Low Back Pain:

Chiropractic Adjustments vs. Muscle Relaxants

A report on the scientific literature 

by Mark Studin DC, FASBE(C), DAAPM, DAAMLP

Chiropractic outperforms muscle relaxants by 427%

Low back pain is one of the most common maladies among the general population and the incidence of occurrence was reported by Ghaffari, Alipour, Farshad, Yensen, and Vingard (2006) to be between 15% and 45% yearly. Hoiriis et al. (2004) reported it to be between 75% and 85% over an adult lifetime in the United States. Chou (2010) writes that, "Back pain is also the fifth most common reason for office visits in the US, and the second most common symptomatic reason..." (p. 388). Historically and based upon this authors 3+ decades of treating low back pain with treatment options that range from heating pads, ice packs, over-the-counter drugs, prescription drugs, surgery, acupuncture and beyond, the most important questions are, "What works? What's proven and what has the best results with the least side effects allowing the patient to regain a normal lifestyle as quickly as possible."

Muscle relaxers are a common drug that has been prescribed by medical doctors for years for nonspecific low back pain. According to Chou (2010), " The term ‘skeletal muscle relaxants’ refers to a diverse collection of pharmacologically unrelated medications, grouped together because they are approved by regulatory agencies for treatment of spasticity or for musculoskeletal conditions such as tension headache or back pain." They are drugs that has been long studied and the effects and side effects have been well documented. Van Tudlar, Touray, Furlan, Solway, and Bouter (2003) concluded that, "Muscle relaxants are effective in the management of nonspecific low back pain, but the adverse effects require that they be used with caution"(p. 1978).

Chou (2010) also stated that, "Skeletal muscle relaxants are an option for acute nonspecific low back pain, although not recommended as first-line therapy because of a high prevalence of adverse effects" (p. 397). He reported that muscle relaxants had a moderate success rate defined by a 1-2 decrease in pain scales rated out of 10. Simply put, if a patient had a pain scale of 9, one could expect the muscle relaxers prescribed to bring the pain to an 8 or 7 at best and include all of the side effects. According to Drugs.com, side effects of muscle relaxants include:

          More common

          Blurred or double vision or any change in vision; dizziness or lightheadedness; drowsiness

          Less common

          Fainting; fast heartbeat; fever; hive-like swellings (large) on face, eyelids, mouth, lips, and/or tongue; mental depression;  shortness of breath, troubled breathing, tightness in chest, and/or wheezing; skin rash, hives, itching, or redness; slow heartbeat (methocarbamol injection only); stinging or burning of eyes; stuffy nose and red or bloodshot eyes

          Less common or rare

          Abdominal or stomach cramps or pain; clumsiness or unsteadiness; confusion; constipation; diarrhea; excitement, nervousness,   restlessness, or irritability; flushing or redness of face; headache; heartburn; hiccups; muscle weakness; nausea or vomiting; pain or peeling of skin at place of injection (methocarbamol only); trembling; trouble in sleeping; uncontrolled movements of eyes (methocarbamol injection only)

          Rare

          Blood in urine; bloody or black, tarry stools; convulsions (seizures) (methocarbamol injection only); cough or hoarseness; fast or irregular breathing; lower back or side pain; muscle cramps or pain (not present before treatment or more painful than before treatment); painful or difficult urination; pain, tenderness, heat, redness, or swelling over a blood vessel (vein) in arm or leg (methocarbamol injection only); pinpoint red spots on skin; puffiness or swelling of the eyelids or around the eyes; sores, ulcers, or white spots on lips or in mouth; sore throat and fever with or without chills; swollen and/or painful glands; unusual bruising or bleeding; unusual tiredness or weakness; vomiting of blood or material that looks like coffee grounds; yellow eyes or skin (http://www.drugs.com/cons/skeletal-muscle-relaxants.html).

When comparing chiropractic spinal adjustments to muscle relaxants for low back pain, it first must be clarified that we are not discussing physical therapy or osteopathic manipulation. While different specialists render tremendous benefits to patients specific to various diagnoses, this research review is limited to a chiropractic spinal adjustment.

