“Spine-related disorders (SRDs) are among the most common, costly and disabling problems in Western society. We define SRDs as the group of conditions that include back pain, neck pain, many types of headache, radiculopathy, and other symptoms directly related to the spine. Virtually 100% of the population is affected by this group of disorders at some time in life. Low back pain (LBP) in the adult population is estimated to have a point prevalence of 28%-37%, a 1-year prevalence of 76% and a lifetime prevalence of 85% [2, 3]. Up to 85% of these individuals seek care from some type of health professional [4, 5]. Two-thirds of adults will experience neck pain some time in their lives, with 22% having neck pain at any given point in time [6].

The burden of SRDs on individuals and society is huge [7]. Direct costs in the United States (US) are US$102 billion annually [8] and $14 billion in lost wages were estimated for the years 2002-4 [7].” [1]

Dr. Jack is a part of the first Cohort at the University of Pittsburgh Primary Spine Practitioner Program.

What is a primary spine practitioner (PSP)?

Dr. Tyler Jack, a chiropractor and owner of Southeast Sports & Rehabilitation in Spartanburg was fortunate enough to be a part of the first Cohort at the University
of Pittsburgh’s Primary Spine Practitioner Program  The focus of the Primary Spine Practitioner (PSP) is a trained professional who serves as the point person for patients with spine related disorders, providing diagnosis and management for patients with spine pain, with a minority of who patients may require referral for imaging studies, interventional procedures, medications and surgery.  The PSPs who function within these systems are currently specially-trained chiropractors.

In addition, the PSP serves to coordinate the care that is provided by other professionals and to follow the patient to maintain their track toward recovery. The PSP serves as a resource for primary care practitioners as well as serving a “primary care” role for patients with spine related disorders.

Why do we need a primary spine practitioner in the Upstate?

Patients are often taxed with having to find their own avenue of care when it comes to spine pain.  Patients have a virtual “supermarket” of types of care including: chiropractic, massage therapy, rehabilitative exercise, physical therapy, acupuncture, primary care, emergency room, orthopedist etc., but what if patients were able to get access to someone who in the diagnosis and management of spine disorders that would be able to determine if any or some of these treatments would be beneficial? This would be where the PSP would be able to provide a value based system for spine pain.

Often times at Southeast Sports & Rehabilitation, Dr. Tyler Jack see’s patients who has been in the carousel of spine pain which has been overly focused on specialists, imaging (X-ray, MRI), high-cost/low-value procedures and ineffective patient communication. Primary spine care services evolved out of the need for improved access and cost efficiency in the diagnosis and management of patients with spine-related disorders.

There is increasing evidence that a spine patient’s experience upon initially encountering the health care system has great influence on whether the patient recovers quickly or becomes part of the chronic pain and disability population.  The Primary Spine Practitioners role is to reduce patient costs, improve outcomes, get patients the care that they need in a fashion that is based on the best available evidence.

How is a primary spine practitioner different?

Primary spine practitioners by training will use a treatment based classification system in order to evaluate and manage patients. While a majority of chiropractors will “adjust” or manipulate the spine, the primary spine practitioners role is to determine which treatments will provide the best response based off of the patients history, examination, and their determined classification of pain generation (which should just make sense!)

I always equate this to stomach pain and a patient who presents to the emergency room.  Would they just start giving antacids, give anti-biotics, prep for gallbladder or appendix removal? NO! They perform and examination and determine which treatment is best suited for each individual!  The PSP is the person who can determine the most cost effective, evidence- based interventions for patients with spine pain.

Dr. Jack has attended to date 3 Live course sessions, Unit 1-3 over the past 8 months and will have 2 more units over the next 5 months.

Dr. Tyler Jack’s connection to the PSP program:

Dr. Jack of Southeast Sports & Rehabilitation in Spartanburg is a member of the first cohort of practitioners completing the Primary Spine Practitioner Program at the University of Pittsburgh. Once he finishes the program, he will be providing this valuable service (primary spine care) to the Spartanburg and Upstate South Carolina region.

This program seeks to fill the void for patients who enter the spine care supermarket and should help them navigate through the system with relief and self-efficacy strategies which will help patients overcome their pain experience.  While Dr. Jack has been providing these services for the last 5 years in Spartanburg, he believes that this is the future of care for spine pain in Spartanburg and the Upstate of South Carolina.

Dr. Jack strives to provide patient-centered care which looks to help improve their condition but also looks to empower patients to overcome their pain by utilizing several strategies including exercise, self-mobilization, and self-care strategies that keeps people feeling better.

The program which consists of about 30 chiropractors from the U.S, Canada, and United Arab Emirates as well as 30 physical therapist.

References:

1. Murphy DR, Justice BD, Paskowski IC, Perle SM, Schneider MJ. The establishment of a primary spine care practitioner and its benefits to health care reform in the United States. Chiropractic & Manual Therapies 2011; 19:17. Chiropractic & Manual Therapies
2. Schmidt CO, Raspe H, Pfingsten M, Hasenbring M, Basler HD, Eich W, Kohlmann T: Back pain in the German adult population: prevalence, severity, and sociodemographic correlates in a multiregional survey. Spine (Phila Pa 1976). 2007, 32 (18): 2005-2011. 10.1097/BRS.0b013e318133fad8. Google Scholar
3. Cassidy JD, Carroll LJ, Cote P: The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976). 1998, 23 (17): 1860-1866. 10.1097/00007632-199809010-00012. discussion 1867. Google Scholar
4. Carey TS, Evans AT, Hadler NM, Lieberman G, Kalsbeek WD, Jackman AM, Fryer JG, McNutt RA: Acute severe low back pain. A population-based study of prevalence and care-seeking. Spine (Phila Pa 1976). 1996, 21 (3): 339-344. 10.1097/00007632-199602010-00018.Google Scholar
5. Carey TS, Evans A, Hadler N, Kalsbeek W, McLaughlin C, Fryer J: Care-seeking among individuals with chronic low back pain. Spine (Phila Pa 1976). 1995, 20 (3): 312-317. 10.1097/00007632-199502000-00009. Google Scholar
6. Cote P, Cassidy JD, Carroll L: The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976). 1998, 23 (15): 1689-1698. 10.1097/00007632-199808010-00015. Google Scholar
7. United States Bone and Joint Decade. The Burden of Musculoskeletal Diseases in the United States. 2008, Rosemont, IL: American Academy of Orthopaedic Surgeons. Google Scholar
8. Martin BI, Turner JA, Mirza SK, Lee MJ, Comstock BA, Deyo RA: Trends in health care expenditures, utilization, and health status among US adults with spine problems, 1997-2006. Spine (Phila Pa 1976). 2009, 34 (19): 2077-2084. 10.1097/BRS.0b013e3181b1fad1. Google Scholar