Pregnancy, Low Back Pain and Chiropractic
A report on the scientific literature
By: Mark Studin DC, FASBE(C), DAAPM, DAAMLP
It has been this authors personal experience that pregnant woman experiencing low back pain secondary to her pregnancy has been told to “wait and see” over time, with the hope that the back pain would go away. This is predominantly because the “drug option” is off the table with complications to the fetus and most doctors are not willing to take the chance to relieve mechanical (no tumors, fractures or infection) low back pain. My patients reported to me that their obstetricians told them their pain was a result of altered biomechanics and hormonal changes affecting the muscles and ligament of their spine. Current research has now verified through scientific evidence what practicing chiropractors and their patients have been claiming for decades, that chiropractic work to help relieve pain for pregnant woman with a safe, conservative treatment for both mother and the fetus. As a result of the effectiveness and safety, it now demands that chiropractic be the first referral option for pregnant woman experiencing low back pain.
According to Petersen, Muhlemann and Humphreys (2014) “Low back and pelvic pain in pregnant women is such a common phenomenon that it is often considered a normal part of the pregnancy [1-3]. However, the high prevalence of this problem (50-80% of women) and the impact that this may have on their quality of life, as well as the fact that back pain during pregnancy is commonly linked to low back pain persisting after pregnancy, mandates that it be taken seriously by health care practitioners. Many of these patients rate their back pain as moderate to severe with a small percentage claiming to be significantly disabled by the pain [6-8]. Pregnancy-related low back pain is most often divided into 3 categories based on location. These are: lumbar spine pain, posterior pelvic pain, or a combination of these two, with posterior pelvic pain reported to be the most common presentation and the location most specific for pregnant patients. Although the etiology of low back pain associated with pregnancy is not definitively known, the predominate theories include biomechanical changes due to the enlarging uterus resulting in an increasing lumbar lordosis and the influence of the hormone relaxin on stabilizing ligaments leading to hypermobility of joints.” [pg. 2]
Petersen went on to report “The results of this current study which showed that a high proportion of pregnant patients with LBP undergoing chiropractic treatment reported clinically relevant ‘improvement’ support those published in a recent cohort study as well as the recent randomized clinical trial (RCT) looking at chiropractic treatment for pregnant patients with low back or pelvic pain.” [pg. 5] Meaning, that chiropractic works for low back pain in pregnant woman and it has been proven in many scientific studies. The result showed that at various times during the pregnancy, upwards of 90% of pregnant woman reported positive results. The specific results reported:
52% improved at 1 week
70% improved at 1 month
85% improved at 3 months
90% improved at 6 months
All of these were with chiropractic care only and no drugs or any other type of intervention beyond patient education by the chiropractor.
Mullen ET. Al reported that when interviewing midwives, that 88.8% had an experience with chiropractors and 97% was positive. In addition, 94.5% of those had chiropractors treated their children and had a positive experience. The most revealing statistic is one of safety. 100% of midwives question answered that chiropractic was safe for their pregnant patients.
We also know that 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. 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 into normal healthy tissues has been identified (Whedon et al., 2015, p. 5)
References:
Patient Outcomes Proves More Effective with Chiropractic Combined with Standard Medical Care Than Standard Medical Care Alone in the Military
A report on the scientific literature
BY: D. Scott Ferguson
DC, William J. Owens DC, DAAMLP
Mark Studin DC, FASBE(c), DAAMLP, DAAPM
Many people suffer from lower back pain at some point in their lives. Most will seek the advice of a healthcare professional. However, many times this care is fragmented and not based on current evidence and can result in poorer outcomes. When considering outcomes, all doctors must consider creating a diagnosis, prognosis and then conclude a treatment plan. It is that treatment plan, which then determines the outcome after an accurate diagnosis. Many times, low back pain patients seek solely standard medical care and bypass a more effective chiropractic solution. This type of self-referral and physician triage has also been prevalent in the military and asks the question based upon outcome studies, is that in the best interest of both the military and the general public?