Wilkey, Gregory, Byfield, & McCarthy (2008) studied randomized clinical trials comparing chiropractic care to medical care in a pain clinic. "The treatment regimens employed by the pain clinic in this study consisted of standard pharmaceutical therapy (nonsteroidal anti-inflammatory drugs, analgesics, and gabapentin), facet joint injection, and soft-tissue injection. Transcutaneous electrical nerve stimulation (TENS) machines were also employed. These modalities were used in isolation or in combination with any of the other treatments. Chiropractic groupsubjects followed an equally unrestricted and normal clinical treatment regimens for the treatment of [chronic low back pain] were followed. All techniques that were employed are recognized within the chiropractic profession as methods used for the treatment of [low back pain]. Many of the methods used are common to other manual therapy professions" (p. 466-467).

After 8 weeks of treatment, the 95% confidence intervals based on the raw scores showed improvement was 1.99 for medicine and 9.03 for the chiropractic group. This research indicates that chiropractic is 457% more effective than medicine for chronic low back pain.

Within that group of 457% falls patients cared for by muscle relaxants.

Hoiriis et al. (2004) reported in their raw data that the chiropractic groups responded 24% better in reducing pain and concluded that, "Statistically, the chiropractic group responded significantly better than the control group with respect to a decrease in pain scores" (p. 396). This was done in "blinded, randomized clinical trials [which] are considered the gold standard of experimental design" (Hoiriis et al., 2004, p. 396).

REFERENCES

1. Ghaffari, M., Alipour, A., Farshad, A. A., Yensen, I., & Vingard, E.(2006).Incidence and recurrence of disabling low back pain and neck-shoulder pain. Spine, 31(21), 2500-2506.

2. Hoiriis, K. T., Pfleger, B., McDuffie, F. C., Cotsonis, G., Elsangak, O., Hinson, R., & Verzosa, G. T. (2004). A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. Journal of Manipulative and Physiological Therapeutics, 27(6), 388-398.

3. Chou, R. (2010). Pharmacological management of low back pain. Drugs, 70(4) 387-402.

4. van Tudlar, M. W., Touray, T., Furlan, A. D., Solway, S., & Bouter, L. M. (2003). Muscle relaxants for nonspecific low back pain: A systematic review within the framework of the cochrane collaboration.Spine, 28(17), 1978-1992.

5. Drugs.com, (2004). Skeletal muscle relaxants (systemic). Retrieved from http://www.drugs.com/cons/skeletal-muscle-relaxants.html

6. Wilkey, A., Gregory M., Byfield, D., & McCarthy, P. W. (2008). A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. The Journal of Alternative and Complementary Medicine, 14(5), 465-473.

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Arthritis and Low Back Pain:
Chiropractic Care vs. Heat Treatment
 

A report on the scientific literature 

Chiropractic care rendered significantly greater relief of pain
and significantly more mobility

By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
 

"31 million Americans experience low-back pain at any given time" (The American Chiropractic Association, 2010, https://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68)
 
Interesting facts about back pain:¹

1. One-half of all working Americans state that they experience back pain each year.
2. One of the most common reasons people call out of work is back pain.  It is also the second most common reason for a visit to the doctor's office.
3. Back pain is often mechanical or non-organic, meaning it is not caused by a serious condition, such as inflammatory arthritis, infection, fracture or cancer.
4. At least $50 billion per year is spent by Americans on back pain.
5. Experts estimate as much as 80% of the population will experience a back problem at some time in their lives.

 
What Causes Back Pain?
 
The back is made up of bones, joints, ligaments and muscles. Ligaments can be sprained, muscles can be strained, disks can rupture, and joints can be irritated.  All of these can result in back pain. It doesn't always take a major event like a sports inury or an accident to cause back pain. Even the simplest of movements, like picking a small object up from the floor, can have painful results. There are also numerous conditions that can cause or complicate back pain, such as arthritis, poor posture, obesity, and psychological stress. Disease of the internal organs, such as kidney stones, kidney infections, blood clots, or bone loss, can also result in back pain.¹
 
The most common form of arthritis is called osteoarthritis. It is also known as degenerative joint disease and is a disease of the joints. It affects more than 20 million American adults. The cause of osteoarthritis is a breakdown of cartilage, the connective tissue that provides a cushion between the bones of the joints. Healthy cartilage is what permits bones to move over one another and acts as a shock absorber during physical movement. Those afflicted with this disease experience a breakdown of cartilage that wears away. As a result, the bones under the cartilage rub together, resulting in pain, swelling, and loss of joint motion.²
 
What Causes Osteoarthritis?²

There is often no known cause of osteoarthritis. Risk factors include:

