Health & Chiro Articles
Study Shows Low Back Surgery No Better Than Rehabilitation
New research published in the May 28, 2005 British Medical Journal suggests that surgery to relieve chronic lower back pain is no better than intensive rehabilitation and nearly twice as expensive. The study did not look at the benefits of chiropractic care, but did compare patients who underwent surgery for lower back pain and those who had rehabilitation led by physiotherapists.
Dr. Jeremy Fairbank, an orthopedic surgeon and lead researcher at the Nuffield Orthopaedic Center in Oxford, England, along with his co-researchers studied 349 chronic back pain sufferers, defined as pain lasting more than 12 months. Of the 349 patients, 176 had spinal fusion surgery while the remainder underwent intensive rehabilitation involving exercises and cognitive behavioral therapy.
Dr. Fairbank stated, “This is strong evidence that intensive rehabilitation is a good thing to do for people with chronic back pain who are thinking about having operations.” The researchers concluded that there was no evidence that surgery was any better than the rehabilitation they compared the surgery to. However, there was a big difference in price with the surgical expense being nearly twice as expensive according to the study.
Helen Campbell of the University of Oxford summed up the results by commenting, “In the short term, compared with intensive rehabilitation, surgical stabilization of the spine as first line treatment for chronic low back pain patients who have already failed standard non-operative care seems not to be cost effective.”
Patients With Long-Lasting Or Recurrent Low Back Pain Helped With Chiropractic Care.
The May 2001 issue of the Journal of Manipulative and Physiological Therapeutics (JMPT) carried a report of a study on the effect of chiropractic care on patients with recurrent or long lasting low back pain. Numerous studies over past years have shown that chiropractic care was beneficial for patients with acute and short term back pain. However, due to the difficulty of conducting a large study, research to show what thousands of chiropractors and their patients have known about help with long term back pain was scarce.
A total of 19 Norwegian chiropractors participated in this study. In all 158 patients were studied, all of whom fit the criteria of suffering from long lasting or reoccurring lower back pain for at least two weeks duration, with at least one previous occurrence in the previous 6 months. All subjects could not have had any chiropractic care in the prior 6 months to be eligible to participate in the study. Participants were questioned each visit to rate their progress as it relates to the pain.
The results showed that approximately 50% of patients reported that they had “improved” at the 4th visit. By the 12th visit, approximately 75% of the patients reported that “improvement” had occurred. The study only recorded data for the first 12 visits so no data on additional benefits after 12 visits was available. The researchers did conclude, “there seems to be a distinct recovery pattern among chiropractic patients with relatively long-lasting or recurrent lower back pain.”
Pregnancy-Related Low Back Pain Helped With Chiropractic
A review of previous studies on the effectiveness of chiropractic for pregnant women with lower back pain was published in the July 2008 edition of the Journal of Manipulative and Physiological Therapeutics (JMPT). This study looked at previously published works on this subject to review the body of evidence for the effectiveness of chiropractic care.
The JMPT report starts off by noting that between 50% and 80% of pregnant women suffer from low back pain (LBP) during their pregnancy. They noted that a review of previous work showed that from 68% to 85% of pregnant women with back pain during pregnancy do not look for any care for their lower back pain. The authors theorize that this is because most pregnant women consider back pain to be a normal part of the pregnancy.
In reviewing all the scientific literature on the subject of chiropractic for low back pain in pregnancy, the authors of the JMPT review narrowed their selection down to 6 studies that met their specific criteria. The results of the various studies showed a high percentage of pregnant women did get relief from their lower back pain through chiropractic.
In one reviewed study 84% of the 25 subjects reported relief of their lower back pain. In a larger study of 103 patients who received chiropractic care during their pregnancy, all of the women reported greater than 50% decrease in back pain on a questionnaire. In yet another case series where 120 pregnant women with LBP underwent an average of 15 chiropractic treatments, the results showed that 25% had complete remission of their back pain, 50% reported feeling very well, 15% were feeling better, and 10% noted no change in condition.