In a recent paper by Goertz et al. (2013), the objective was, “To assess changes in pain levels and physical functioning in response to standard medical care (SMC) versus SMC plus chiropractic manipulative therapy (chiropractic adjustments) for the treatment of low back pain among 18 to 35-year-old active-duty military personnel” (p. 627). The authors stated, “Lifetime prevalence of low back pain has been estimated to be as high as 84%, with a median cost per quality-adjusted life year of $13,015” (p. 627). The fact that lower back pain is a major source of disability and abuse of pain medication makes providing the best care possible a priority based upon outcome studies. In this paper, it was reported that, “The majority of systematic reviews find that chiropractic manipulative therapy (adjustments) seems to reduce pain and disability at least moderately for many patients with low back pain” (p. 627). Therefore, the questions are, “Should chiropractic care be part of your treatment plan and should it be included with standard medical treatment for lower back pain?”
In the Goertz et al. (2013) study, the patients were allowed to seek standard medical care in an unrestricted fashion which meant they could go to their medical doctors as they normally would for lower back pain. “Standard care included any or all of the following: a focused history and physical examination, diagnostic imaging as indicated, education about self-management including maintaining activity levels as tolerated, pharmacological (drug) management with the use of analgesics and anti-inflammatory agents, and physical therapy and modalities such as heat/ice and referral to a pain clinic” (p. 628). On the chiropractic side, the authors stated “Treatments consisted of HVLA [high velocity low amplitude a.k.a. chiropractic adjustment] manipulation as the primary approach in all cases, with ancillary treatments at the doctor’s discretion, including brief massage, the use of ice or heat in the lumbar area, stretching exercises, McKenzie exercises, advice on activities of daily living, postural/ergonomic advice; and mobilization” (p. 628). This is important since chiropractors view the spine as an entire system and the approach to patients is different as well as the therapeutic intervention.
In conclusion, the authors reported, “The results of our pragmatic pilot study indicate a statistically and clinically significant benefit to those receiving chiropractic manipulative therapy (adjustments) in addition to standard medical care” (p. 631). Finally, they report, “The results of this trial suggest that chiropractic, in conjunction with standard medical care, offers a significant advantage for decreasing pain and improving physical functioning compared with only standard medical care, for active-duty men and women between 18 and 35 years of age with acute low back pain when delivered in a pragmatic treatment setting” (p. 633).
This study concurs with a previous study by Liliedahl et al. (2010) who studied 85,402 patients and adds to the growing body of evidence in diverse forums that chiropractic for mechanical back pain is more effective and cost-effective than standard medical care. Evidence such as this helps to dispel the partial truths and overcome the prejudices to help the public make informed choices.
References:
1. Goertz, C. M., Long, C. R., Hondras, M. A., Petri, R., Delgado, R., Lawrence, D. J.,…Meeker, W. C. (2013). Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: Results of a pragmatic randomized comparative effectiveness study. Spine, 38(8), 627-634.
2. Liliedahl, R. L., Finch, M. D., Axene, D. V., & Goertz C. M. (2010). Cost of care for common back pain conditions initiated with chiropractic doctor vs. medical doctor/doctor of osteopathy as first physician: Experience of one Tennessee-based general health insurer. Journal of Manipulative and Physiological Therapeutics, 33(9), 640-643.
Disc Herniations and Low Back Pain Post Chiropractic Care
88% of patients reported continued improvement at 1 year post-care
A report on the scientific literature
By Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Robert Reiss DC
According to Hoy et. al. (2014), "Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, LBP [low back pain] ranked highest in terms of disability (YLDs), and sixth in terms of overall burden (DALYs)...LBP causes more global disability than any other condition" (p. 968). 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) wrote that, "Back pain is the fifth most common reason for office visits in the US, and the second most common symptomatic reason..." (p. 388).
There are many treatment options available that fall into one of two categories, surgical or conservative care. Spinal manipulation/adjustments are one of the most widely used conservative treatment options with doctors of chiropractic performing the majority of them. There have been various studies comparing the effectiveness of spinal manipulative therapy (SMT) on low back pain (LBP) patients with disc herniations to other therapies, all of which have been inconclusive.
