Medical Studies

1. Chiropractic Proven Best for Chronic Spine Pain
2. Cost Effectiveness of Chiropractic Care
3. Does Research Support Chiropractic Care?
4. Effectiveness of Chiropractic
5. New Revelations in Back Pain, JAMA, MRI and False Positives

Chiropractic Proven Best for Chronic Spine Pain
New Research Shows Manipulation Superior to Acupuncture, Drugs

A randomized, controlled clinical trial just published in Spine¹ reveals that chiropractic "manipulation" is superior to both drugs and acupuncture in the treatment of chronic spinal pain (people with pain lasting more than 13 weeks). The study, conducted at a multidisciplinary spinal pain outpatient unit (MSPU) in an Australian public hospital, involved 115 patients randomly assigned to receive one of three interventions: medication, needle acupuncture or chiropractic manipulation.

Patients randomized to the acupuncture or spinal manipulation group were given an initial physical examination by the treating clinician to determine which form of acupuncture needle placement and needling would take place, or what type of spinal manipulation would be performed, respectively. Patients randomized to the medication group were given Celebrex, unless the patient had used it previously. The next drug of choice was Vioxx, followed by paracetamol (up to 4g/day). Doses were left to the sports physician's discretion.

Chiropractors administered "high-velocity, low-amplitude" manipulations. Chiropractic patients were given two treatments per week.

The patients were assessed four times: at the initial visit, and two, five and nine weeks after the initial treatment. The Oswestry Questionnaire for low back and thoracic spine pain ("back" pain), the Neck Disability Index (NDI) for neck pain, and the Short-Form-36 Health Survey questionnaire (SF-36) were self-administered. Visual analog scales (VAS) were used to assess subjective pain intensity.

Objective measurements included straight-leg raising, recorded using a protractor with a plumb-bob to measure the angle. Lumbar spine ranges of movement also were measured using a calibrated Perspex device; cervical spine ranges of movement were measured using a cervical range-of-motion instrument (CROM).

While a number of patients didn't finish the study, due to noncompliance or treatment changes, the statistical significance of the results was maintained for most outcomes. At the end of the study, the group receiving manipulation experienced the most recovered patients (9) compared with three for the acupuncture group and only two for the medication group. This was significant, considering the nature of chronic spine pain.

Patient assessments for the three groups also indicated superiority for chiropractic manipulation for all tests except the VAS for neck pain. This superiority is demonstrated in the percentage of improvement that patients in each of the three groups experienced as measured by the assessment tools (see charts above).

One of the study's most remarkable findings was that patients in the manipulation group reported a 47 percent improvement on the SF-36 questionnaire, compared to only 15 percent for the acupuncture group and 18 percent for the medication group. This finding is all the more significant because the SF-36 does not measure back pain per se, but gives a perception of the level of one's overall health.

In addition to these results, the authors included the following comments in their report:

"The results of this efficacy study suggest that spinal manipulation, if not contraindicated, may be superior to needle acupuncture or medication for the successful treatment of patients with chronic spinal pain syndrome.

"Considering that the patients in this study had experienced chronic spinal pain syndrome for an average of 4.5 years in the medication group, 6.4 years in the acupuncture group, and 8.3 years in the spinal manipulation group, it is notable that manipulation, during a maximum treatment duration of nine weeks, achieved asymptomatic status for every fourth patient (27%). This result is superior to the percentages for acupuncture (9.4%) and medication (5%) for short-term outcomes.

"Medication apparently did not achieve a marked improvement in chronic spinal pain and caused adverse reactions in 6.1% of the patients. The adverse symptoms disappeared once medication was stopped.

"The results of this study can be generalized because the study sample had a broad socioeconomic background and a wide age range.

"In summary, the significance of the study is that for chronic spinal pain syndromes, it appears that spinal manipulation provided the best overall short-term results, despite the fact that the spinal manipulation group had experienced the longest pretreatment duration of pain."

Reference

Giles LGF, Muller R. Chronic spinal pain ­ a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine 2003; 28:1490-1503.