Interestingly, none of the studies reviewed for the JMPT report indicated any adverse effects or evidence of harm to either the pregnant woman or unborn child from the chiropractic care. The authors of the JMPT report noted that there was a need for more comprehensive studies involving control groups, but they did note that all studies they included reported positive results for the subject under chiropractic care. They noted in their conclusion, “Results from the 6 included studies showed that chiropractic care is associated with improved outcome in pregnancy-related LBP.”
Canadians Say Back Pain Is An Important Health Condition, And Rate Chiropractic High
From the June 25, 2003 issues of the Ottawa Citizen, and the June 26 London Free Press, comes a report on the surprisingly high rate at which Canadians suffer from back pain. According to the article, a poll released indicated that almost two-thirds of Canadians experienced back pain in the past year, while more than seven in 10 withstood back pain of some degree over the last two years. Dr. Greg Stewart, president of the Canadian Chiropractic Association stated, “This is information that is even surprising to practitioners in the back-pain industry.”
Results of an Environics Research Group poll conducted in April 2003 suggest that four in 10 respondents reported pain lasting from several days to a week and almost a third said their injuries lingered for a month or longer. About 37 per cent of back pain victims said health conditions such as surgery, pregnancy or work-related injuries were at the root of their pain.
“It’s accumulated damage; so if you had back pain every time you lifted or when you bent over, well it wouldn’t take long for behavior to change.” said Dr. Stewart. “Unfortunately these things are obviously gradual onset and so you literally get away with it too much until the damage is severe enough that the symptoms become very severe.”
The poll also found that 88 per cent of Canadians rate back pain as a “very” or “somewhat” important health condition, ranking as important as cancer, heart disease and AIDS, to about a third of those. Fourteen per cent said they did nothing about their condition. Almost 55 per cent cited cost as a barrier to seeking treatment, usually because they wouldn’t be covered by a provincial health plan or an employee benefits plan. Of those who sought help, 90 per cent said they were satisfied with treatment provided by a chiropractor.
Chiropractic Care Helps Failed Back Surgery – A Case Study
A case study published in the January 10, 2009 issue of the scientific periodical, the Journal of Vertebral Subluxation Research documented the recovery of a 58 year old man who was suffering from low back pain and left lateral leg pain and had lower back surgery that was unsuccessful in helping his problems.
The study starts off by noting that approximately 80% of adults will have low back pain at some time in their lives. The authors of the case study point out that, “Back pain is treated by surgical means and non surgical means and literature has shown that many low back surgeries are not successful.”
In this particular case a 58 year old man was reaching out for an item at work when he felt a “pop” in his back that resulted in pain radiating down the back of the right thigh and into the leg. He initially tried chiropractic care for an unspecified time with little initial results but then he elected to have spinal surgery, where he had a laminectomy of L5/S1. After his surgery the pain was worse and more extensive. This problem left him disabled and unable to return to work. His condition remained for 3 years before seeking chiropractic care for a second time.
A chiropractic examination and x-rays were performed and a diagnosis of “lumbar and pelvic segmental dysfunction (subluxation) with associated left lateral leg pain.” A regimen of specific chiropractic adjustments was initiated to correct the subluxations.
After about 5 weeks of chiropractic adjustments, the patient reported that his left leg pain had diminished significantly and the low back pain had diminished but was present more than the leg pain. This was an improvement as in the initial stages of care, the man reported that his leg pain was worse than the low back pain. After a total of 32 visits, the man reported that he had no leg pain and only complained of mild low back pain on one visit. He reported feeling much better since beginning chiropractic care and that chiropractic care had made a big difference in his life.
In the conclusion, the author stated, “Literature has shown that failed back surgery syndrome is a common problem, and that more patients are seeking chiropractic care for the solution to such a devastating condition. Chiropractic care can improve function and quality of life as it did in this patient.”
Euro Backpain Barometer Survey Launched By British Chiropractic Association
According to an April 11, 2008 release by the British Chiropractic Association (BCA) and reported on in the April 16, 2008 issue of the Guardian UK, Germany is the number one country for people complaining of back pain with a rate of 67 percent. The BCA reviewed the number of back pain cases by country and issued their “Euro Backpain Barometer” to highlight the results.
