Computerized Care?

Or here's another approach -- don't see a doctor at all. Recent research by Dr. Kate Lorig of Stanford University and colleagues indicates chronic back pain sufferers benefit from participating in a moderated email group.

	"Most back pain comes from muscle spasm," says Dr. Robert Baratz. "So if the chiropractor, by whatever they did, took that tightened muscle and released it, then they have done what anybody else would do."

Lorig and her colleagues enrolled 580 back pain sufferers in the study then randomly assigned them to either the control group or the treatment group. The control group received a magazine subscription of their choice. The treatment group participated in the email discussion group, moderated by a physician, a physical therapist and a psychiatrist. "They could discuss anything they wanted to," says Lorig. "And we did not limit in any way what they could discuss, with two exceptions: we asked that they did not name medical practitioners and they had to be nice to each other."

According to Lorig, the patients were overwhelmingly nice to each other, and quickly ventured into intimate or otherwise embarrassing topics.

"There's something special about the Internet," she says. "People were talking about things - incontinence, problems with back pain and menstruation, sexual dysfunction - stuff that generally does not get talked about in support groups."

After a year, the patients participating in the discussion group reported less pain, less disability, improved function and less health distress. Moreover, participants' visits to their care provider declined an average of 1.5 visits, while the control group's average visits declined by just .65 visits. Similarly, the number of days hospitalized declined more steeply among the discussion group participants than the controls. The results of the study appeared in the April 8, 2002 issue of Archives of Internal Medicine.

	After a year, the patients participating in the discussion group reported less pain, less disability, improved function and less health distress.

How did the email discussion group actually help people? The data is inconclusive; Lorig and her colleagues couldn't find any single factor that could explain how participating helped ease back pain. But Lorig herself has some ideas.

"I think if you give people some information and tools, that they use those things in a way that's beneficial to them," she says. "I think that's what's happening here, and it's so idiosyncratic that there is no one thing. People take what they need."

To that end, Lorig is currently working to develop Internet-based education and discussion groups for people with chronic diseases.

Check out the following Web sites to participate in Lorig's current research:

The Stanford Department of Medicine http://healthyliving.stanford.edu
A web site for injured workers with low back pain.The first 100 people to respond will receive a book or video tape about the management of back pain.

Healthy Living
https://healthyliving.stanford.edu/hl/LearnSelfManagement.asp
Beginning July 2002, Lorig's group will start recruitment and enrollment for a two year study to determine the effectiveness of the online program for people living in the United States with heart disease, lung disease or diabetes.

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