Cost Effectiveness of Chiropractic Care

“Treatment costs in cases managed by chiropractic physicians increased 12%
between 1986 and 1989. Treatment cost in cases managed by medical physicians increased 71% in the same time period.“

Journal of Manipulative and Physiological Therapeutics, Jarvis et al. (1997)

Chiropractic treatment of back pain is a perfect example of how health care expenses can be reduced while increasing the quality of care. Many studies have shown that chiropractic care is quite cost-effective especially under managed care. Generally, per-visit costs are lower, prescription drug use is reduced, and there is a reduction of inappropriate diagnostic imaging tests, such as MRIs.

Does Research Support Chiropractic Care?
By Richard Cole, DC, DACNB, DAAPM, FICC

For years chiropractic doctors have known their treatments worked well and were appreciated by their patients. While this anecdotal evidence has always been an important measure of success, what physicians and patients really want when considering treatment options is solid scientific data.

Now the evidence is in and available to all.

Almost every single day I pick up a journal and read another article that supports the use of modern chiropractic care. Whether basic science research, case reports or complicated studies on techniques, the mounting data is beginning to strongly favor the use of conservative spine treatment over more invasive procedures whenever feasible. Conservative measures include those used by chiropractic physicians such as spinal manipulation and rehabilitation.

This February three MDs were published in the prestigious Spine journal and stated, “Chiropractic… techniques and other complimentary methods all play an important roll in the care of patients with back or neck pain.”  

Orthopedics Today, a journal for orthopedic surgeons, stated chiropractic care has come into its own. The article went on to say it was time for medical doctors to begin to understand and utilize the impressive health benefits of chiropractic care for patients suffering from spine problems.

A new study in the April issue of the British Medical Journal concluded that manual therapy, a treatment most often provided by chiropractors, is "more effective and less costly for treating neck pain" than other available treatments.

The Back Letter, a publication that reports on the major spine conferences and publishes a synopsis for physicians, has stated chiropractic care has been proven effective in the treatment of low back pain, neck pain and headache…and is cost effective, as well. 

Modern chiropractic physicians peruse a vast array of medical literature and employ the latest research in their practices. For instance, research has proven spine muscle tone and strength are critical in supporting healthy spine structures. Furthermore, exercise and flexibility are essential in preventing spine pain. Doctors, both medical and chiropractic, who heed this research incorporate special exercises in their treatment programs to ensure full and appropriate recovery for their patients.

Some conclusions from the recently published research include:

1. While back surgery may be necessary, it should be a last resort option.
2. Conservative treatments should be used prior to back surgery whenever possible.
3. Chiropractic treatment is an effective conservative therapy.
4. Chiropractic care is cost efficient.
5. Chiropractic care is safe.
6. Exercises should be used by doctors treating spine problems
7. Medical doctors should refer patients for chiropractic care.

When doctors keep up with the research, outcomes are improved. While it is difficult to keep pace with the rapidly evolving field of chiropractic care, it is essential that all doctors remain diligent in this endeavor for the sake of their patients.

Research Shows Effectiveness and Popularity of Chiropractic Care for Workers

“80% of Insured American Workers Have Coverage for Chiropractic Services”

Fully 80 percent of American workers in conventional insurance plans, preferred provider organizations and point-of-service plans now have coverage that pays at least part of the cost of chiropractic care, according to a 1994 AHCPR (Agency for Healthcare Policy and Research) report.

A study published in the July 1, 1998 issue of the Annals of Internal Medicine shows that chiropractic treatment is appropriate for low-back pain in a considerable number of cases. This study by the Rand Corporation found that 46 percent of a sample of low-back pain patients received appropriate care from doctors of chiropractic – an appropriateness rating similar to that of common medical procedures. Such proofs of effectiveness have made chiropractic care increasingly more popular as a part of employee insurance plans.

A March 1998 article in Business and Health magazine explained this trend, saying, “Many companies say chiropractic coverage has lowered their medical and worker’s comp costs, while raising overall health and productivity.” The article also cites an Oregon study which found that median work time lost for employees with back pain injuries who used chiropractic care was only nine days as compared with 34.5 days for workers who used medical care.