But now, a 2013 study by Leemann, Peterson, Schmid, Anklin, and Humphreys concluded that, “a large percentage of acute and importantly chronic lumbar disc herniation patients treated with high-velocity, low-amplitude side posture SMT reported clinically relevant “improvement” with no serious adverse events” (p. 162). The study’s purpose was to evaluate patients with low back pain and leg pain that was the result of a herniated lumbar disc which had been confirmed by magnetic resonance imaging. The patients were treated with high-velocity, low-amplitude spinal manipulations by chiropractors. The patients’ outcomes of self-reported global impression of change and pain levels were collected at various time points up to 1 year.
The results showed significant improvement for all outcomes at all of the time points. “Patients responding ‘better’ or ‘much better’ were categorized as ‘improved,’ and all other patients as ‘not improved.’ ‘Improved’ was the primary outcome measure. ‘Slightly improved’ was not considered clinically relevant improvement” (Leemann et al., 2013, p. 158). At 1 year, 88.0% were much better or better. According to the authors, “The results in this current study are encouraging when considering that it is chronic LBP patients who are a large economic burden with greater use of prescription medications and increased use of other health care resources” (Leemann et al., 2013, p. 161).
To find a qualified doctor of chiropractic near you, go to the US Chiropractic Directory at www.USChiropracticDirectory.com and search your state.
References:
1. Hoy, D., March L., Brooks, P., Blyth, F., Woolf, A., Bain, C.,…Buchbinder, R. (2014). Extended Report, The global burden of low back pain: Estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases, 73, 968–974.
2. 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.
3. 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.
4. Chou, R. (2010). Pharmacological management of low back pain. Drugs, 70(4), 387-402.
5. Leemann, S., Peterson, C. K., Schmid, C., Anklin, B., & Humphreys, B. K. (2013). Outcomes of acute and chronic patients with magnetic resonance imaging-confirmed symptomatic lumbar disc herniations receiving high-velocity, low-amplitude, spinal manipulative therapy: A prospective observational cohort study with one-year follow-up. Journal of Manipulative and Physiological Therapeutics, 37(3), 155-163.
Chronic Low Back Pain:
Chiropractic vs. Medicine
Research Results: Chiropractic is 457% more effective
A report on the scientific literature
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
As reported in 2003 by the National Institute of Neurological Disorders and Stroke, "If you have lower back pain, you are not alone. Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation. Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work. Back pain is the second most common neurological ailment in the United States — only headache is more common" (http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm)
They went on to report many of the causes of low back pain. " As people age, bone strength and muscle elasticity and tone tend to decrease. The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae" (National Institute of Neurological Disorders and Stroke, 2003, http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm).
"Pain can occur when, for example, someone lifts something too heavy or overstretches, causing a sprain, strain, or spasm in one of the muscles or ligaments in the back. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward. This rupture may put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain. When these nerve roots become compressed or irritated, back pain results" (National Institute of Neurological Disorders and Stroke, 2003, http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm).
"Low back pain may reflect nerve or muscle irritation or bone lesions. Most low back pain follows injury or trauma to the back, but pain may also be caused by degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, viral infections, irritation to joints and discs, or congenital abnormalities in the spine. Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, posture inappropriate for the activity being performed, and poor sleeping position also may contribute to low back pain. Additionally, scar tissue created when the injured back heals itself does not have the strength or flexibility of normal tissue. Buildup of scar tissue from repeated injuries eventually weakens the back and can lead to more serious injury" (National Institute of Neurological Disorders and Stroke, 2003, http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm).
Chronic low back pain is where the symptoms have persisted for longer than 3 months, as reported by Bogduk in 2004, although recent studies have classified chronic low back pain as pain persisting for only 4 weeks. The duration is important from a diagnosis and prognosis perspective, where it is critical for the doctor to develop an accurate plan of care. The most important component is not the label, but a complete history being performed, including examination and subsequent testing, when indicated, to develop the right treatment plan.
