Drug Use, Disability
& Non-Specific Back Pain
Yet Chiropractic Utilization Remains Relative Stagnant
By: Mark Studin DC
Citation: Studin M. (2021) Chiropractic Outcomes, Drug Use, Disability & Non-Specific Back Pain, American Chiropractor Magazine 43(6) 40, 42, 43-44
Low back pain remains an epidemic worldwide, with a lifetime prevalence, as reported by Balague et al. (2012), to be 84%. The prevalence of chronic low back pain is approximately 23%, with 11-12% of the population being disabled by low back pain.1 Despite the cost of managing back pain increasing substantially2, with consistent poor outcomes, medicine has dogmatically held onto the label of "non-specific low back pain." Non-specific low back pain is defined as low back pain not attributable to a recognizable, known specific pathology (e.g., infection, tumor, osteoporosis, fracture, structural deformity, inflammatory disorder, radicular syndrome, or cauda equina syndrome) and represents 90-95% of all back pain.1, 3
Both the evidence and technological advances have clarified that specific pathologies exist with this type of back pain. The label of "non-specific back pain" as a result is no longer applicable. There are mechanical lesions, they have negative neurological sequella, and are demonstrable. Gevers-Montoro (2021) reported the peripheral nervous system's effects, spinal cord mechanisms, supraspinal process, and nociceptors when treated chiropractically.4 Panjabe (2006) wrote, "The spinal column has two functions: structural and transducer. The structural function provides stiffness to the spine. The transducer function provides the information needed to precisely characterize the spinal posture, vertebral motions, spinal loads, etc., to the neuromuscular control unit via innumerable mechanoreceptors present in the spinal column ligaments, facet capsules, and the disc annulus. These mechanical transducers provide information to the neuromuscular control unit, which helps to generate muscular spinal stability via the spinal muscle system and neuromuscular control unit.5 (p. 669). Panjabi clarified why mechanical lesions create precise responses.
Solomonow reported (2009): "Inflammatory response in ligaments is initiated whenever the tissue is subjected to stresses which exceed its routine limits at a given time. For example, a sub-injury/failure load, well within the physiological limits of a ligament when applied to the ligament by an individual who does not do that type of physical activity routinely." 6 (p. 143) Jaumard, Welch, and Winkelstein (2011) reported: In the capsular ligament under stretch, the collagen fiber structure and the nerve endings embedded in that network and cells (fibroblasts, macrophages) are all distorted and activated. Accordingly, capsular deformations of certain magnitudes can trigger a wide range of neuronal and inflammatory responses…Although most of the proprioceptive and nociceptive afferents have a low-strain threshold (~10%) for activation, a few receptors have a high-strain threshold (42%) for signal generation via neural discharge. In addition, capsular strains greater than 47% activate nociceptors with pain signals transmitted directly to the central nervous system. Among both the low- and high-strain threshold neural receptors in the capsular ligament, a few sustain their firing even after the stretching of the capsular ligament is released. This persistent afterdischarge evident for strains above 45% constitutes a peripheral sensitization that may lead to central sensitization with long-term effects in some cases.7 (p. 12)
This type of cascading effect works in 2 directions, one to create a bio-neuro-mechanically failed spinal system, and one to correct a bio-neuro-mechanically failed system. Without delving into a myriad of evidence-based mechanisms, these alone should suffice to overcome the dogma of non-specific back pain."
As a result of these studies and many other outcome-based studies have positioned chiropractic to be considered the "best" first-line of treatment/management (Primary Spine Care Provider) for mechanical lesions. Whedon et al. reported the average annual charges per person for filling opioid prescriptions were 74% lower among chiropractic recipients than other therapies. They also reported the adjusted likelihood of filling a prescription opioid analgesic was 55% lower for recipients of chiropractic services provided by a Doctor of Chiropractic compared with other therapies.8
Blanchette et al. (2016) reported that medical care ended spinal-related compensation 12% longer than chiropractic, and physical therapy care required 239% more time to end full compensation than chiropractic. Medical care also required 20% more time and physical therapy 313% more time versus chiropractic care regarding partial compensation.9
Despite the overwhelming evidence, the Mayo Clinic, one of the world's prominent medical institutions, lists chiropractic in the last section under "Alternative Medicine" and states it "might ease symptoms" after checking with their doctor. Chiropractic is itemized near last after listing physical therapy, drugs (including antidepressants and narcotics), surgery, implanted nerve stimulators, radiofrequency neurotomy (surgery), steroid injections, and most of all, doing nothing.10
Ndetan et al. reported that over 96% of survey respondents with spine-related problems who said the use of chiropractic manipulation stated that the therapy helped them with their condition, with approximately a 46% increased odds that it helped when compared to osteopathic manipulation. (pg. 116) Compared these statistics to medicine, which persists in diagnosing 90-95% as non-specific low back and significant evidence of a perpetual failed care path.
Regarding the use of drugs, the opiate epidemic, and referrals from the medical community, Ndetan et al. continue, "Apart from the fact that chiropractic manipulation (chiropractic spinal adjustment) helped, they were less likely to report using prescription medications and surgery. Despite these potential benefits, these respondents also reported less likely to receive recommendations for chiropractic care from a medical doctor. Within this area of discussion is the consideration that since chiropractic patients are less likely to use medications for pain, perhaps a better referral system involving primary care providers would lessen the need for opiate medications and thereby play some role in the efforts to reduce the current abuse problems associated with this category of drugs in the United States." (pg. 116) With all the positive chiropractic evidence, only 10% of the population at best receives chiropractic care when 84% of people will experience back pain in their lifetime.11
Prominent medical establishments as the Mayo Clinic still list chiropractic as an alternative footnote after listing physical therapy, drugs (including antidepressants and narcotics), surgery, implanted nerve stimulators, a radiofrequency neurotomy (surgery), steroid injections, and most of all, doing nothing as primary treatment modalities. Despite the overwhelming evidence in the literature that non-specific back pain is a "very specific" patho-neuro-biomechanical lesion, medicine still ignores the proof that will help 84% of the population that will suffer back pain in their lifetime and is a financial drain on the healthcare system. With a reported 96% favorable outcome with chiropractic care, medicine still diagnosis 90-95% of back pain cases as "non-specific back pain," continues perpetual failed treatment pathways, and ignores the evidence.