According to the BCA survey study, back pain in the United Kingdom is on the increase, rising by 5% in just 12 months, with 52% of the country currently suffering, compared to 47% in 2007. Overall, the study shows that cultural differences create back problems at different rates. The study showed the rate and order of back problem frequencies to be as follows:
Germany 67%
Italy 63%
UK 52%
France 50%
Finland 50%
Sweden 36%
Netherlands 26%
The reasons people blame as the cause of their pain varies from country to country with Italians blaming high heels, Germans blaming sitting in front of computers for long periods of time and in the UK pregnancy is a large identified reason.
The study also shows that many do not seek help for their back problems, with most suffering for 3 to 5 years. The BCA study notes that the Swedes are the longest suffering, with 78% claiming to have had back pain for three or more years. In Finland 11% of those with back pain have been suffering for as long as they remember and 23% of the British with back pain have been suffering for 10 or more years.
Tim Hutchful from The British Chiropractic Association comments: “Incidence of back pain is continuing to rise at an alarming rate in Britain and across Europe as a whole, and poor posture continues to be the main culprit. This study highlights what a detrimental effect back pain can have on people’s lives.”
American Healthcare: An Oxymoron
The above headline is from an interesting article in a Canadian publication the “Financial Post” and was written by Diane Francis, a journalist who took an outside look at the US healthcare system and compared it to the Canadian system. Ms. Francis’s views add some interesting insights into the healthcare system in the US and the discussion, or lack thereof, related to this issue.
In the article, Ms. Francis starts off by comparing the two systems and concludes, “Canadians are lucky on this one. We may have line-ups and our newspapers may occasionally publish horror stories about someone left in a gurney for hours outside an emergency room. But the U.S. system is the worst-executed in the world and its private sector interests have convinced the government to insure the riskiest people namely veterans, indigents and seniors while leaving the gravy to private-sector insurers.”
The article notes that the US government provides insurance for almost half of the Americans who are insured. But that half are the highest risk portion of the population that will incur the most expenses. The article also suggests that there are two types of medical systems in the US. One system is for the well-off with insurance where medical costs are passed off to those paying for the insurance. The article suggests that the second medical system “takes care of the old, disabled, impoverished or militarily wounded.”
In her article Diane Francis also comments on the human side of the US healthcare and notes, “It’s hard to imagine the human suffering that has resulted from this situation. Canadians don’t have the anxiety about healthcare that underlies American existence. People there don’t leave jobs, don’t start new ones or businesses because they fear losing insurance benefits.”
The article lists a series of facts about the US health care system that helped Ms Francis come to her conclusions. These facts are:
The United States is spending 15.3% of its Gross National Product (GNP) on medicine and that doesn’t include the cost of litigation over medical bills.
There are 49 million people without any insurance. The same number are inadequately insured.
Despite that shortfall, the U.S. spends about $5,700 per capita compared with Canada’s $2,900 and has worse results in areas such as lifespan or infant mortality.
Some estimate is that half of the personal bankruptcies in the U.S. are because of high medical bills due to a catastrophic illness.
In a previous article by Ms. Francis earlier in the year, she notes one of the glaring facts about the US healthcare system and states, “Health spending is rising faster than incomes in most developed countries, which raises questions about how these countries will pay for future health care needs. The issue may be particularly acute in the United States, which not only spends much more per capita on health care than any other country, but which also has had one of the fastest growth rates in health spending among developed countries.”
Americans Use Of Non-Medical Care Increases
According to a new nationwide US government survey, 38 percent of adults in the United States use some form of what the study called, Complementary and Alternative Medicine (CAM). The survey conducted by the National Center for Complementary and Alternative Medicine of the National Institutes of Health (NIH) was released on December 10, 2008. In older adults ages 60 to 69 the percentage is slightly higher with 41% using some form of CAM procedure.
Josephine P. Briggs, M.D., director of the National Center for Complementary and Alternative Medicine (NCCAM), part of the NIH, defines CAM by saying, “CAM covers a wide range of therapies and practices not currently considered part of conventional medicine. Thus, its important to be well informed if you are considering using any.”
Of those non-medical procedures considered “CAM”, one of the most used and most accepted is chiropractic. Although not entirely accurate by chiropractic standards, the National Institutes of Health senior website explains chiropractic by saying, “The goal of chiropractic medicine is to help the body heal by correcting its alignment. Doctors of chiropractic, who are also called chiropractors or chiropractic physicians, use a type of hands-on therapy called manipulation, or adjustment, as their main type of procedure. Adjustments are done to increase the range and quality of motion in the area being treated.”
