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Cervical Disc Herniation with Radiculopathy (Arm Pain): Chiropractic Care vs. Injection Therapy

Cervical Disc Herniation with Radiculopathy (Arm Pain): Chiropractic Care vs. Injection Therapy

85.7% decrease in pain with spinal adjustments

25% decrease in pain with injection therapy

A report on the scientific literature

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

Mark C. Zientek, DC DAAMLP, CHCQM

William J. Owens DC, DAAMLP

There is a large portion of the population who are dealing with various pain syndromes which includes neck pain from cervical disc herniations. According to Peterson, Schmid, Leemann, Anklin, and Humphreys (2013), this occurs in 83.2 out of every 100,000 people where symptoms range from mild to severe, but all negatively affect a person’s quality of life. To improve one’s quality of life, it becomes necessary to choose ways to manage and alleviate pain while reducing the side-effects of the actual treatment. Common methods range from simple masking of symptoms with over-the-counter medications to prescription opiates and invasive surgeries. Most people look for ways to manage pain and return to daily living activities without risky procedures and their inherent complications.

The use of over-the-counter medications and narcotics such as codeine and/or an oxycodone-acetaminophen combination like Percocet, is a common form of treatment by many primary care physicians and medical specialists alike. Kuehn (2013) reported:

“The FDA is concerned about inappropriate use of [opioid pain medications], which has reached epidemic proportions in the United States,” said FDA Commissioner Margaret A. Hamburg, MD, during a press briefing in September.

There was a 300% increase in prescribing of opioid pain medications between 1999 and 2010, a period in which the number of painkiller overdose deaths among women increased 5-fold and the number of such overdose deaths among men increased 3.6 times, according to the Centers for Disease Control and Prevention (MMWR Morb Mortal Wkly Rep. 2013:62[26];537-542). In 2010 alone, more than 15,000 US deaths were attributed to drug overdoses, and of the 10,000 overdose deaths in which a drug was identified, nearly two-thirds involved opioid pain medications…

The announcement comes after growing calls for the agency to tighten restrictions on the use of these drugs. In July 2012, Physicians for Responsible Opioid Prescribing (PROP), a group that includes prominent specialists in addiction, public health, emergency medicine, and pain medicine, petitioned the FDA to change the labeling for this class of drugs to discourage inappropriate use (Kuehn BM.JAMA. 2012;308[12]:1194-1196). The group argued that the drugs’ indications were overly broad and not consistent with the evidence base and may have been facilitating marketing for broader use than was appropriate. Specifically, the group argued that the agency should drop moderate chronic non-cancer pain as an indication, set a maximum daily dose, and add a maximum duration of use of 90 days. (p. 1547).

The problem, as acknowledged by the FDA, is that the AMA and many in medical academia appear to concur with the addictive qualities of the medications. The alternative option is the chiropractic spinal adjustment and it has been concluded in scientific outcomes to be a superior avenue for the relief of pain and reduction of disability with few side effects.

The earlier discussed study by Peterson et al. (2013) has confirmed that spinal adjustments (manipulations) provide significant improvement for patients with neck pain from cervical herniated discs, as well as arm pain (cervical radiculopathy) without the inclusion of opiates or surgery. In addition, this improvement was seen at all times, particularly at 3 months. In addition, in this Swiss study, it was found that the presence of radiating arm pain (radiculopathy) was not a contraindication to chiropractic treatment nor was it a negative forecaster of outcomes.

This study also found that with cervical herniated discs with radiculopathy, 85.7% of the patients experiencing acute pain reported significant improvement by three months with no patients being worse. For the sub-acute patients, 76.2% reported significant improvement by three months with no patients being worse with their disability indexes which were reduced from the onset of chiropractic care.

Another form of treatment for neck and arm pain commonly used is cervical spinal injections. In the same study compares cervical injection provided a 25% reduction in patients’ symptoms. The results of this current study of spinal adjustment (manipulation) treatments had substantially better results with more than 85% of acute patients and 76% of sub-acute patient improving, with a 65% reduction in arm pain as well as 59% reduction in neck pain at three months.

