Back Pain

In April 2009 Consumer Reports released the results of a patient survey study, that will be published in their May 2009 paper edition, showing that chiropractic rated highest among patients in satisfaction of relief of back pain. Results of the study were reported on in several news articles including an April 6, 2009 WebMD article and an April 8, 2009 CBS news story.

The survey noted that 80% of US adults report having back pain some time in their life. Of those responding to the survey chiropractic received the highest grade with 59% saying that they were “highly satisfied” with their results. Physical therapy and acupuncture rated second and third with 55% and 53% respectively. In comparison, satisfaction with medical specialist and primary care medical physicians rated only 44% and 34% respectively.

CBS News medical expert Dr. Jennifer Ashton commented that the results of this study reflect what she is seeing in her practice. She noted that back pain is the most common ailment in the country and it is difficult to treat. Dr. Ashton stated that her patients are looking elsewhere, “They’re staying away from things like medication, prescription drugs and surgery.” Dr. Ashton also warned against a “quick fix” to get rid of the pain. She noted, “A lot of times that’s prescription narcotics, which is actually probably the worst thing for you.” She also warned, “Surgery is another option, but one that should be used as a last resort.”

American Chiropractic Association President Glenn Manceaux, DC, responded in a press release, “For the treatment of back pain, few options are better than chiropractic. As shown in this latest survey, chiropractic spinal manipulation is an evidence-based and effective treatment for low-back pain and other musculoskeletal injuries. Coupled with the high levels of patient satisfaction, patients should turn to chiropractic as their first choice.”

Dr. John Maltby, President of the International Chiropractors Association added, “For well over 100 years chiropractors have been seeing a large number of patients suffering with back problems. And although chiropractic does not directly treat the pain, we do work to correct the underlying structural and neurological problem that in many cases is causing the problem. This study shows what we have known for a long time. Chiropractic get results and helps people lead normal and healthier lives.”

A study published out of Canada in the winter 2006 issue of the Journal of Chiropractic Medicine shows that sleeping on a new mattress can significantly reduce stiffness and back pain. The study was conducted at Oklahoma State University and is the first of it’s kind.

The published report notes that sleep deficiency interferes with daytime activity, social interactions, mood, and even loss of work production resulting in 48 million lost hours of productivity every week due to poor sleep.

In this study researchers looked at a control group of 59 healthy participants (30 women and 29 men) who slept on their own five-plus year-old mattresses for four weeks and then slept on a new bedding system for the same time period. They then analyzed the difference in lower back discomfort, spine stiffness, sleep quality, comfort and efficiency.

The results showed that the volunteers reported immediate and sustained benefits in all areas of measurement after sleeping on a new mattress, regardless of their age or weight. This was especially true of participants who entered the study with high back pain complaints, as they reported a 63 per cent improvement in back discomfort with a new mattress.

Dr. Stacy Irvine, chiropractor and fitness expert, stated on behalf of the Better Sleep Council Canada, “There are many ways to treat back pain, but people may not realize that an answer might be right under their noses, literally, in the age and state of their mattress.” Dr. Irvine continued, “This research shows that a new mattress could hold a key to unlocking some of that pain and discomfort.”

Gary Baskerville of the Better Sleep Council Canada added, “On average, Canadians spend more than 2,000 hours each year sleeping. The mattress is one of the hardest working pieces of furniture in our home. And now we have further proof of its very real contribution to our personal health and comfort.”

The above headline comes from an October 10, 2010 article on the website Health Reform. The article, by Stephen Kelly, starts off by saying, “Research has shown that chiropractic care provides greater improvement and satisfaction to patients with chronic lower back pain. Patients who have been taking medicinal help have reported their back pain to be worse or much worse, whereas chiropractic patients felt more satisfied and their back pain was much better.”

The article is a general overview of chiropractic care as it relates to back and musculoskeletal health problems. The author discusses how back pain creates problems in daily life including disruption of sleep. He points out that not only the sleep of the victim is affected, but also that of the whole family. Kelly then offers some comfort by saying, “The good news is you can again sleep peacefully like a baby.”

In his lay-person description of chiropractic, Kelly says, “Spinal manipulation and chiropractic care is a safe, effective treatment for acute lower back pain.” He also reported that, “Not only does chiropractic care improve your spinal pain, but it can also bring relief to those killing headaches. Spinal manipulative therapy is an effective treatment for tension headaches.”

