Chiropractor is first stop for new back pain clinics

Back pain is the leading cause of disability in Canada, a top-five reason for emergency room visits and is a factor in more than half of all opioid use.
Low Back Rapid Access Clinics, a province-wide initiative that has recently rolled out in this area, aim to streamline the treatment of back pain in order to make the health care system more efficient on many levels.
Dr. Neil Patrick, a chiropractor who has offices in Creemore and Collingwood, is the advanced practice provider (APP) for the South Georgian Bay sub-region of this LHIN, known as the North Simcoe Muskoka Local Health Integration Network. He is the first stop for people referred to the program by their family doctor, or nurse practitioner.
Contributing to the efficiency of the program, it brings services into the community, so people don’t have to travel as far. When a physician makes a referral based on postal code, they go to the closest APP. In this area the program is administered by the Couchiching Family Health Team. Director of clinical services Angela Munday said it’s all about streamlining wait times and getting people the treatment they need as quickly as possible.
The program is a continuation of a pilot program launched in 2012. It is an initiative of world renowned spine surgeon Dr. Raj Rampersaud, who found people were waiting for a very long time on a wait list to see a back surgeon, when more than 85 per cent of them didn’t require surgery. In some cases, people were missing work, and becoming addicted to opioids.
“The way it was done in the past, all of those people are sitting on a three-year waitlist to see a surgeon only to be told you don’t qualify, you don’t need back surgery. Only 15 per cent of them do,” said Munday.
With the implementation of Low Back Rapid Access Clinics, people who suffer from low back pain for more than six weeks but less than a year can referred for assessment quickly.
Patrick, being the first point of contact locally, would do an in-depth assessment over four to six sessions. Like all APPs, he has received special assessment training at University Health Network in Toronto. The assessment involves a physical examination, gathering of medical history, and a management plan.
If the assessment determines a person does need surgery, they are referred on to the Family Health Team, while those who do not require surgery can proceed with physiotherapy or chiropractic treatment.
“There is a paradigm shift in thinking,” said Patrick. “For those patients it’s not so much about curing the condition, it’s about managing it and controlling it with exercises.”
The result is that the only people waiting for surgery are people who actually need surgery, which means the waiting list is drastically reduced, to anywhere from three months to a year.
“We are one of the few regions that does not have a spine surgeon,” said Munday. So patients are referred to Toronto to see Rampersaud, the founder of the program.
Patrick, who has done volunteer advocacy work with the Ontario Chiropractic Association, said he is a champion of the program. Because chiropractic care is not publicly funded, there is a feeling the profession has been underutilized in the healthcare system and this program utilizes their expertise. APPs (who may also be physiotherapists and nurse practitioners) who do the assessments would not be the ones to provide treatment, to avoid conflict of interest.
An advantage, said Patrick, is that once a patient is referred to the program, they proceed through a care process more efficiently.
“As it has rolled out there have been nothing but positive results,” said Patrick.
He said it is fostering a more collaborative approach to healthcare, utilizing chiropractors but also other specialists, and taking some pressure off family physicians.
“Low back pain is a big issue and they don’t always know what to do with it,” said Patrick.
In the old system, patients would be sent by their doctor to see a series of specialists and may be sent for unnecessary imaging, like MRIs, another pressure on the health care system.