Wilkey, Gregory, Byfield, & McCarthy reported in 2008 that the proportion of the population that suffers from persistent or chronic low back pain is between 8% and 33%. 13% accounts for those whose pain never goes away and the remainder fluctuate in and out of pain. They also reported that the low back pain was generally recurring, indicating that doing nothing is a poor choice.
While there are a limitless number of treatments, the National Institute of Health in the United States and the National Health Service in the United Kingdom have listed accepted treatment modalities for this very prevalent condition. While there are choices for the public, the question is what is the best treatment choice for each individual back pain sufferer? The answer has to be based on real evidence and outcome based studies offer the answer.
As mentioned ealier, 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 was1.99 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 doctors are trained to determine the cause of the injury and are expert at formulating an accurate and effective diagnosis, prognosis and treatment plan. The cornerstone of that plan is the chiropractic adjustment.
These studies along with many others conclude that a drug-free approach of chiropractic care is the best solutions for patients with chronic low back pain. 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. National Institute of Neurological Disorders and Stroke. (2003, July). Low Back Pain Fact Sheet. Retrieved from http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
2. Bogduk, N. (2004). Management of chronic low back pain. The Medical Journal of Australia, 180(2), 79-83.Retrieved from http://www.mja.com.au/public/issues/180_02_190104/bog10461_fm.html
3. 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.
Effectiveness of Chiropractic Care
Certified for:
1. Low Back Pain: Chronic, severe, moderate & non-specific
2. Neck Pain: Severe and moderate
3. Migraine Headaches
4. Headaches: Cervicogenic
5. Dizziness: Cervicogenic
6. Hip Pain: From Arthritis
A report on the scientific literature
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
In order to understand the vast importance of this study, it is critical to understand the context of the work. These conclusions were based on randomized clinical trials and evidenced based results. The studies which the conclusions were based upon come from the input of hundreds of sources.
Randomized Clinical Trials
According to the National Cancer Institute (2004), "Randomization is a process that assigns research participants by chance, rather than by choice, to either the investigational group or the control group of all phase III (and some phase II) clinical trials...Each study participant has a fair and equal chance of receiving either the new intervention being studied (by being placed in the investigational group), or of receiving the existing or 'control' intervention (by being placed in the control group)" (http://www.cancer.gov/clinicaltrials/learning/what-is-randomization).
"The goal of randomization is to produce comparable groups in terms of general participant characteristics, such as age or gender, and other key factors that affect the probable course the disease would take. In this way, the two groups are as similar as possible at the start of the study. At the end of the study, if one group has a better outcome than the other, the investigators will be able to conclude with some confidence that one intervention is better than the other. A randomized, controlled trial is considered the most reliable and impartial method of determining what medical interventions work the best" (National Cancer Institute, 2004, http://www.cancer.gov/clinicaltrials/learning/what-is-randomization).
Evidenced Based Healthcare/Practice
According to Schardt and Mayer (2010), "[Evidenced based practice] is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician's cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal and unique concerns, expectations, and values. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology" (http://www.hsl.unc.edu/Services/Tutorials/EBM/whatis.htm).
"The evidence, by itself, does not make a decision for you, but it can help support the patient care process. The full integration of these three components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life. The practice of EBP is usually triggered by patient encounters which generate questions about the effects of therapy, the utility of diagnostic tests, the prognosis of diseases, or the etiology of disorders. Evidence-Based Practice requires new skills of the clinician, including efficient literature searching, and the application of formal rules of evidence in evaluating the clinical literature" (Schardt & Mayer, 2010, http://www.hsl.unc.edu/Services/Tutorials/EBM/whatis.htm).