Dr. Gary Walsemann, president of the International Chiropractors Association noted that many articles use terminology that is not entirely accurate when describing chiropractic. Dr. Walsemann noted, “Chiropractors have maintained that they are correcting the underlying cause of health problems and not directly treating them. In response many authors describe chiropractic in terms that suggest chiropractic is a treatment for certain health issues.” Dr. Walsemann continued by clarifying, Chiropractors do not treat conditions directly, we also do not manipulate, we deliver specific chiropractic adjustments to the spine to correct nerve system interference caused by spinal subluxations. As nerve interference is corrected, the body’s own innate healing abilities correct the person’s health issues and help return that person to good health.”

In the conclusion of his article, Kelly noted other reasons “Why Chiropractic Care Might Be a Better Option for Your Back Pain”. He concluded, “Furthermore, chiropractic care is a more cost-effective option because it eliminates the pain, and improves the sleep cycle in much lesser time than conventional medicines or other alternative methods. Patients receiving manipulative treatment have shown better sleep patterns and fewer absences from work”.

From the March 11, 2008, issue of the the scientific periodical, the Journal of Vertebral Subluxation Research (JVSR), comes a case study involving a pregnant women who was suffering from back pain and therefore sought out chiropractic care. This was her third pregnancy and the previous two pregnancies resulted in cesarean births. The 29 year old woman was hoping to deliver this baby vaginally.

In this case, the woman started chiropractic care in her 34th week of pregnancy because of suffering from back pain. She reported having experienced on and off lower back pain throughout her pregnancy. She had also had similar problems in the third trimester of her previous pregnancy.

A chiropractic examination was performed and the determination of subluxations was made. Care was initiated focusing mainly on the lower spine. On the patient’s 4th visit, she reported that her low back pain had improved significantly and she was “getting around better” than before the care.

In the 40th week of her pregnancy, the woman went into labor. She labored 12 hours at home with her husband before going to the hospital. Although she reported that the medical staff was extremely anxious, given her previous birth history, she delivered a healthy baby girl, naturally and without the use of medications or a Caesarean surgical procedure, as had been the case in her prior births.

The study authors, Joel Alcantara, BSc, DC and Ingrid Hamel, DC, FICPA, concluded, “This case report described the successful chiropractic management of a patient with pregnancy-related low back pain and possibly facilitated a successful vaginal birth despite two previous Caesareans.”

A new study from Italy published in the March issue of The Spine Journal, showed that chiropractic care was effective in helping patients with acute back pain and sciatica with disc protrusion. This randomized double-blind clinical trial involved 102 ambulatory patients with at least moderate pain or radiating pain, who had an MRI study showing disc protrusion.

The patients were divided into two groups. One group received chiropractic adjustments 5 days per week by experienced chiropractors, with a maximum of 20 visits. The second group received what the study termed, “simulated manipulations” in order to have a group for comparison to those receiving real chiropractic care.

The results showed that those who got the real chiropractic care improved significantly over the group that received the simulated manipulations. In the group that received the chiropractic care, 55% were free of radiating pain in the follow ups compared to 20% of patients who got the simulated manipulations. Additionally, when measuring local pain, 28% of those who received real chiropractic were free of local pain, versus only 6% of those who got the simulated manipulation.

The results also showed improvements in days of pain with the group that received the real care reporting 6 less days of pain than those in the simulated care group. In addition to these benefits the group with the real care reported using less medications to help with the pain as a result of the chiropractic care.

In this study none of the patients in either group had any adverse effects, and one from each group did report no results at all and were listed as “treatment failures”. The researchers conclusions were, “Active manipulations have more effect than simulated manipulations on pain relief for acute back pain and sciatica with disc protrusion.”

Published in the February 1st 1999 issue of “Spine” research magazine, was a study that showed a link between chronic low back pain and slower reaction times, reduced short term memory, and certain motor tasks. The study measured subjects with chronic lower back pain using a computer to test their short term memory and reaction time to certain items that appeared on the screen.

The conclusion was that chronic Lower Back Pain hampers short term memory and decreases the patients speed of process of certain information.

In a related note the “Journal of Manipulative and Physiological Therapeutics” July August 1999 issue published a pilot study comparing chiropractic care to acupuncture and medication for patients with chronic low back problems. The results were that no change took place with the acupuncture and medication group while significant changes occurred in the chiropractic group. Considering the information above about memory and reaction times we can see the profound positive effect chiropractic can have on these patients.

The above is the essence of a release from the American Chiropractic Association (ACA). It was in response to a report titled, “Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society” released on October 2, 2007 by Roger Chou, MD and other researchers.

The report was published in the scientific journal, the Annals of Internal Medicine and offers several suggestions for patients with back pain. One such suggestion is for patients who do not improve with self-care options. In these cases the report recommends that doctors should consider the addition of nonpharmacologic therapy with proven benefits, one of which they suggest is spinal manipulation.

