Re: Oregon's Proposed Low Back Pain Guidelines - Very Good News!!! [1 Attachment]

[Guest guest]

Great news indeed!!! Vern you are the man!!  I for one thank you for your great work- often behind the scenes -to promote chiropractic in our fine state.  In so doing you are promoting the well being of all Oregonians-not to mention saving us all a bundle of money that would be wasted on futile more invasive therapies/drugs.  Now we must make sure the meds don't sabotage the direction this  is headed.

I salute you Vern for another job well done. Schneider DCPDXOn Thu, Aug 11, 2011 at 5:58 PM, vsaboe <vsaboe@...> wrote:

 

[Attachment(s) from vsaboe included below]

Dear colleagues, Very good actually incredibly good news.  I’m just sitting down to write this, just in the door from a meeting of the Oregon Health Services Commission (HSC) who prioritize what conditions will be covered by the “Oregon Health Plan” as well as what evidence based treatments will be paid for and they will perform the same function for Oregon’s coming Universal Health Care System scheduled to come on line in 2015.  This commission has always been over represented by medical providers and as such and predictably the interventions are slanted toward medicine and heavily weighted toward pharmacology (go figure).  Hence when the HSC came out with their Draft “Low Back Pain Guidelines” the Oregon Chiropractic Association had obvious concerns which were validated once we read them.  Attached is the OCA’s response giving our concerns and recommendations all of which I testified to in front of the HSC’s “Outcomes Subcommittee” on June 9.

 Well in short the initial draft of the guidelines placed or appeared to prioritize a myriad of drugs including narcotics (e.g., benzodiazepines, tramadol, opioids etc.) ahead of “Nonpharmacologic therapy” spinal manipulation despite the fact that both had a moderate level of evidence as per efficacy and despite the significantly more significant and common adverse events (death, injury) associated with drug therapy.   Well the unexpected happened they listened the completely reversed the order of interventions in “Table C:”  putting all the drugs behind the nonpharmacologic therapies with Spinal Manipulation leading the pack with the most evidence and the only non-drug therapy for acute back pain….can you believe it!!!!  The commission made some other changes we recommended as well…..

 In my testimony I the commission members for placing patient safety ahead of politics.  I then voice our recommendation that in “Figure 2. On page 8” which is an algorithm entitled “Management of low back pain (LBP).  In boxes 23-26 where in there is a reference to those patients with radiculopathy and spinal stenosis the algorithm goes through a pathway that only dead ends in “surgery or other invasive procedures?”  No algorithm boxes for “non-surgical” treatments for lumbar stenosis or radiculopathy!  Well they had the right guy sitting in that conference room, a chiropractor who had gone through the certification program of Dr. Jim , and performs flexion-distraction treatment for disc pathology and stenosis ha!  They are now going to add those branches allowing for evidence based none surgical interventions for these conditions……however I also pointed out that they needed another branch in this area for neurosurgical or emergency surgical cases e.g., quickly progressing neurologic deficits, paresis of the lower extremity/extremities, urinary retention, bowel dysfunction, saddle anesthesia (cauda equine).

 There was also a portion relative to “advanced imaging” which had no provision for folks with quickly progressing neurological deficits…….

  What I came away with was first we the chiropractic profession are respected by the medical providers on the commission, they were not only professional toward me but very kind and friendly they in fact acted like colleagues all working toward the common goal of providing the best care for Oregonians…way cool.

  Lastly, as I was leaving the conference room for home (with a little extra spring in me-step for sure) a Kathy Kirk RN BS, “Pain Management Coordinator” stopped me in the hall an was all excited about how in the OCA’s written response to the initial draft guidelines fully undress the realtity of drug therapy and its negative consequences to population health.   She and I spoke of how it makes no sense that someone with chronic low back pain on the Oregon Health Plan can gain all the narcotics they wish at $100-$200 per month with all of the adverse effects yet the plan will not pay a dime for chiropractic supportive care that gets them out of pain for a time, until the next exacerbation……well I assure you colleagues she and I will be working together to change that and change be in the wind!!!  A very good day for CHIROPRACTIC!

 To The Continued Good Fight…….  Vern Saboe, DC

-- Schneider DC PDX

[Guest guest]

Wow...this is just...wow! Seitz, DC Tuality Physicians 730-D SE Oak St Hillsboro, OR 97123 (503)640-3724deshaw1996@...; drdan@...; danm@...; annmdurrant@...; drjennifer@...; millerbunch6@...; skrndc1@...; mochihchu@...; caughlindrc@...; drbobdc83@...; rongrice@...; vsaboe@...; ajspine1@...; oregonchiro@...; From: vsaboe@...Date: Thu, 11 Aug 2011 17:58:13 -0700Subject: "Oregon's Proposed Low Back Pain Guidelines - Very Good News!!!" [1 Attachment]

[Attachment(s) from vsaboe included below]

Dear colleagues, Very good actually incredibly good news. I’m just sitting down to write this, just in the door from a meeting of the Oregon Health Services Commission (HSC) who prioritize what conditions will be covered by the “Oregon Health Plan” as well as what evidence based treatments will be paid for and they will perform the same function for Oregon’s coming Universal Health Care System scheduled to come on line in 2015. This commission has always been over represented by medical providers and as such and predictably the interventions are slanted toward medicine and heavily weighted toward pharmacology (go figure). Hence when the HSC came out with their Draft “Low Back Pain Guidelines” the Oregon Chiropractic Association had obvious concerns which were validated once we read them. Attached is the OCA’s response giving our concerns and recommendations all of which I testified to in front of the HSC’s “Outcomes Subcommittee” on June 9. Well in short the initial draft of the guidelines placed or appeared to prioritize a myriad of drugs including narcotics (e.g., benzodiazepines, tramadol, opioids etc.) ahead of “Nonpharmacologic therapy” spinal manipulation despite the fact that both had a moderate level of evidence as per efficacy and despite the significantly more significant and common adverse events (death, injury) associated with drug therapy. Well the unexpected happened they listened the completely reversed the order of interventions in “Table C:” putting all the drugs behind the nonpharmacologic therapies with Spinal Manipulation leading the pack with the most evidence and the only non-drug therapy for acute back pain….can you believe it!!!! The commission made some other changes we recommended as well….. In my testimony I the commission members for placing patient safety ahead of politics. I then voice our recommendation that in “Figure 2. On page 8” which is an algorithm entitled “Management of low back pain (LBP). In boxes 23-26 where in there is a reference to those patients with radiculopathy and spinal stenosis the algorithm goes through a pathway that only dead ends in “surgery or other invasive procedures?” No algorithm boxes for “non-surgical” treatments for lumbar stenosis or radiculopathy! Well they had the right guy sitting in that conference room, a chiropractor who had gone through the certification program of Dr. Jim , and performs flexion-distraction treatment for disc pathology and stenosis ha! They are now going to add those branches allowing for evidence based none surgical interventions for these conditions……however I also pointed out that they needed another branch in this area for neurosurgical or emergency surgical cases e.g., quickly progressing neurologic deficits, paresis of the lower extremity/extremities, urinary retention, bowel dysfunction, saddle anesthesia (cauda equine). There was also a portion relative to “advanced imaging” which had no provision for folks with quickly progressing neurological deficits……. What I came away with was first we the chiropractic profession are respected by the medical providers on the commission, they were not only professional toward me but very kind and friendly they in fact acted like colleagues all working toward the common goal of providing the best care for Oregonians…way cool. Lastly, as I was leaving the conference room for home (with a little extra spring in me-step for sure) a Kathy Kirk RN BS, “Pain Management Coordinator” stopped me in the hall an was all excited about how in the OCA’s written response to the initial draft guidelines fully undress the realtity of drug therapy and its negative consequences to population health. She and I spoke of how it makes no sense that someone with chronic low back pain on the Oregon Health Plan can gain all the narcotics they wish at $100-$200 per month with all of the adverse effects yet the plan will not pay a dime for chiropractic supportive care that gets them out of pain for a time, until the next exacerbation……well I assure you colleagues she and I will be working together to change that and change be in the wind!!! A very good day for CHIROPRACTIC! To The Continued Good Fight……. Vern Saboe, DC

[Guest guest]

“Manipulation leading the pack with the most evidence and the only non-drug therapy for acute back pain….can you believe it!!!!â€

Yep, and I wonder if they will throw a bone to Chiropractic or keep things in house and let their PT’s and DO’s do the manipulating and management.

--just a little friday morning skepticism.

ph Medlin D.C.

From: vsaboe

Sent: Thursday, August 11, 2011 5:58 PM

'Steve and Carrell DeShaw' ; 'Dan Beeson' ; ' ' ; annmdurrant@... ; drjennifer@... ; millerbunch6@... ; 'Sunny Kierstyn' ; 'Dr. Matt Freedman' ; caughlindrc@... ; ' M. s, D.C.' ; ' Grice' ; vsaboe@... ; 'anthony saboe' ; 'Jan Ferrante' ;

Subject: "Oregon's Proposed Low Back Pain Guidelines - Very Good News!!!" [1 Attachment]

Dear colleagues,

Very good actually incredibly good news. I’m just sitting down to write this, just in the door from a meeting of the Oregon Health Services Commission (HSC) who prioritize what conditions will be covered by the “Oregon Health Plan†as well as what evidence based treatments will be paid for and they will perform the same function for Oregon’s coming Universal Health Care System scheduled to come on line in 2015. This commission has always been over represented by medical providers and as such and predictably the interventions are slanted toward medicine and heavily weighted toward pharmacology (go figure). Hence when the HSC came out with their Draft “Low Back Pain Guidelines†the Oregon Chiropractic Association had obvious concerns which were validated once we read them. Attach ed is the OCA’s response giving our concerns and recommendations all of which I testified to in front of the HSC’s “Outcomes Subcommittee†on June 9.

Well in short the initial draft of the guidelines placed or appeared to prioritize a myriad of drugs including narcotics (e.g., benzodiazepines, tramadol, opioids etc.) ahead of “Nonpharmacologic therapy†spinal manipulation despite the fact that both had a moderate level of evidence as per efficacy and despite the significantly more significant and common adverse events (death, injury) associated with drug therapy. Well the unexpected happened they listened the completely reversed the order of interventions in “Table C:†putting all the drugs behind the nonpharmacologic therapies with Spinal Manipulation leading the pack with the most evidence and the only non-drug therapy for acute back pain….can you believe it!!!! The commission made some other changes we recommended as well…..

In my testimony I the commission members for placing patient safety ahead of politics. I then voice our recommendation that in “Figure 2. On page 8†which is an algorithm entitled “Management of low back pain (LBP). In boxes 23-26 where in there is a reference to those patients with radiculopathy and spinal stenosis the algorithm goes through a pathway that only dead ends in “surgery or other invasive procedures?†No algorithm boxes for “non-surgical†treatments for lumbar stenosis or radiculopathy! Well they had the right guy sitting in that conference room, a chiropractor who had gone through the certification program of Dr. Jim , and performs flexion-distraction treatment for disc pathology and stenosis ha! They are now going to add those branches allowing for evidence based none surgical interventions for these conditions……however I also pointed out that they needed another branch in this area for neurosurgical or emergency surgical cases e.g., quickly progressing neurologic deficits, paresis of the lower extremity/extremities, urinary retention, bowel dysfunction, saddle anesthesia (cauda equine).

There was also a portion relative to “advanced imaging†which had no provision for folks with quickly progressing neurological deficits…….

What I came away with was first we the chiropractic profession are respected by the medical providers on the commission, they were not only professional toward me but very kind and friendly they in fact acted like colleagues all working toward the co mmon goal of providing the best care for Oregonians…way cool.

Lastly, as I was leaving the conference room for home (with a little extra spring in me-step for sure) a Kathy Kirk RN BS, “Pain Management Coordinator†stopped me in the hall an was all excited about how in the OCA’s written response to the initial draft guidelines fully undress the realtity of drug therapy and its negative consequences to population health. She and I spoke of how it makes no sense that someone with chronic low back pain on the Oregon Health Plan can gain all the narcotics they wish at $100-$200 per month with all of the adverse effects yet the plan will not pay a dime for chiropractic supportive care that gets them out of pain for a time, until the next exacerbation……well I assure you colleagues she and I will be working together to change tha t and change be in the wind!!! A very good day for CHIROPRACTIC!

To The Continued Good Fight…….