Conclusion
In a 2010 study by Bronfort, Haas, Evans, Leininger and Triano, the researchers both randomized clinical trials and studied evidenced based practice results utilizing guidelines found in scientific literature. In each case, they compared the results of manipulation (chiropractic spinal adjustments or extremity adjusting) to "sham" treatment and concluded that manipulation was effective for:
1. Low back pain, soreness or tension
2. Neck pain
3. Hip pain from arthritis
4. Migraine
5. Headache localized in the neck or back of the head
6. Dizziness emanating from the neck
The following entities were included in the above study to help conclude the results of this research: The American College of Physicians/American Pain Society, The Journal of the AMA, the World Health Organization, Journal of Manipulative Physiological Therapeutics, New Zealand Journal of Medicine and many others. Some clarified what was not yet conclusive while others certified chiropractic as a viable choice for care. The arguments as to whether chiropractic works or not has been long silenced. The only question that now arises is when will the more scientific literature be published?
Asthma is one area is that is lacking in research. As the author of this article and a chiropractic practitioner for 30 years, there has not been one asthma patient that didn’t respond to chiropractic care ranging from the acute to the chronic patient where most discarded their drugs and inhalers (as a result of the advice of their medical practitioners) because they didn’t need them anymore. During most of my career, there was no literature, it just worked. Today, we do not have to go simply on faith as there is much literature in the scientific community confirming the benefits of chiropractic.
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions for many problems 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.
References
1. National Cancer Institute. (2004, August 3).What is randomization? Retrieved from http://www.cancer.gov/clinicaltrials/learning/what-is-randomization
2. Schardt, C., & Mayer , J. (2010, July). What is evidence-based practice. Retrieved from http://www.hsl.unc.edu/Services/Tutorials/EBM/whatis.htm
3. Bronfort, G., Haas M., Evans R., Leininger, B., &Triano, J. (2010). Effectiveness of manual therapies: The UK evidence report. Chiropractic and Osteopathy, 18(3). Retrieved from http://www.chiroandosteo.com/content/18/1/3
Acute (Severe) Low Back Pain, Early Intervention
and Chiropractic
87% of chiropractic patients showed improvement
A report on the scientific literature
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
One of the most common areas of the body to be hurt while working, playing sports, cleaning out the garage or any other household or life chore is the lower back. The American Chiropractic Association has reported that 31 million Americans experience low back pain at any given time. This represents a significant health concern, especially if many of the conditions contributing to low back pain go untreated.
The cause of the pain can be injuries as simple as a strained muscle or sprained ligament to the more complicated intervertebral disc injury. Regardless of the structures involved, most of us have had a personal experience with lower back pain, either from an injury while working or simply waking up with it. Finding a doctor that can determine what exactly is wrong (creating an accurate diagnosis) and prescribing the right treatment is the most important aspect of getting well. In fact, one of the most dangerous phrases one can utter is, "Maybe the pain will go away," and is often adopted by too many sufferers.
According to a 2008 study by Globe, Morris, Whalen, Farabaugh, and Hawk on low back pain disorders reported, "Most acute pain, typically the result of injury (micro- or macrotrauma), responds to a short course of conservative treatment [chiropractic care]. If effectively treated at this stage, patients often recover with full resolution of pain...Delayed or inadequate early clinical management may result in increased risk of chronicity and disability" (p. 654).
A 2005 study by DeVocht, Pickar, & Wilder concluded through objective electrodiagnostic studies (neurological testing) that 87% of chiropractic patients exhibited decreased muscle spasms. This study validates the reasoning behind the later study that people with severe muscle spasms in the low back respond well to chiropractic care and prevents future problems and disabilities. It also dictates that care should not be delayed or ignored due to risk of complications.
Chiropractic doctors are trained to determine the cause of the injury and have the experience to formulate an accurate and effective diagnosis, prognosis and treatment plan. The cornerstone of that plan is the chiropractic adjustment. Chiropractic and lower back pain has been one of the most commonly researched topics to date. There is a large volume of research showing that the chiropractic adjustment is effective for treating lower back pain.
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. 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. American Chiropractic Association. (2010). Back Pain Facts & Statistics. Retrieved from https://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68
2. Globe, G. A., Morris, C. E., Whalen W. M., Farabaugh, R. J., & Hawk C. (2008). Chiropractic management of low back disorders: Report from a consensus process. Journal of Manipulative and Physiologic Therapeutics, 31(9), 651-658.