Quick relief of symptoms and sustained effectiveness have long attracted consumers to chiropractic care, whose popularity is demonstrated by the more than 20 million adults who used chiropractic services in just 1997 alone. The 1994 AHCPR guidelines for low-back pain concluded that spinal manipulation, chiropractic’s primary treatment technique, is one of only three treatments whose effectiveness is substantiated by rigorous research.

“I have treated many patients suffering with low-back pain who have been told that the pain will go away on its own,” said Dr. Richard Cole of Cole Pain Therapy Group in Memphis. “That’s a very frustrating thing for patients to hear. In chiropractic care, we know that further treatment is necessary in many cases. And chiropractic care has been proven to be extremely effective at treating low-back pain. Many companies and insurers have recognized this and incorporated such care into their workers’ coverage.”

Chiropractic doctors prescribe therapeutic regimens that often include physical therapy, rehabilitative exercises and nutritional supplements – all to help patients regain and maintain a healthy balance between their neurological system, muscles, and bones.

Using a leading-edge combination of rehabilitation, traditional chiropractic methods, and years of experience with acute and chronic pain patients, ConservCare doctors have made a difference in the lives of thousands of people of all ages. For more information, call (901) 372-7730.

“Of 1,996 low-back pain cases studied, patients receiving chiropractic treatment averaged 6.26 compensation days compared to 25.56 compensation days for medical patients.”

Chiropractic Journal of Australia, Ebrall (1992)

New Revelations in Back Pain

JAMA, MRI & False Positives

by JC Smith, MA, DC

 The epidemic of back pain is enormous: It's a $100 billion industry, it's the leading workers' comp injury, it's the leading reason for disability for people under the age of 45, it will strike 90% of all American adults, it's the second-leading surgical procedure, and it's only getting worse. As a huge burden upon society, many studies have been done to investigate this epidemic, and the results have been shocking because they don't endorse the standard medical procedure of MRIs, drugs, and back surgery. In fact, many researchers now admit that these ineffective medical methods have only added to this epidemic and escalated the cost of back pain. Let me share with you the new revelations on this issue of back attacks because it may save you a lot of pain and money.

 For many patients suffering from painful back pain or leg pain, the first test ordered by their primary care physician is an MRI scan. Not only are MRI scans very expensive, but most are unnecessary according to a recent study in the Journal of the American Medical Association. The researchers recommended that MRI scans not be the first imaging test for patients with back pain, and they also lead to more specialist consultations and a higher rate of back surgery operations. Nor do the MRI scans reveal the real cause of back pain in most cases!

 This study confirms an earlier guideline on acute low back pain by the US Public Health Service that suggested only 1 in 200 patients with severe low back and leg pain required an MRI scan, and surgery is believed necessary in only 1 in 100 cases of severe low back pain. It also recommended spinal manipulative therapy as a first avenue of treatment for acute low back pain, which has been mostly ignored by the medical profession for economic reasons.

 Not only are too many MRI scans ordered for the epidemic of low back pain, but many are also misleading. MRI studies on asymptomatic patients with no back pain found that over 80% had herniated, degenerated, ruptured discs, and many showed bones spurs and spinal stenosis as well. These findings in patients with no pain are now considered part of the natural aging process and deemed as “false positives,” which means yes, the disc abnormality is there, but no, it may have nothing to do with your pain. Yet many MDs fail to inform their patients of this revelation.

 As this JAMA article mentioned, many surgeries are based on these false positive MRI exams, which explains why the failure rate of spine surgery is so high. In another study on workers’ comp cases, 71% of patients having one back surgery never returned to work, and 95% of those patients with multiple surgeries never worked again. Doesn't sound too promising, does it?

 And the cost is enormous: one study stated that a lumbar fusion may cost up to $169,000, and back surgeries rank at the top of the list of hospital procedures nowadays, right up there with heart procedures: both are huge money-makers for hospitals, which explains why chiropractic care is omitted in most hospitals--not because it doesn't work or isn't recommended by the guidelines, but because it's too cheap! Don't get me started on that ruse.

