Low Back Pain
Chronic spinal pain – a
randomized clinical trial comparing medication, acupuncture
and spinal manipulation. Giles LGF, Muller R.
Spine 2003;28:1490-1503.
Three
groups of patients with back pain were given a nine week
course of care using medicine, acupuncture or chiropractic
care. The results showed a significantly higher number of
satisfied chiropractic patients.
The 40 medical patients were
given two anti-inflammatories (NSAIDS) and the pain killer
Celebrex ™, Viox ™ or
paracetamol. 18 dropped out early because the drugs either
didn’t help or caused side effects. Of the 22 who completed
the study only two found relief.
Out of 32 patients who tried
acupuncture 10 dropped out early because they weren’t
being helped. Of the rest 3 reported pain relief.
Out of 33
chiropractic patients eight dropped out because they weren’t
being helped. Of the rest nine reported pain relief.
Is low back pain part of a general health
pattern or is it a separate and distinctive entity? A critical
literature review of co-morbidity with low back pain.
Hestbaek L, Leboeuf-Yde
C, Manniche CJ Manipulative Physiol Ther May 2003 • Vol
26 • No. 4
This review paper (literature search) goal is
to see if there is co-morbidity or other health problems in
people with persistent lower back pain. Twenty-three papers
were reviewed. All “showed positive associations to all
disorders investigated (headache/migraine, respiratory disorders,
cardiovascular disease, general health, and others) with
the exception of diabetes.”
The conclusion states: “The literature leaves no doubt
that diseases cluster in some individuals and that low back
pain is part of this pattern. However, the nature of the
relationship between low back pain and other disorders is
still unclear.” Unfortunately the authors did not investigate
whether the most important findings chiropractors could locate,
the vertebral subluxation complex, was a factor. The presence
of VSC may clarify the relationship between lower back pain
and visceral etc. disorders.
The course of low back pain in a general
population. Results from a 5-year prospective study Hestbaek L, et al. Journal
of Manipulative and Physiological Therapeutics. May 2003;
Vol. 26, No. 4.
In this study, more than one third of people
who experienced LBP in the previous year did so for more
than 30 days. Forty percent of those still had LBP 1 and
5 years later, and 9% were pain free in year 5. LBP rarely
seems to be self-limiting but merely presents with periodic
attacks and temporary remissions.
Chronic low back pain: a study
of the effects of manipulation under anesthesia. Nicholas F.
Palmieri, NF Smoyak S Journal of Manipulative and Physiological
Therapeutics October 2002 • Volume
25 • Number 8
The objective of this project was to evaluate
the efficacy of using self-reported questionnaires to study
manipulation under anesthesia (MUA) for patients with chronic
low back pain. Self-reported outcome assessment instruments
were used to evaluate changes in patients receiving MUA versus
those not receiving MUA.
A total of 87 subjects from two ambulatory surgical centers and 2 chiropractic
clinics participated in this study. The intervention group consisted of 38
patients and the nonintervention (control) group consisted of 49 patients.
Patients
in the intervention group received MUA. Patients in the nonintervention group
received traditional chiropractic treatment.
In this sample of patients with
chronic low back pain, self-reported outcomes improved after the procedure
and at follow-up evaluation. There was more improvement reported in the intervention
group than the nonintervention group. This study supports the need
for large-scale studies on MUA. It also revealed that self-reported
outcome assessments are easily administered and a dependable
method to study MUA.
Upper cervical management of a patient
with neuromusculoskeletal and visceral complaints. McCoy M. Today’s Chiropractic
May/June 2001. P. 46-47.
This is the case of a 65-year-old man
who began to have symptoms of lower extremity pain and parasthesias, ambulatory
problems, urinary difficulties (having to urinate every half
hour) and visual problems after back surgery which fused
his thoracolumbar segments. Patient also had gout which affected
his right big toe and fingers, ankles, elbows and fingers.
He was on Indocin for the gout. He was also on medication
for high blood pressure and wore glasses for reading.
Twice
as a child he suffered from head trauma. One time he fell over
a railing and landed on top of his head.
The patient reported
that during the evening of his first adjustment he experienced
shock-like sensations bilaterally into his arms and legs. He
also reported chills, a fever, and coldness in his hands, sweats,
and an increase in frequency of urination, gluteal muscle soreness
and loss of appetite. By the next morning the symptoms resolved.