3. DeVocht, J. W., Pickar, J. G., & Wilder, D. G. (2005). Spinal manipulation alters electromyographic activity of paraspinal muscles: A descriptive study. Journal of Manipulative and Physiologic Therapeutics, 28(7), 465-471.
A report on the scientific literature
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
Here are the facts:[1]
When conservative therapies for low back pain (LBP) are not effective, elective surgery may be proposed to these patients. In the United States, it has been estimated that between 6 and 7.5% of chronic LBP patients undergo spinal surgery. The main reasons for surgical treatment of
LBP are high levels of pain, disability and underlying pathology. Patients with disc degeneration represent a large part of spinal surgerypractice. Over the last 20 years, a new technology, disc replacement, has become increasingly popular because it is believed to maintain or restore the integrity of spinal movement and minimize the side-effects compared to fusion. Although disc replacement may relieve a patient from pain and related disability, soreness and stiffness of the lumbo-pelvic region seem to be common aftermaths of the surgery.[2]
While this type of surgery, or the necessity for surgery is not the topic of this article, the authors feel strongly that the decision for spinal surgery, predominantly an elective procedure should be made via a team approach. The patient must (not should) consult both the non-surgical health care provider as well as the surgical provider and those specialist must have a level of dialogue to reach a consensus of the best course of care weighing all of the risks vs. benefits with the patient. No one provider has all of the answers.
Spinal manipulation (adjustments) is one of the recommended conservative therapies for low back pain. Usually, adverse events occur in the first 24 to 48 hours, are benign and resolve completely in a few days. Major complications, for which the overall prevalence is unknown, include increased pain from disc herniation (transient) or cauda equina syndrome (estimated to be less than 1/ 3,700,000 to 1/1,000,000 of lumbar manipulations) and are considered irreversible. Since disc prostheses are believed to restore normal segmental range of motion and reduce potential residual instability, patients with total disc replacement could probably be manipulated similarly to patients with specific low back pain by standard side posture spinal manipulation to alleviate residual pain.[3]
After disc replacement, patients with residual, chronic low back pain would present spinal manipulation side-effects similar to those generally described in a chronic low back pain population.
The main objective of a 2010 study was to evaluate the potential adverse events of lumbar spine manipulations in disc replacement surgery patients. The most frequent side-effects reported were a slight increase in pain as well as minor to moderate lower back stiffness. Both side effects are frequently seen in non-surgical LBP patients after manipulation. In a recent study, Rubinstein described post-spinal manipulation adverse events as being mild to moderate in intensity, with little or no influence on daily activities. He also showed that such events are brief, with spontaneous recovery and typically lasting no more than a few days.[4]
In the same article, it was mentioned that adverse events usually appear at the first treatment and are the result of muscles accommodating to the correct positioning of the spine and need a day or so to “calm down.”
In a recent systematic review of safety of chiropractic intervention, the frequency of adverse events reported after a chiropractic intervention varied between 33 to 60.9%, regardless of treatment type and the patients' clinical presentation and again, is a minor to moderate stiffness and resolves in a very short time spontaneously. Regarding severe adverse reactions; in the present study, none of the patients had severe and irreversible reactions after spinal manipulation.
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with post surgical low back pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.coman search your state.
Comparing the Satisfaction of Low Back Pain Patients Receiving Medical vs. Chiropractic Care: Results from the UCLA Back Pain Study
A report on the scientific literature
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
The relationship between a patient and a doctor is a very important aspect of healthcare. Many patients call this “bedside manner." Researchers call it “patient satisfaction.” In a recent study published in the peer reviewed journal, American Journal of Public Health, and produced by the UCLA School of Public Health, the authors reported on the results of a comparison of patient satisfaction between patients that received chiropractic care and those that received medical care for lower back pain. The authors stated, “Results from observational studies suggest that back pain patients are more satisfied with chiropractic care than with medical care” (Hertzman-Miller et al., 2002, p. 1628).
