone you know, has been injured in a Baltimore auto accident and have headaches, neck pain or back pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz