As medical providers we swear to "do no harm." So when considering the whole patient and taking into consideration the cost, overmedication, and medical harm associated with the management of low back pain, it is important for clinicians to consider the power of their diagnostic labelling words.

The study above provides evidence that the use of certain words such as "arthritis", "degeneration", and "disc bulge" when treating a patient with low back pain results in poorer patient perceptions about their condition. A patient who hears these words will likely have a lower expectation of their recovery, a higher chance of surgery and a greater perceived seriousness of their pain. Words like "lumbar sprain", "non-specific low back pain", and even simply "episode of back pain" have better patient beliefs and outcomes related to their low back pain, shifting their perspective and enabling them to feel more comfortable with accepting a non-invasive low risk medical treatment option like chiropractic rehab. Clinical guidelines recommend giving advice and reassurance to help reduce or avoid unnecessary tests and treatments for non-specific low back pain.

Consistent recommendations include:

• educating people about the nature of low back pain,
  
• reassurance that it is not a serious disease and will improve,
  
• encouragement to avoid bed rest,
  
• stay active, and
  
• return to usual activities.
  

The study found that providing reassurance does not remove the negative effects of the labels arthritis, degeneration and disc bulge. Overall, this study suggests that clinicians might consider avoiding labels like arthritis, degeneration and disc bulge. Instead, clinicians could consider using labels like an episode of back pain, lumbar sprain or non-specific LBP when communicating with patients with low back pain.

In chiropractic school we were trained ad nauseam to use incredibly specific diagnoses such as "Acute traumatic facet syndrome with associated myospasm, deep referred right leg pain and lumbar intersegmental joint dysfunction complicated by chronic degenerative hypertrophic osteoarthritis and Grade I L5/S1 spondylolisthesis." I have been a practicing physician for a while now and I whole-heartedly agree with this study. I have learned that my words greatly matter to what a patient thinks and how they believe they will progress over the course of care for their low back pain. While a working diagnosis like the one above may be beneficial knowledge to the treating clinician and could certainly impact the prognosis, it means nothing to a patient. Explaining in full medical detail to a patient what every bit of the diagnosis means to a patient could be detrimental to the success of treatment, leaving them feeling hopeless and that surgery may be inevitable.

As clinicians we must be better for our patients. They deserve it!  

Inflammation can have both positive and negative health effects. Acute inflammation works with the immune system to address infectious and non-infectious cellular damage. (1) However, when inflammation becomes chronic, it can seriously impact health. For example, studies have shown a correlation between chronic inflammation and all-cause, cancer, cardiovascular, and cerebrovascular mortality. (10)(12)

​You can find the following recommended supplements at https://us.fullscript.com/welcome/spokane-wellness

Curcumin
Curcumin (Curcuma longa)600–1,000 mg, total per day, minimum 8–10 weeks (4)(13)

• Curcumin decreased C-reactive protein (CRP) (-0.58 mg/l), tumor necrosis factor-alpha (TNF-α) (-3.48 pg/ml), interleukin 6 (IL-6) (-1.31 pg/ml), and malondialdehyde (MDA) (-0.33 umol/l), and increased superoxide dismutase (SOD) activity (20.51 u/l) and total antioxidant capacity (TAC) (0.21 mmol/l). (3)
• In patients with various chronic diseases, curcumin decreased CRP (-3.67 mg/l) and hs-CRP concentrations. (4) 
• Compared to placebo, curcumin decreased IL-6 by ~49%, TNF-α by ~63%, and MDA by ~38% in patients with diabetes mellitus. (13)

Omega-3 fatty acids (EPA/DHA)
Omega-3 fatty acids (EPA/DHA)2.5 g, total per day, minimum 12 weeks (7)(15) 

• In patients with various health conditions, omega-3s moderately decreased serum CRP, as well as IL-6 and TNF-α with a smaller effect. (5)
• Compared to placebo, omega-3 supplementation decreased total serum cortisol by 19% and IL-6 levels by 33% during a stressful event, and CRP by ~30%, IL-6 by ~22%, and TNF-α by ~16% in patients with chronic kidney disease undergoing hemodialysis. (7)(15)

Probiotics
Probiotics1.6 × 109 CFU, total per day, minimum 8 weeks (8)(11)

• Prebiotics and probiotics modulate the intestinal microbiome and decrease oxidative stress and inflammation by increasing intestinal anaerobes and maintaining the integrity of the intestinal barrier. (6) 
• Compared to placebo, a multistrain synbiotic reduced TNF-α by ~6% and hs-CRP by ~10% in postmenopausal females with obesity and a history of hormone-receptor-positive breast cancer. (11) 
• Compared to placebo, Lactobacillus rhamnosus GG reduced IL1-Beta and lipopolysaccharide concentrations by ~ 35% and ~30%, respectively, in patients with CAD. (8)

Quercetin
Quercetin≥ 500 mg, total per day, minimum of 8 weeks (2)(9)(14)

• In individuals with chronic diseases, quercetin had a large effect on decreasing IL-6 and a smaller effect on decreasing serum CRP. (9) 
• Quercetin decreased TNF-α and IL-6 in females with polycystic ovarian syndrome. (14)
• Compared to placebo, quercetin increased serum TAC by ~20% in post-myocardial infarction patients. (2)

The following protocols were developed using only a,b,c-quality evidence
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References

1. Chen, L., Deng, H., Cui, H., Fang, J., Zuo, Z., Deng, J., Li, Y., Wang, X., & Zhao, L. (2018). Inflammatory responses and inflammation-associated diseases in organs. Oncotarget, 9(6), 7204–7218. https://doi.org/10.18632/oncotarget.23208 
2. Dehghani, F., Sezavar Seyedi Jandaghi, S. H., Janani, L., Sarebanhassanabadi, M., Emamat, H., & Vafa, M. (2021). Effects of quercetin supplementation on inflammatory factors and quality of life in post-myocardial infarction patients: A double blind, placebo-controlled, randomized clinical trial. Phytotherapy Research, 35(4), 2085–2098. https://doi.org/10.1002/ptr.6955 (B)
3. Dehzad, M. J., Ghalandari, H., Nouri, M., & Askarpour, M. (2023). Antioxidant and anti-inflammatory effects of curcumin/turmeric supplementation in adults: A GRADE-assessed systematic review and dose-response meta-analysis of randomized controlled trials. Cytokine, 164, 156144. https://doi.org/10.1016/j.cyto.2023.156144 (A)
4. Gorabi, A. M., Abbasifard, M., Imani, D., Aslani, S., Razi, B., Alizadeh, S., Bagheri-Hosseinabadi, Z., Sathyapalan, T., & Sahebkar, A. (2022). Effect of curcumin on C-reactive protein as a biomarker of systemic inflammation: An updated meta-analysis of randomized controlled trials. Phytotherapy Research, 36(1), 85–97. https://doi.org/10.1002/ptr.7284 (A)
5. Kavyani, Z., Musazadeh, V., Fathi, S., Hossein Faghfouri, A., Dehghan, P., & Sarmadi, B. (2022). Efficacy of the omega-3 fatty acids supplementation on inflammatory biomarkers: An umbrella meta-analysis. International Immunopharmacology, 111, 109104. https://doi.org/10.1016/j.intimp.2022.109104 (A) 
6. Lopes, R. de C. S. O., Balbino, K. P., Jorge, M. D. P., Ribeiro, A. Q., Martino, H. S. D., & Alfenas, R. D. C. G. (2018). Modulation of intestinal microbiota, control of nitrogen products and inflammation by pre/probiotics in chronic kidney disease: A systematic review. Nutricion Hospitalaria, 35(3), 722–730. https://doi.org/10.20960/nh.1642 (A)
7. Madison, A. A., Belury, M. A., Andridge, R., Renna, M. E., Rosie Shrout, M., Malarkey, W. B., Lin, J., Epel, E. S., & Kiecolt-Glaser, J. K. (2021). Omega-3 supplementation and stress reactivity of cellular aging biomarkers: An ancillary substudy of a randomized, controlled trial in midlife adults. Molecular Psychiatry, 26(7), 3034–3042. https://doi.org/10.1038/s41380-021-01077-2 (B)
8. Moludi, J., Kafil, H. S., Qaisar, S. A., Gholizadeh, P., Alizadeh, M., & Vayghyan, H. J. (2021). Effect of probiotic supplementation along with calorie restriction on metabolic endotoxemia, and inflammation markers in coronary artery disease patients: A double blind placebo controlled randomized clinical trial. Nutrition Journal, 20(1), 47. https://doi.org/10.1186/s12937-021-00703-7 (C)
9. Ou, Q., Zheng, Z., Zhao, Y., & Lin, W. (2020). Impact of quercetin on systemic levels of inflammation: A meta-analysis of randomised controlled human trials. International Journal of Food Sciences and Nutrition, 71(2), 152–163. https://doi.org/10.1080/09637486.2019.1627515 (A)
10. Proctor, M. J., McMillan, D. C., Horgan, P. G., Fletcher, C. D., Talwar, D., & Morrison, D. S. (2015). Systemic inflammation predicts all-cause mortality: A glasgow inflammation outcome study. PloS One, 10(3), e0116206. https://doi.org/10.1371/journal.pone.0116206
11. Raji Lahiji, M., Zarrati, M., Najafi, S., Yazdani, B., Cheshmazar, E., Razmpoosh, E., Janani, L., Raji Lahiji, M., & Shidfar, F. (2021). Effects of synbiotic supplementation on serum adiponectin and inflammation status of overweight and obese breast cancer survivors: A randomized, triple-blind, placebo-controlled trial. Supportive Care in Cancer, 29(7), 4147–4157. https://doi.org/10.1007/s00520-020-05926-8 (B)
12. Sharif, S., Van der Graaf, Y., Cramer, M. J., Kapelle, L. J., de Borst, G. J., Visseren, F. L. J., Westerink, J., & SMART study group. (2021). Low-grade inflammation as a risk factor for cardiovascular events and all-cause mortality in patients with type 2 diabetes. Cardiovascular Diabetology, 20(1), 220. https://doi.org/10.1186/s12933-021-01409-0
13. Usharani, P., Mateen, A. A., Naidu, M. U. R., Raju, Y. S. N., & Chandra, N. (2008). Effect of NCB-02, atorvastatin and placebo on endothelial function, oxidative stress and inflammatory markers in patients with type 2 diabetes mellitus: A randomized, parallel-group, placebo-controlled, 8-week study. Drugs in R&D, 9(4), 243–250. https://doi.org/10.2165/00126839-200809040-00004 (B)
14. Vaez, S., Parivr, K., Amidi, F., Rudbari, N. H., Moini, A., & Amini, N. (2023). Quercetin and polycystic ovary syndrome; inflammation, hormonal parameters and pregnancy outcome: A randomized clinical trial. American Journal of Reproductive Immunology , 89(3), e13644. https://doi.org/10.1111/aji.13644 (B)
15. Valle Flores, J. A., Fariño Cortéz, J. E., Mayner Tresol, G. A., Perozo Romero, J., Blasco Carlos, M., & Nestares, T. (2020). Oral supplementation with omega-3 fatty acids and inflammation markers in patients with chronic kidney disease in hemodialysis. Applied Physiology, Nutrition, and Metabolism, 45(8), 805–811. https://doi.org/10.1139/apnm-2019-0729 (B)

​Disclaimer: The content provided is not intended to be for medical diagnosis or treatment, is not a substitute for your professional judgment, and is not meant to provide you medical or professional advice. Statements regarding dietary and other health care supplements have not been evaluated by the FDA, and are not intended to diagnose, treat, cure, or prevent any disease.