Glenn Manceaux, DC, President of the ACA issued comments as a result of the report and stated, “As shown in the literature, chiropractic spinal manipulation is a very effective treatment for low-back pain and other musculoskeletal injuries.”

Although several of the recommendations in the American College of Physicians report do suggest the use of medications, the ACA release points to several previous studies promoting a non drug approach. They noted that in one study published in 2003 in the medical journal Spine, manual manipulation showed better short-term relief of chronic spinal pain than did a variety of medications.

Dr. Manceaux, ACA president recommended, “If your back pain is not resolving quickly, visit your doctor of chiropractic.” He continued, “Many chiropractic patients with relatively long-lasting or recurring back pain feel improvement shortly after starting chiropractic treatment. The relief and return to function they experience after a month of treatment is often greater than after seeing a family physician.”

In the Reuters Health News August 20, 2002 issue is a story reporting on a study that says nerve blocks do not do what they are supposed to do to reduce pain or improve the quality of life. According to Steven H. Sanders, program director in the psychology department at the Siskin Hospital for Physical Rehabilitation in Chattanooga, Tennessee, nerve blocks are often recommended for both acute and chronic low back pain, but long-term studies of the blocks are scarce. Dr. Sanders said, “We wanted to see whether (the blocks) made any difference.”

To check the validity of this common procedure, Dr. Sanders and his group evaluated two groups: 30 patients with low back pain who received the blocks and 30 with low back pain who did not. The nerve blocks, more specifically called lumbar sympathetic nerve blocks, are injected into the area surrounding sympathetic nerves in the lower back. Most contain either local anesthetic or local anesthetic with corticosteroid drugs. To help assure that the results were accurate, both groups of patients had the same treatment except for the nerve blocks. The patients that got the nerve block had three to six blocks performed. The subjects in the block and non-block groups were matched as far as age, gender, duration of pain (which ranged from 2 to 4 years) and previous back surgery. The patients ranged in age from 43 to 56 years.

The results at the end of 6 months showed that the patients who received nerve blocks did no better than those who did not get nerve blocks in terms of pain, reduced use of pain medication, mood and other issues. The blocks did increase the treatment costs from an average of $4,500 per patient in the group without nerve blocks to $5,900 for the patients who got nerve blocks. In light of these results Dr. Sanders comments were that he felt these procedures represented, “a lot of expense, but no clinical benefits. You have to wonder why you do these (blocks).”

In the May 2001 issue of the Journal of Manipulative and Physiological Therapeutics (JMPT) is a case report of how chiropractic helped a patient with Spinal Stenosis. In this study a 78-year-old man had low back pain and severe bilateral leg pains. Lumbar spinal stenosis (LSS) is a condition resulting in narrowing of the spinal canal and pressure on the spinal cord and/or nerve roots. Degenerative changes are also common. The patient commonly has chronic low back pain and unilateral or bilateral leg symptoms.

The patient in this study was a 78-year-old man with acquired degenerative Lumbar Spinal Stenosis. The onset was slow and progressive with increasing low back pain of 2 years’ duration and progressively worsening bilateral anterior leg pain of 4 months’ duration. The patient described an “achy low back” pain with a belt-line distribution and an “electric,” “sharp,” and “crampy” pain along the front of the lower leg. The MRI study of his lower back reveled a narrowing of the spinal canal.

In this case the man underwent an initial course of chiropractic care for a two week period during which significant changes were noted by the patient. The conclusion of the case report demonstrates successful care of a patient with symptoms either caused by or complicated by central spinal cord stenosis.

Published in the January 2003 issue of the peer-reviewed periodical, Journal of Manipulative and Physiological Therapeutics (JMPT), is the results of a study on lower back pain in children. The journal article starts off by noting that about 50% of children suffer from lower back pain at one time or another. It also notes that about 15% of children experience frequent or continual pain.

The study was conducted on 54 children between the ages of 4 and 18 in the cities of Calgary, Alberta, and Toronto, Ontario, Canada. In the study the children with lower back pain received chiropractic care from a variety of volunteer chiropractors in Canada. The children were tracked regularly during the study to monitor their progress. Results were obtained in several ways including responses from the patients themselves on how they felt their progress was coming.

Results of the study showed improvement over the follow-up period was observed in 46% to 92% of the children for various criteria. In a period of 30 days 82% of the children reported that they were “much improved.”

The researchers conclusions were, “Patients responded favorably to chiropractic management, and there were no reported complications.”