Dr. Robert Braile, a chiropractor in Georgia and past President and Chairman of the Board of the International Chiropractors Association notes that chiropractic usage continues to be on the increase. He states, “We are in an economy where times are tough, and nearly 50 million Americans are without health care insurance. Certainly many of these people are going to look for more affordable ways to deal with their health care concerns. Chiropractic has always represented an affordable and safe alternative to more expensive and risky forms of medical care.”
NCCAM Director Dr. Josephine Briggs noted the reasons why more Americans are turning to non medical forms of healthcare by saying, “The most common reason why people turn to complementary and alternative medicine in our survey results is chronic back pain – far and away, the leading reason to use complementary and alternative medicine,” she says. “Neck pain, joint pain, headache: All these other conditions are also given as common reasons. But chronic back pain is the leading reason, a very common and difficult condition to treat.”
In a December 12, 2009 release by the National Institutes of Health (NIH), they also noted that an increasing number of older Americans are turning to the Internet for health information. They noted that 68 percent of online seniors look for health and medical information when they go on the Web.
Health Care Spending Hits $1.7 Trillion In 2003 In US
According to a February 11, 2004 Associated Press story, health care spending in the United States grew to an estimated $1.7 trillion in 2003. This represents more than $5,800 for every American. The federal Centers for Medicare and Medicaid Services stated that this expenditure represents more than 15% of the gross domestic product of the United States.
The rate of increase of health care spending was 7.8% over the previous year. This figure continues to place healthcare spending increases far ahead of the rest of the US economy. The article continued to note that health care spending, is projected to outpace growth in the rest of the economy for the next 10 years.
The Centers for Medicare and Medicaid Services also estimated that by 2013, annual spending on health is expected to reach $3.4 trillion and be more than 18 percent of gross domestic product. These projections did not include the anticipated increases from the new Medicare prescription drug law, which will offer seniors prescription drug coverage beginning in 2006. However, Centers for Medicare and Medicaid Services officials said they expect a shift in who pays prescription drug bills rather than a significant increase in spending on drugs. It was noted that the increase in spending on prescription drugs will continue to outpace the rest of health care for the next 10 years.
The report published in the January / February 2004 Issue of the Health Affairs, the number one cited health policy journal devoted to publishing original peer-reviewed research and commentary, reported that private health insurance premiums per enrollee grew 10.4 percent in 2003, the third consecutive year of double-digit premium growth.
US Medicare System Expands Chiropractic Coverage
News of a pilot program to expand chiropractic coverage in Medicare was reported in the April 7, 2005 issue of the Senior Journal. According to the report the Centers for Medicare and Medicaid have announced the start of a two-year demonstration to expand Medicare coverage of chiropractic services in five states. The purpose of this pilot program is to determine the impact on satisfaction, use of services, and costs for Medicare beneficiaries.
The states involved in the pilot program involve areas in Maine, New Mexico, Illinois, Iowa, and Virginia. In the areas of this pilot program, chiropractors are able to offer Medicare Part B patients an expanded array of services that they are allowed to provide by state law to their entire list of patients, but that were not previously paid for by Medicare.
Normally, only chiropractic adjustments are a covered service under Medicare. In the pilot program the services that will also be covered will include diagnostic and therapy services, including extraspinal manipulation or adjustment of a body part other than the spine, x-rays, EMG and nerve conduction studies, clinical lab tests, and certain additional procedures.
The program is designed to last for two years and evaluate the possibility of expanding chiropractic coverage in Medicare across the entire program. Centers for Medicare Services Administrator Mark B. McClellan, M.D., Ph.D noted, “Medicare currently only pays for a limited number of services from doctors of chiropractic, even though chiropractic services may be less costly alternatives to other types of medical care.” He continued, “By expanding chiropractic coverage in this demonstration, we are reducing out-of-pocket costs for seniors who visit chiropractors, and we will learn whether paying chiropractors for delivering these additional services can help improve health outcomes and keep Medicare costs down.”