Chiropractic is one of the safest treatments currently available in healthcare and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration, particularly as a first line treatment. Whedon, Mackenzie, Phillips, and Lurie (2015) based their study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury in normal healthy tissues has been identified” (Whedon et al., 2015, p. 265). One risk factor for chiropractic care is a disc herniation. A properly credentialed chiropractor who has been trained to differentially diagnose and appropriately triage the patient is clinically indicated in this population of patients. The chiropractor can engage in co-management with medical specialists.

To best serve patients, a clear understanding of the outcomes and risks of procedures becomes necessary. Further research into the efficacy of chiropractic manipulation provides a clearly safe and effective treatment to the above-referenced condition. Examination of the research provides insight of avenues for relief of symptoms upon which physicians can undoubtedly rely.

Reference:

1. Peterson, C. K., Schmid, C., Leemann, S., Anklin, B., & Humphreys, B. K. (2013). Outcomes from magnetic resonance imaging–confirmed symptomatic cervical disk herniation patients treated with high-velocity, low-amplitude spinal manipulative therapy: A prospective cohort study with 3-month follow-up. Journal of Manipulative and Physiological Therapeutics, 36(8), 461-467

2. Kuehn, B. M. (2013). FDA tightens indications for using long-acting and extended-release opioids to treat chronic pain.The Journal of the American Medical Association, 310(15), 1547-1548.

3. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.

Published in Neck Problems

Cervical and Lumbar Disc Herniations and Chiropractic Care

Cervical and Lumbar Disc Herniations and Chiropractic Care

A report on the scientific literature

80% of the chiropractic patients studied had good clinical outcomes

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

The term "herniated disc," refers to localized displacement of nucleus, cartilage, fragmented apophyseal bone, or fragmented annular tissue beyond the intervertebral disc space.[1]Simply stated, the annulus, or outer part of the disc has been torn completely through the wall allowing the inner portion, or the nucleus pulposis material to escape the inner confines in a “focal” or finite direction. Unlike a bulging disc, which an entirely different physiological process and diagnosis, caused by degeneration, a herniated disc is traumatically induced phenomena.

The highest prevalence of herniated lumbar discs is among people aged 30–50 years, with a male to female ratio of 2:1. In people aged 25–55 years, about 95% of herniated discs occur at the lower lumbar spine (L4/5 and L5/S1 level); disc herniation above this level is more common in people aged over 55 years.[2]

Symptoms of a Cervical Herniated Disc

A cervical (neck) herniated disc will typically cause pain patterns and neurological deficits as follows:[3]

C4 - C5(C5 nerve root) - Can cause weakness in the deltoid muscle in the upper arm. Does not usually cause numbness or tingling. Can cause shoulder pain.
C5 - C6(C6 nerve root) - Can cause weakness in the biceps (muscles in the front of the upper arms) and wrist extensor muscles. Numbness and tingling along with pain can radiate to the thumb side of the hand. This is one of the most common levels for a cervical disc herniation to occur.
C6 - C7(C7 nerve root) - Can cause weakness in the triceps (muscles in the back of the upper arm and extending to the forearm) and the finger extensor muscles. Numbness and tingling along with pain can radiate down the triceps and into the middle finger. This is also one of the most common levels for a cervical disc herniation.
C7 - T1(C8 nerve root) - Can cause weakness with handgrip. Numbness and tingling and pain can radiate down the arm to the little finger side of hand.