1. Age – More people over the age of 45 are affected by osteoarthritis
2. Female – Osteoarthritis more often affects women than in men
3. Particular hereditary conditions like defective cartilage and joint deformity
4. Joint injuries that result from sports, work-related activity or accidents
5. Obesity

 
Signs and Symptoms of Osteoarthritis²

Osteoarthritis often begins at a slow rate. Early on, joints may be sore after physical work or exercise. The pain of early osteoarthritis dissipates and then returns over time, particularly as a result of overuse of the affected joint . Other symptoms may include:

1. Swelling or sensitivity in one or more joints, especially when related to a change in the weather
2. Loss of joint flexibility
3. Stiffness in the joint(s) after getting out of bed
4. Either a crunching feeling or sound resulting from bone rubbing on bone
5. Bony lumps on the finger joints or at the base of the thumb
6. Intermittent or regular pain in a joint

 
In 2006, "...an experimental design was used to compare the effects of chiropractic care (and moist heat) to the effects of moist heat alone for treating lower back pain that is secondary to [arthritis] of the lumbar spine" (Beyerman, Palmerino, Zohn, Kane, & Foster, 2006, p. 107).  This was the first study of its kind. There were 3 parameters measured, pain, mobility and activities of daily living. The results conclusively revealed in every metric analyzed that chiropractic care rendered significantly better results, rendering greater relief of pain and significantly more mobility had been restored.
 
Low back pain and osteoarthritis is a very common condition treated daily in chiropractor’s offices nationwide. This study confirms scientifically the clinical results treating chiropractors have been experiencing for over 100 years. The degree to which pain interferes with aspects of daily living was statistically measured, specifically with walking, sitting and social life and those test subjects under chiropractic care had superior results that simply utilized moist heat.³
 
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with low back pain and arthritis. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.



References:

1.  The American Chriopractic Association. (2010). Back pain facts and & statistics. Retrieved from https://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68
2.  Dawson, E. G., & Shaffrey, C. I. (2009, December). Osteoarthritis: Degenerative spinal joint disease. Spineuniverse. Retrieved from http://www.spineuniverse.com/conditions/spondylosis/osteoarthritis-degenerative-spinal-joint-disease

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Muscle Pain, Trigger Points and Chiropractic

A report on the scientific literature 

By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
 

"Myofascial pain syndrome is a chronic form of muscle pain. The pain of myofascial pain syndrome centers around sensitive points in your muscles called trigger points. The trigger points can be painful when touched and the pain can spread throughout the affected muscle" (Mayo Foundation for Medical Education and Research, 2009, http://www.mayoclinic.com/health/myofascial-pain-syndrome/ds01042)

Nearly everyone experiences muscle pain from time to time that generally resolves in a few days. But people with myofascial pain syndrome have muscle pain that persists or worsens. Myofascial pain caused by trigger points has been linked to many types of pain, including headaches, jaw pain, neck pain, low back pain, pelvic pain, and arm and leg pain" (Mayo Foundation for Medical Education and Research, 2009, http://www.mayoclinic.com/health/myofascial-pain-syndrome/ds01042).

"MPS may be related to a closer-studied complex condition known as fibromyalgia. By accepted definition, the pain of fibromyalgia is generalized, occurring above and below the waist and on both sides of the body. On the other hand, myofascial pain is more often described as occurring in a more limited area of the body, for example, only around the shoulder and neck, and on only one side of the body.

Neither MPS nor fibromyalgia is thought to be an inflammatory or degenerative condition, and the best evidence suggests that the problem is one of an altered pain threshold, with more pain reported for a given amount of painful stimuli. This altered pain threshold can be manifest as increased muscle tenderness, especially in the certain areas, e.g., the trapezius muscle. These syndromes tend to occur more often in women than in men, and the pain may be associated with fatigue and sleep disturbances" (Wikipedia, 2010, http://en.wikipedia.org/wiki/Myofascial_pain_syndrome).

In 2009, a comprehensive study  by Vernon & Schneider reported that manual-type therapies (chiropractic care) have acceptable evidentiary support in the treatment of myofascial pain syndrome and myofascial trigger points. This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions for myofacial pain syndrome. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.uschirodirectory.comand search your state.
 

References:

1.  Mayo Foundation for Medical Education and Research. (2009, December). Mayofacial pain syndrome. Retrieved from http://www.mayoclinic.com/health/myofascial-pain-syndrome/ds01042

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