from the desk of:
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
"NYS W/C Critical Update, Part 5"
NYS Workers Compensation Regulatory Requirement for Research to Certify Ongoing Care
Acute and Chronic Low Back Pain
Disclaimer: This opinion does not reflect any organization, including, but not limited to, the US Chiropractic Director or any state or national organization. It is the sole opinion of Dr. Mark Studin and is intended to be a tutorial for the new NYS WC Guidelines. Each doctor has to base his/her utilization of the guidelines, codes and treatment plans based upon the clinical findings of his/her individual patients.
The New York State Workers Compensation Medical Guidelines require researched evidence as one criteria to approve the necessity for ongoing care for patients. The most prevalent diagnosis is low back pain and a diagnosis chiropractors are confronted with on a daily basis.
Should care be required to go beyond the initial allowable visits and require a variance through filing an MG-2 for low back pain, the following research may be cited as published peer reviewed verification that chiropractic care is beneficial and clinically indicated.
It is also strongly recommended that you attach a detailed narrative in SIMPLE language so that the board or a W/C judge can understand it.
Reference: Hoinis, K., Pfleger, B., McDuffie, F., Cotsonis, G., Elsangak, O., Hinson, R., Verzonsa, G., (2004) A Randomized Clinical Trial Comparing Chiropractic Adjustments to Muscle Relaxants for Subacute Low Back Pain, Journal of Manipulative Physiological Therapeutics, 27:388-398
According to Hoinis et. al. in 2004 concluded that chronic low back pain patients benefit from chiropractic adjustments. In addition, they cite that spinal manipulation for acute low back pain, resulting in both short-term benefits and long-term benefits of 1 to 3 years.
NOTE: I am not a supporter of using manipulation in citing research for chiropractic care as it co-mingles with physical therapy and osteopathic findings, however that is what the researchers reported and is valid to support your care for short and long-term care.
Reference: 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.
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 group subjects 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. To say that the medical approach doesn't have a place in healthcare would be inaccurate and irresponsible, but based upon evidenced based outcome studies, research concludes that for chronic low back pain, the path is chiropractic first and drugs 457% second. Chiropractic is clinically indicated by "peer reviewed research" for chronic low back pain patients.
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