Symptoms of a Lumbar Herniated Disc

The most common symptom of a lumbar disc herniation is pain. The pain is usually described as being located in the buttock with radiation down the back of the thigh and sometimes to the outside of the calf. The specific location may vary and depends on which disc is affected (and thus which nerve root is affected). The pain (and other symptoms and signs) come from pressure on the nerve root. The pain frequently starts as simple back pain and progresses to pain in the leg. When the pain moves to the leg, it is not unusual for the back pain to become less severe. Straining such as bowel movement, coughing or sneezing are all things that tend to cause the leg pain to worsen. Very large disc herniations may cause something known as the "cauda equina syndrome". This is a rare syndrome caused by a very large disc herniation putting pressure on many nerve roots. Signs and symptoms include urinary problems (either retention or incontinence), loss of leg or foot strength, "saddle" anesthesia (loss of sensation in the area of the body that would be in contact with a saddle), decreased rectal sphincter tone and variable amounts of pain (ranging from minimal to severe).[4]

A research paper published in a Peer Reviewed Medically Indexed Journal (scientific journal,) was conducted to evaluate how patients with disc herniations responded to chiropractic care. The authors stated “all patients were evaluated before commencement of chiropractic care by MRI scans for presence of disc herniations. Pre-care evaluations also included clinical examination and visual analog scores [asking them to rate their pain by using a number from 0 to 10]. Patients were then treated with a course of care that included traction, flexion distraction [a specific Chiropractic technique], spinal manipulative therapy, physiotherapy and rehabilitative exercises. All patients were re-evaluated by post-care follow-up MRI scans, clinical examination and visual analog scores. Percentage of disc shrinkage on repeat MRI, resolution of clinical examination findings, reduced visual analog pain scores and whether the patient returned to work were all recorded. This is an important study because it shows MRI scans pre-care and post-care.

The paper goes on to report “Clinically, 80% of the patients studied had a good clinical outcome with post-care visual analog scores accompanied with resolution of abnormal clinical examination findings. Anatomically, after repeat MRI scans, 63% of the patients studied revealed a reduced size or completely resorbed disc herniation (completely resolved.) One significant finding was “seventy-eight percent of the patients were able to return to work in their pre-disability occupations.”[5]

This study shows that Chiropractic care can be a very important part of treatment in patients, when clinically indicated with disc herniations. Injuries such as disc herniations can have a negative impact on the ability to work and complete personal tasks. Evaluating treatment options is paramount when deciding how best to fix the problem especially the non-surgical approach that Chiropractic offers to patients. If you have an injury to your spine, the first step is making sure that you are diagnosed effectively and efficiently, and then engage in treatment as quickly as possible. Although Chiropractic is effective in treating conditions in the early and late phases it has been shown to be most effective when started immediately.[6]

This study, along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions to herniated discs. To find a qualified doctor of chiropractic near you, go to the US Chiropractic Directory at www.USChiroDirectory.comand search your state.

[1]http://www.asnr.org/spine_nomenclature/discussion.shtml

[2]http://clinicalevidence.bmj.com/ceweb/conditions/msd/1118/1118_background.jsp#incidence

[3]http://www.spine-health.com/conditions/herniated-disc/cervical-herniated-disc-symptoms-and-treatment-options

[4]http://www.cinn.org/spine/herniation-lumbar.html

[5]Magnetic resonance imaging and clinical follow-up: study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations. J MANIPULATIVE PHYSIOL THER, 1996 Nov-Dec; 19(9): 597-606

[6]Donald Aspegren, DC, MS, Brian A. Enebo, DC, PhD, Matt Miller, MD, Linda White, MD, Venu Akuthota, MD, Thomas E. Hyde, DC, and James M. Cox, DC. FUNCTIONAL SCORES AND SUBJECTIVE RESPONSES OF INJURED WORKERS WITH BACK OR NECK PAINTREATED WITH CHIROPRACTIC CARE IN AN INTEGRATIVE PROGRAM: A RETROSPECTIVE ANALYSIS OF 100 CASES. J Manipulative Physiol Ther 2009;32:765-771.

Published in Herniations

Cervical Disc Herniation with Radiculopathy (Arm Pain): Chiropractic Care vs. Injection Therapy

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Cervical and Lumbar Disc Herniations and Chiropractic Care

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