 Another article on low back pain in JAMA revealed that 97% of back pain is “mechanical” in nature, meaning misaligned spinal joints, strained muscles and/or ligaments are the problem, and only 4% of these are disc problems. Of these 97% mechanical problems, the experts say 70% of these problems can be helped with spinal manipulation. Recall that there are 24 movable vertebrae in your spine sitting atop 3 pelvic bones, all connected by 137 joints, which explains why spinal manipulation has proven to be so effective. In other words, you don't slip discs as much as you slip joints in the majority of back pain problems!

 The research is clear: back surgeries are often based on a false premise (the slipped disc concept), patients are not informed of the recommended guidelines of manipulative therapy first, and when the back surgery invariably fails, they want to do another, and another, and another until they send you home with a morphine pump to live in pain the rest of your life. Indeed, some experts (including yours truly) believe back surgery is a modern scam that ranks right up there with other surgical scams perpetrated on the public, such as hysterectomies, tonsillectomies, Caesareans, to name a just a few.

 The bottom line on back pain: don’t jump into an MRI or back surgery before first trying conservative care like spinal manipulation or decompression as the experts recommend. Learn how to manage this mechanical problem for the rest of your life, otherwise you can expect a life of pain and disability as you gracefully age. Just as bypass surgery does not cure you of heart disease, it only gives you some time to change your lifestyle to correct the many underlying co-factors in heart disease. Realistically, back surgery, pain pills, or epidural shots do not cure you of a back attack, which is mostly a lifestyle issue that has many co-factors too, so let me explain them to you if your goal is to effectively manage this problem.

 My formula for a back attack comes from a few conclusions I've reached after 25 years in practice helping 10,000 patients. While everyone is unique, here's my general equation for back pain:

• How misaligned are those 137 joints in your spine? From childhood accidents, sport injuries, bicycle/horse/skating falls, and car accidents, most people have numerous areas of spinal misalignments that have never been corrected.
• How compressed is your spine? From years of prolonged sitting, most folks have lumbar disc degeneration from too much compression sitting at work or at home in front of computers or TVs.
• How strong or weak are your spinal muscles? Unless you're still athletic or an exercise junkie, most sedentary folks have deconditioned spinal muscles that are only getting weaker as they gracefully age from disuse.
• What is your posture like while you sleep or sit? While sleeping on your back is best to allow your spine to remodel itself, most folks don't sleep on their back. And don't get me started on how most people slouch while they sit, only inflaming your spinal misalignment and adding to disc compression.
• What are your daily activities? Do you know how to lift properly? Do you bend or twist at your job? Do your sport or recreational activities exacerbate your pre-existing spinal weaknesses? Although softball, bowling, tennis or golf may be fun, the twisting motion is a big strain on your spine and pelvis.
• What is your diet like? Are you overweight from eating junk phoods, which only compounds your spinal compression? Do you consume foods like grain-based carbs or acidic drinks like coffee and Coke that chemically add to the inflammation and degeneration of your muscles and joints causing arthritis and fibromyalgia?

As you can see from my back attack formula, there's no quick-fix to this enormous problem whether it's a "wonder" adjustment, a "wonder" back surgery, a "wonder" drug or epidural shot. As I mentioned, just as heart surgery does not cure you of heart disease, the typical back treatments do not correct the underlying co-factors inherent to most back pain patients. Until you address these co-factors with proper treatment and serious lifestyle changes, you can expect to have a relapse every 6 months for the rest of your life, along with the inevitable spinal degeneration, pain and disability. Doesn't sound too promising, does it? So, are you ready to address all of these issues or do you want to have more of the same back pain and inevitable degeneration?

As Bob Hope once said, "You know you're getting old when your back goes out more often than you do!" Now you understand why he was right. In my office, we help patients address each of these co-factors with corrective methods that may take time to achieve, but it's crucial if you want to learn how to manage and how to stabilize this common back pain problem that affects 90% of adults. It's equivalent to teaching patients how to care for their teeth after a lifetime of negligence. Indeed, imagine if you've never been to a dentist, never used toothpaste or had your teeth cared for--that's the kind of spines most chiropractors see daily.

But, if you're willing to take responsibility for your spinal health and begin the many corrective issues I've discussed, there's a good chance with your effort, time and proper multi-faceted care, you can attain good spinal health naturally.