Vern Saboe, DC

[Guest guest]

NOT ON MY WATCH! From: ph Medlin [mailto:spinetree@...] Sent: Friday, August 12, 2011 8:59 AM'Steve and Carrell DeShaw'; 'Dan Beeson'; ' '; annmdurrant@...; drjennifer@...; millerbunch6@...; 'Sunny Kierstyn'; 'Dr. Matt Freedman'; caughlindrc@...; ' M. s, D.C.'; ' Grice'; 'anthony saboe'; 'Jan Ferrante'; ; vsaboeSubject: Re: " Oregon's Proposed Low Back Pain Guidelines - Very Good News!!! " [1 Attachment] “Manipulation leading the pack with the most evidence and the only non-drug therapy for acute back pain….can you believe it!!!!†Yep, and I wonder if they will throw a bone to Chiropractic or keep things in house and let their PT’s and DO’s do the manipulating and management. --just a little friday morning skepticism. ph Medlin D.C. From: vsaboe Sent: Thursday, August 11, 2011 5:58 PM'Steve and Carrell DeShaw' ; 'Dan Beeson' ; ' ' ; annmdurrant@... ; drjennifer@... ; millerbunch6@... ; 'Sunny Kierstyn' ; 'Dr. Matt Freedman' ; caughlindrc@... ; ' M. s, D.C.' ; ' Grice' ; vsaboe@... ; 'anthony saboe' ; 'Jan Ferrante' ; Subject: " Oregon's Proposed Low Back Pain Guidelines - Very Good News!!! " [1 Attachment] [Attachment(s) from vsaboe included below] Dear colleagues,Very good actually incredibly good news. I’m just sitting down to write this, just in the door from a meeting of the Oregon Health Services Commission (HSC) who prioritize what conditions will be covered by the “Oregon Health Plan†as well as what evidence based treatments will be paid for and they will perform the same function for Oregon’s coming Universal Health Care System scheduled to come on line in 2015. This commission has always been over represented by medical providers and as such and predictably the interventions are slanted toward medicine and heavily weighted toward pharmacology (go figure). Hence when the HSC came out with their Draft “Low Back Pain Guidelines†the Oregon Chiropractic Association had obvious concerns which were validated once we read them. Attach ed is the OCA’s response giving our concerns and recommendations all of which I testified to in front of the HSC’s “Outcomes Subcommittee†on June 9.Well in short the initial draft of the guidelines placed or appeared to prioritize a myriad of drugs including narcotics (e.g., benzodiazepines, tramadol, opioids etc.) ahead of “Nonpharmacologic therapy†spinal manipulation despite the fact that both had a moderate level of evidence as per efficacy and despite the significantly more significant and common adverse events (death, injury) associated with drug therapy. Well the unexpected happened they listened the completely reversed the order of interventions in “Table C:†putting all the drugs behind the nonpharmacologic therapies with Spinal Manipulation leading the pack with the most evidence and the only non-drug therapy for acute back pain….can you believe it!!!! The commission made some other changes we recommended as well…..In my testimony I the commission members for placing patient safety ahead of politics. I then voice our recommendation that in “Figure 2. On page 8†which is an algorithm entitled “Management of low back pain (LBP). In boxes 23-26 where in there is a reference to those patients with radiculopathy and spinal stenosis the algorithm goes through a pathway that only dead ends in “surgery or other invasive procedures?†No algorithm boxes for “non-surgical†treatments for lumbar stenosis or radiculopathy! Well they had the right guy sitting in that conference room, a chiropractor who had gone through the certification program of Dr. Jim , and performs flexion-distraction treatment for disc pathology and stenosis ha! They are now going to add those branches allowing for evidence based none surgical interventions for these conditions……however I also pointed out that they needed another branch in this area for neurosurgical or emergency surgical cases e.g., quickly progressing neurologic deficits, paresis of the lower extremity/extremities, urinary retention, bowel dysfunction, saddle anesthesia (cauda equine).There was also a portion relative to “advanced imaging†which had no provision for folks with quickly progressing neurological deficits…….What I came away with was first we the chiropractic profession are respected by the medical providers on the commission, they were not only professional toward me but very kind and friendly they in fact acted like colleagues all working toward the co mmon goal of providing the best care for Oregonians…way cool.Lastly, as I was leaving the conference room for home (with a little extra spring in me-step for sure) a Kathy Kirk RN BS, “Pain Management Coordinator†stopped me in the hall an was all excited about how in the OCA’s written response to the initial draft guidelines fully undress the realtity of drug therapy and its negative consequences to population health. She and I spoke of how it makes no sense that someone with chronic low back pain on the Oregon Health Plan can gain all the narcotics they wish at $100-$200 per month with all of the adverse effects yet the plan will not pay a dime for chiropractic supportive care that gets them out of pain for a time, until the next exacerbation……well I assure you colleagues she and I will be working together to change tha t and change be in the wind!!! A very good day for CHIROPRACTIC!To The Continued Good Fight…….Vern Saboe, DC