“Our study was conducted in a large managed care organization in Southern California...for approximately 100000 members” Hertzman-Miller et al., 2002, p. 1628). They go on to report, “Of the 681 randomized, 340 were assigned to the 2 medical groups and 341 were assigned to the 2 chiropractic groups” (Hertzman-Miller et al., 2002, p. 1630). Interestingly, the paper goes on to show “Chiropractic patients reported receiving more self-care advice than did medical patients, were more likely to report an explanation of their treatment, and visited their primary providers [their assigned chiropractor in this study] more often" (Hertzman-Miller et al., 2002, p. 1630). The results showed, “In this randomized trial, chiropractic patients were more satisfied with their back care providers after 4 weeks of treatment than were medical patients” (Hertzman-Miller et al., 2002, p. 1631). It should also be noted, “No deaths or serious adverse events occurred during the 4-week period” (Hertzman-Miller et al., 2002, p. 1630).
This paper in no way minimizes the importance of the medical physician as part of the team necessary to care for patients, understanding that there are diagnoses that mandate the services exclusively of the MD and other circumstances where concurrent care is required. However, when there is a choice based on overlapping care, common sense dictates a drugless treatment first, treatment involving drugs second and surgery last. Those patients, according to this study, who have chosen the chiropractic, drugless approach first, have reported a very high level of satisfaction with chiropractic care with no adverse events.
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. 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. Hertzman-Miller, R. P., Morgenstern, H., Hurwitz, E. L., Yu, F., Adams, A. H., Harber, P., & Kominski, G. F. (2002). Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: Results from the UCLA low-back pain study. American Journal of Public Health, 92(10),1628-1633.
Recurrent Low Back Pain and Chiropractic
A report on the scientific literature
By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
Low back pain is a very common occurrence in our society. There are people that experience it once in their lives, but it is much more common to have back pain that reoccurs when you least expect it. Chiropractic care has been show to be effective in eliminating it or in the cases of chronic recurrent lower back pain, in managing symptoms to allow chronic low back pain sufferers go through their days “pain free.”
Although pain is the #1 reason someone would consult a doctor of chiropractic, the effects of chiropractic on people with recurrent pain are dramatic. In a recent study published in a peer reviewed medically indexed article, the authors stated the objective was, “To investigate the recovery pattern in chiropractic patients being treated for long-lasting or recurrent low back pain…” (Stig, Nilsson, & Leboeuf-Yde, 2001, 288). A total of 158 people were included in the study. The results of the research showed, “Approximately 50% of patients reported that they had ‘improved’ at the 4th visit and within 2 weeks...At the 12th visit...approximately 75% of the patients reported that ‘improvement’ had occurred” (Stig, Nilsson, & Leboeuf-Yde, 2001, 288). “Improvement” was defined as a rating of 1-2/10 on a 10 point scale with 0 being no pain and 10 being the worst pain imaginable.1
The results of this study indicate that 75% of the population gets better in a short amount of time. Should those patients with low back pain have chosen a preventive regimen of chiropractic care, our clinical experience dictates those numbers would have been much higher. Some patients require care once monthly, while others once weekly depending upon their occupations and activity levels as risk factors in exposing the spine to stress. Stresses that affect the spine are physical, chemical or emotional and all three have significant causative values.
The research continues to grow, showing the effectiveness of chiropractic management of lower back pain and in this case, lower back pain that reoccurs. The chiropractic adjustment is the primary method of treatment that produced these amazing results. If you have lower back pain, please speak with a doctor of chiropractic today. Research has shown that improvement occurs without drugs or surgery.
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions to recurrent low back pain. 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. Stig, L-C., Nilsson, O., & Leboeuf-Yde, C. (2001). Recovery pattern of patients treated with chiropractic spinal manipulative therapy for long-lasting or recurrent back pain. Journal of Manipulative and Physioliological Therapeutics, 24(4), 288-91.
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