Pain, Chronic Pain

Chronic spinal pain ­ a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Giles LGF, Muller R. Spine 2003;28:1490-1503.

This was a randomized, controlled clinical trial involving 115 patients with chronic spinal pain (over 13-week duration) comparing spinal manipulation, drugs and acupuncture. Those in the medication group were given Celebrex or Vioxx and paracetamol. Chiropractic patients were adjusted twice a week. The patients were assessed four times using the Oswestry Questionnaire for low back and thoracic spine pain ("back" pain), the Neck Disability Index (NDI) for neck pain, and the Short-Form-36 Health Survey questionnaire (SF-36). Visual analog scales (VAS) were used to assess subjective pain intensity. Objective measurements were also used including range of motion.

At the end of the study, the group receiving manipulation experienced the most recovered patients compared to acupuncture (second) and medication (third). Interestingly, the patients in the manipulation group scored significantly higher on the SF-36 questionnaire that reveals the patient’s perception of their overall health.

"The results of this efficacy study suggest that spinal manipulation, if not contraindicated, may be superior to needle acupuncture or medication for the successful treatment of patients with chronic spinal pain syndrome, except for those with neck pain. The NDI showed that for neck pain, acupuncture achieved a better result than manipulation.” In addition, "Medication…did not achieve a marked improvement…and caused adverse reactions in 6.1% of the patients. The adverse symptoms disappeared once medication was stopped.”

Chiropractic management of chronic chest pain utilizing mechanical force, manually assisted short-lever adjusting procedures Polkinghorn B and Colloca, C J Manipulative Physiological Therapeutics February 2003: Vol. 26 – No. 2

A 49-year-old male suffering from chronic chest pain, dyspnea and anxiety for over four months gradually progressed to the point of precluding active employment and most physical activity. Prior efforts to treat the condition had met with failure.

Chiropractic adjustments were given to the thoracic spine; in particular, the costosternal articulations. The patient responded favorably to the intervention, obtaining prompt relief of his symptoms. Chiropractic care rendered over a 14-week period of time resulted in complete resolution of the patient's previously chronic condition, with recovery maintained at 9 months follow-up.

Chiropractic care for patients aged 55 years and older: report from a practice-based research program. Hawk C, Long CR, Boulanger KT, et al Journal of the American Geriatrics Society 2000:48, pp. 534-45.

Data on over 805 patients 55 years or older were collected over a 12-week period. Patients completed a questionnaire over this 12 week time which included information on their chief complaints and health status. The Medical Outcomes Study 12-Item Short Form Health Survey (SF-12) and the Pain Disability Index (PDI) were also completed.

The study revealed that for two-thirds of the patients, a chiropractor was the only provider for mild to moderate musculoskeletal complaints.

72.3% of the patients had pain related complaints (32.9% of these were for low back pain). Patients decreased use of regular prescription or non-prescription drugs by 7.3% during the 12-week period.

Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug (NSAID), and spinal manipulation. Giles LG, Muller R. Journal of Manipulative and Physiological Therapeutics July/August 1999:22(6), pp.376-81.

Seventy seven patients received needle acupuncture, a nonsteroidal anti-inflammatory drug (NSAID) or chiropractic care. They were followed up after 30 days.

Spinal care was the only intervention to achieve a statistically significant improvement. Patients receiving chiropractic care demonstrated a 30.7% reduction in Oswestry scores and a 25% reduction in neck disability index scores, a 50% reduction for low back pain, 46% reduction for upper back pain and 33% reduction for neck pain. Acupuncture and NSAIDS achieved no significant improvement.

An investigation of the interrelationship between manipulative therapy induced hypoalgesia and sympathoexcitation. Vicenzino B, Collins D, Benson H et al., Journal of Manipulative and Physiological Therapeutics,, Sept. 1998:21(7), pp448-53.

This study investigated a proposed model of how manipulation produced decreased pain or pain inhibiting effects. Twenty-four patients diagnosed with chronic lateral epicondylalgia were assigned to either a placebo group, control group or a group receiving chiropractic neck adjustments.

The patients receiving neck “manipulations” had more pain diminishment and more activity of the sympathetic system than the other patients.

Copyright 2004 Koren Publications, Inc. & Tedd Koren, D.C.