Patient
had twenty chiropractic visits over a 5 month period. By the
time of the seventh visit he did not need an adjustment. The
numbness and tingling along the right side of his body were
gone and he was walking better. His legs felt stronger and
he was not using his cane much. Sitting and standing were less
troublesome.
He reports a decrease in frequency of urination
to only a few times a day and that he doesn’t need his
glasses for reading anymore.
Back pain reporting pattern in
a Danish population-based sample of children and adolescents.
Wedderkopp N, Leboeuf-Yde C, Andersen LB, et al. Spine 2001;
26(17): 1879-83
In this study researchers surveyed 481 eight
to ten year olds and 325 adolescents (14-16 years old). Within
a one month period, 39% stated they had experienced back pain – the
thoracic (mid-back) area being the most common area of complaint
in childhood; thoracic and lumbar (low back) pain being more
common among adolescents. Neck pain was rare in those surveyed.
Complementary
care: when is it appropriate? Micozzi MS 1998. Annals of Internal
Medicine:128:65-66.
“The Agency for Health Care Policy and Research (AHCPR)
recently made history when it concluded that spinal manipulative
therapy is the most effective and cost-effective treatment
for acute low back pain…One might concluded that for
acute low-back pain not caused by fracture, tumor, infection,
or the cauda equina syndrome, spinal manipulation is the
treatment of choice.”
See also: Bigos S., Bowyer O., Braen
G., et al. Acute Low Back Problems in Adults. Clinical Practice
Guideline No. 14. AHCPR Publication No. 95-0642. Rockville,
MD: Agency for Health Care Policy and Research, Public Health
Service, U.S. Department of Health and Human Services. December,
1994.
Chiropractic management of a patient with subluxations,
low back pain and epileptic seizures. Alcantara, Herschong,
Plaugher and Alcantara. J Manipulative Physiol Ther, Volume
21, Number 6, pp. 410-418, April 1998.
This is a case study
of a 21-year-old female with a history since childhood of grand
mal and petit mal seizures occurring every three hours.
Examination
revealed subluxation/dysfunction at L5-S1, C6-C7 and C3-C4,
retrolisthesis at L5, hypolordosis of the cervical spine and
hyperextension at C6-C7.
Gonstead care was administered and
at a 1.5 year follow-up, the patient reported her low back
complaints had resolved and her seizures had decreased (period
between seizures as great as 2 months).
The authors conclude, "Data
suggests that epilepsies are common, with an incidence between
40 and 200 per 100,000 with an overall prevalence between 0.5-1.0%
of the general population. When one considers the potential
side effects of antiepileptic drugs, research into the effects
of chiropractic care for patients with epilepsy should be initiated."
Conservative
treatment of acute and chronic nonspecific low-back pain. Van
Tulder MW, Koes BW, Bouter LM Spine 1997;22:2128-2156.
This
study reported that there is “strong evidence
of the effectiveness of manipulation for patients with chronic
low-back pain.”
Chiropractic/Dental co-treatment of lumbosacral
pain with temporomandibular (TMJ) joint involvement. Chinappi
AS and Getzoff H J Manipulative Physiol Ther, Vol. 19 No. 9
Nov/Dec 1996.
This is the case of a 33-year old woman with centralized
lumbosacral pain.
After 30 months of chiropractic care she was
still experiencing some lower back pain and limited improvement
and agreed to see an orthodontist who diagnosed a “Class 11 malocclusion
with significant loss of vertical dimension, characteristic
of bilateral posterior bite collapse”.
From the abstract:
The co-treatment approach, which integrated
dental orthopedic and craniochiropractic care, ameliorated
the pain and improved head, jaw, neck and back function.
Conclusion:
The position of the jaw, head and vertebral column, including
the lumbar region, are intricately linked. Orthodontic treatment
improved the position of the mandible, which in turn enabled
the body to respond to chiropractic care.
Evaluation of the
Toftness system of chiropractic adjusting for subjects with
chronic back pain, chronic tension headaches, or primary dysmenorrhea.
Snyder, BJ, Sanders, GE Chiropractic Technique, 1996;8:3-9.
24
subjects with chronic back pain, 19 subjects with chronic tension
headaches and 26 subjects with dysmenorrhea underwent a series
of Toftness adjustments or sham interventions.
Toftness adjustments
had significant clinical benefit, whereas those receiving sham
interventions did not improve.
Manga Report, (Canada) 1993.
