New Research on Back Pain, Diet and Diabetes, Advanced Care Planning, and Other Issues Frequently Seen in Family Medicine

Abstract

From the United States and Netherlands, we have 2 articles on back pain, with findings that indicate significant treatment differences between the countries, and a high likelihood of persistence. The Inflammatory Diet is now shown to be related to diabetes. Multiple perspectives on palliative care for the homeless. Could pharmacists assist in preventing suicide? There are changes in the practice of family medicine. Social determinants of health substantially influence health and medical care. Moreover, care for patients from deprived communities is under-reimbursed. Patient pre-existing conditions increased after the Affordable Care Act, suggesting that repealing pre-existing condition protections would likely exacerbate disparities in health and health care. (J Am Board Fam Med 2019;32:759-762.) Interventions and Long-Term Outcomes of Back Pain in Older Patients Early imaging of patients with low back pain is discouraged unless certain "red flags" are present; older age is 1 of the recognized red flags. Powell et al 1 examined the long-term implications of early imaging in more than 57,000 patients in Medicare Advantage Plans. Patients seeing primary care or chiropractors for the initial visit had less imaging and fewer interventions. Imaging was associated with increased narcotic use and surgical intervention. Some of the findings are troubling in light of the ongoing "opioid epidemic." Unfortunately, van der Gaag et al 2 found that back pain in Dutch adults over age 55 years is quite persistent over the next 5 years. Of note, the imaging rate was substantially higher in the United States than in the Netherlands. The use of physical therapy or chiropractic therapy was higher in the Netherlands. Perhaps, we should also think, "Yoga anyone?" Penrod et al 3 found that back pain is one of the most common associations with mentions of yoga in the medical records of a large health system. In addition, over 10 years, the percentage of charts with mention of yoga increased 10-fold.