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:
Blurred or double vision or any change in vision; dizziness or lightheadedness; drowsiness
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)
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).
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.
Low Back Pain, Reduced Disability and Chiropractic:
A Study in Proper Diagnosis
A report on the scientific literature
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
When you are experiencing pain in the lower back, it can often be intense and cause for worry. You wonder how something can hurt so badly and are looking for anything to reduce the discomfort. Many times these types of pain cause an admission the emergency room. In a recent study by Orlin and Didriksen (2007), the authors stated, “The objectives of this study were to report on and evaluate the results of chiropractic care for patients with low back pain in an orthopedic department” (p. 135). This is an important study since it shows the results of direct cooperative care amongst chiropractors and orthopedic surgeons in a hospital setting.1 With pain in any body area, proper diagnosis is a key component of care and directly effects treatment methods and expected response time (prognosis). The primary goal is to reduce pain and return you to your normal personal and working activities. The longer an accurate diagnosis and treatment plan is delayed, the longer disability continues.
Many studies have shown that collaboration among clinicians is in the best interest of the patient and results in better care. When you are diagnosed with low back pain, the assessment of the mechanics of the bones and muscles is an important component of your examination. This is completed in conjunction with neurologic and orthopedic examination procedures completed by the chiropractor and ensures that the cause of your pain is identified. In some cases such as trauma, advanced imaging such as MRI may be ordered prior to treatment. A proper diagnosis MUST precede treatment. Otherwise, the doctor does not know what he/she is treating!
In this study, the authors stated, “Examination by the doctor of chiropractic indicated that the patients had lumbopelvic fixation” (Orlin & Didreksen, 2007, p. 135). What this means is there was a biomechanical problem in the bones of the spine and pelvic area, also known as a subluxation. This is a functional problem that doctors of chiropractic are specifically trained to identify and treat. When these types of conditions are identified early on in care, the response to treatment is impressive. The authors stated, “According to pre-established inclusion and exclusion criteria, 33 patients were treated in the chiropractor’s clinic, whereas 11 who could not be transported were initially treated by the chiropractor in the hospital.” (Orlin & Didreksen, 2007, p. 135). In this study, only two patients could not return to work.
"The period of sick leave among the patients was reduced by two thirds as compared with that associated with conventional medical treatment.” (Orlin & Didreksen, 2007, p. 135). This is important because it showcases integrative care utilizing doctors of chiropractic, but also demonstrates how achieving a diagnosis quickly truly influences care. In fact, this approach is so effective that the Federal Government is utilizing doctors of chiropractic as part of the comprehensive approach to caring for our soldiers. H.R. 1017 requires the VA to have doctors of chiropractic on staff at no fewer than 75 major VA medical centers before the end of 2011 and for all major VA medical centers to have a doctor of chiropractic on staff before the end of 2013. There are nearly 160 VA treatment facilities nationwide. Currently, the VA provides chiropractic care at 32 treatment facilities across the country.2
All in all, cooperation is truly the “best medicine” for spine care. If you have spinal pain, seeking the attention of a doctor of chiropractic is a good decision. Communicating with your medical provider that you have sought out chiropractic care allows for better management of your pain and will ultimately help others as well. The final word from the authors was that, “This study shows that a chiropractor may play an important role in an orthopedic department by reducing pain and shortening the duration of sick leave among patients" (Orlin & Didreksen, 2007, p. 138).
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions to acute neck pain and returning to a normal life. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.
1. Orlin, J. R. & Didriksen, A. (2007). Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. Journal of Manipulative and Physiologic Therapeutics, 30(2),135-139.
2. Lukcas, C. & Lee, M. (2010). House passes bill to expand chiropractic care to all major VA medical hospitals. ACA Today. Retrieved from http://www.acatoday.org/press_css.cfm?CID=3943
Muscle Pain, Trigger Points and Chiropractic
A report on the scientific literature
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.
1. Mayo Foundation for Medical Education and Research. (2009, December). Mayofacial pain syndrome. Retrieved from http://www.mayoclinic.com/health/myofascial-pain-syndrome/ds01042