Enhanced chiropractic coverage
under OHIP (Ontario Health Insurance Plan) as a means for reducing
health care costs, attaining better health outcomes and achieving
equitable access to health services. Manga, P. Report to the
Ontario Ministry of Health, 1998. “On the evidence, particularly
the most scientifically valid clinical studies, spinal manipulation
applied by chiropractors is shown to be more effective than
alternative treatments for low back pain.”
See also Manga,
Pran., et al. Chiropractic Management of Low-Back Pain. Pran
Manga and Associates, Ontario, Canada, 1993
Low back pain of
mechanical origin: randomized comparison of chiropractic and
hospital outpatient treatment. Meade, T. W., Dyer, S. et al.
British Medical Journal, June 1990, 300, pp. 431-437.
Chiropractic
management of patients with acute and chronic back pain was
significantly more cost effective than standard medical management
under the National Health System. The main outcome measure
used was the Oswestry Questionnaire.
Low Back Pain and Chiropractic
W J Med 1989;150:351-5
“...The percentage of chiropractic patients who were ‘very
satisfied’ with the care they received for low back
pain was triple that for patients of family physicians.”
Short
term trial of chiropractic adjustments for the relief of chronic
low-back pain. Waagen GN, Haldeman S et al Manual Medicine
1986;2:63-67.
The efficacy of manual treatment in low back pain:
a clinical trial. US gov’t and Manga reports. Arkuszewski
Z. Manual Medicine, 1986; 2:68-71.
Spinal manipulation out-performs
conventional care in the most costly low back patients.
The
New Zealand Commission Report, 1979. Royal Commission of Inquiry
on Chiropractic in New Zealand.
This study has been referred
to as “Probably the most
comprehensive and detailed independent examination of chiropractic
ever undertaken in any country…”
From the paper:
“The Commission has found it established
beyond any reasonable degree of doubt that chiropractors have
a more thorough training in spinal mechanics and spinal manual
therapy than any other health professional. It would therefore
be astonishing to contemplate that a chiropractor, in those
areas of expertise, should be subject to the directions of
a medical practitioner who is largely ignorant of those matters
simply because he has had no training in them.”
Low back
pain of mechanical origin: randomized comparison of chiropractic
and hospital outpatient treatment. Meade TW, Dyer S, Browne
W et al. British Medical Journal 1990; 300:1431-7.
This paper
compared chiropractic and hospital outpatient care for managing
low back pain of mechanical origin. From the paper:
There is
therefore, economic support for the use of chiropractic in
low back pain, though the obvious clinical improvement in pain
and disability attributable to chiropractic treatment is in
itself, an adequate reason for considering the use of chiropractic.
“The
benefit of chiropractic treatment became more evident throughout
the follow-up period.
“Chiropractic was particularly effective
in those with fairly intractable pain-that is, those with a
history of severe pain.”
Low back pain and the lumbar
intervertebral disc: Clinical consideration for the doctor
of chiropractic. Troyanovich SJ, Harrison DD, Harrison DE.
Journal of Manipulative and Physiological Therapeutics, Feb.
1999; vol. 22, no. 2, pp96-104.
This review of the literature
distills and synthesizes previously published research. The
article lists various causes of low back pain, noting findings
in patient histories, physical examinations, and diagnostic
imaging that represent "red
flags" indicating the need for referral to a specialist
for surgical intervention.
After patients are screened for red
flags, conservative treatment should be the first line of
treatment for patients without absolute signs for surgical
intervention.
The authors concluded:
Of the available conservative treatments,
chiropractic management has been shown through multiple studies
to be safe, clinically effective, cost-effective, and to provide
a high degree of patient satisfaction. As a result, in patients
. . . for whom the surgical indications are not absolute, a
minimum of 2 or 3 months of chiropractic management is indicated.
Practice
guideline: Acute low back problems in adults. Washington, DC:
The Agency for Health Care Policy and Research (AHCPR), U.S.
Public Health Service, Dec. 1994, p. 30.
The United States Agency
for Health Care Policy Research on acute low-back pain in adults.
This
was a review of many treatments for acute low-back pain in
adults.
The panel of medical doctors, osteopaths, nurses, physical
therapists and others familiar with the treatment of low
back pain reviewed over 100 published studies relating to
spinal manipulation.
The results of their five year study concluded
that relief “can
be accomplished most safely with non-prescription medication
and/or spinal manipulation.”
The panel found little evidence to support the use of injections,
muscle relaxers, steroids, acupuncture, and early surgical
intervention and found that “bed rest should be avoided” because
it was useless and may make the condition worse.
Copyright 2004
Koren Publications, Inc. & Tedd Koren,
D.C.