[Guest guest]

Nicely done Vern!Thank you for your good fight. Shane McLaughlin D.C.Sent from my iPadOn Aug 11, 2011, at 5:58 PM, "vsaboe" <vsaboe@...> wrote:

Dear colleagues, Very good actually incredibly good news. I’m just sitting down to write this, just in the door from a meeting of the Oregon Health Services Commission (HSC) who prioritize what conditions will be covered by the “Oregon Health Plan†as well as what evidence based treatments will be paid for and they will perform the same function for Oregon’s coming Universal Health Care System scheduled to come on line in 2015. This commission has always been over represented by medical providers and as such and predictably the interventions are slanted toward medicine and heavily weighted toward pharmacology (go figure). Hence when the HSC came out with their Draft “Low Back Pain Guidelines†the Oregon Chiropractic Association had obvious concerns which were validated once we read them. Attached is the OCA’s response giving our concerns and recommendations all of which I testified to in front of the HSC’s “Outcomes Subcommittee†on June 9. Well in short the initial draft of the guidelines placed or appeared to prioritize a myriad of drugs including narcotics (e.g., benzodiazepines, tramadol, opioids etc.) ahead of “Nonpharmacologic therapy†spinal manipulation despite the fact that both had a moderate level of evidence as per efficacy and despite the significantly more significant and common adverse events (death, injury) associated with drug therapy. Well the unexpected happened they listened the completely reversed the order of interventions in “Table C:†putting all the drugs behind the nonpharmacologic therapies with Spinal Manipulation leading the pack with the most evidence and the only non-drug therapy for acute back pain….can you believe it!!!! The commission made some other changes we recommended as well….. In my testimony I the commission members for placing patient safety ahead of politics. I then voice our recommendation that in “Figure 2. On page 8†which is an algorithm entitled “Management of low back pain (LBP). In boxes 23-26 where in there is a reference to those patients with radiculopathy and spinal stenosis the algorithm goes through a pathway that only dead ends in “surgery or other invasive procedures?†No algorithm boxes for “non-surgical†treatments for lumbar stenosis or radiculopathy! Well they had the right guy sitting in that conference room, a chiropractor who had gone through the certification program of Dr. Jim , and performs flexion-distraction treatment for disc pathology and stenosis ha! They are now going to add those branches allowing for evidence based none surgical interventions for these conditions……however I also pointed out that they needed another branch in this area for neurosurgical or emergency surgical cases e.g., quickly progressing neurologic deficits, paresis of the lower extremity/extremities, urinary retention, bowel dysfunction, saddle anesthesia (cauda equine). There was also a portion relative to “advanced imaging†which had no provision for folks with quickly progressing neurological deficits……. What I came away with was first we the chiropractic profession are respected by the medical providers on the commission, they were not only professional toward me but very kind and friendly they in fact acted like colleagues all working toward the common goal of providing the best care for Oregonians…way cool. Lastly, as I was leaving the conference room for home (with a little extra spring in me-step for sure) a Kathy Kirk RN BS, “Pain Management Coordinator†stopped me in the hall an was all excited about how in the OCA’s written response to the initial draft guidelines fully undress the realtity of drug therapy and its negative consequences to population health. She and I spoke of how it makes no sense that someone with chronic low back pain on the Oregon Health Plan can gain all the narcotics they wish at $100-$200 per month with all of the adverse effects yet the plan will not pay a dime for chiropractic supportive care that gets them out of pain for a time, until the next exacerbation……well I assure you colleagues she and I will be working together to change that and change be in the wind!!! A very good day for CHIROPRACTIC! To The Continued Good Fight……. Vern Saboe, DC