20. September 2016 · Comments Off on Chiropractic Patients Recover Faster, Spend Less Money · Categories: Chiropractic Care, Latest News, Lower Back Pain

Back pain is an expensive health problem for both patients and businesses. A 2012 study reported that we spend about $635 billion on pain every year, with a significant amount of that spent on back pain. Over the years, quite a few studies have shown that chiropractic care is more effective for back pain than medical care, plus chiropractic patients spend less money on their care than medical patients do.

Because back pain is such a common problem, a group of Canadian researchers recently investigated the role that the type of primary caregiver has on financial compensation.

This was a large study of 5,511 patients who experienced a work-related back injury in Ontario, Canada. The patients saw the following providers for their first visit:

  • 85.3% saw a medical doctor
  • 11.4% saw a chiropractor
  • 3.2% saw a physical therapist

The authors set out to “compare the duration of financial compensation for back pain” among patients from each care group.

The study found that chiropractic patients had the shortest amount of time receiving compensation for their pain and also were less likely to have a recurrence.

In addition, chiropractic patients didn’t need to see other healthcare providers for their pain. 75% of chiropractic patients saw no other provider, while 58.6% of physical therapy patients also saw a medical doctor.

The authors conclude:

“The type of healthcare provider first visited for back pain is a determinant of the duration of financial compensation during the first 5 months. Chiropractic patients experience the shortest duration of compensation, and physiotherapy patients experience the longest.”

Blanchette M, Rivard M, Dionne CE, et al. Association between the type of first healthcare provider and the duration of financial compensation for occupational back pain. Journal of Occupational Rehabilitation 2016 Sep 17.

12. May 2015 · Comments Off on Chiropractic More Effective for Back Pain than Medical Care · Categories: Chiropractic Care, Latest News, Lower Back Pain

Chiropractic More Effective for Back Pain than Medical Care

Chiropractic great for back pain

This study based used a practice-based, observational model to look at the effectiveness of intervention in a selected group of patients with both acute and chronic lower back pain (LBP).  It compared the efficacy of chiropractic intervention with standard medical care in both types of LBP.

2780 patients were enrolled in the study over a 2-year period (1994 to 1996) from the practices of 60 DCs (1855 patients) and 111 MDs (925 patients) in 51 chiropractic and 14 general practice clinics. Patient data was obtained at the initial visit through a questionnaire administered in person, and the patients were followed up with 7 mailed questionnaires at regular intervals over a period of 4 years. Mailings were sent at 2 weeks, 1 month, 3 months, 6 months, and 1 year after the initial visit. In phase 2, patients were followed up at 24, 36, and 48 months.

Patients were eligible if LBP was their primary complaint, and was of mechanical origin; they were excluded if manipulation was contraindicated, or the back pain was of nonmechanical origin (such as from organic referred pain).  Acute patients were those whose back pain was of less than 7 weeks duration; chronic back pain patients were those whose back pain was of 7 weeks duration or longer.

The physicians in the study delivered a variety of treatment methods. Chiropractic physicians gave care that included spinal manipulation, physical therapy, an exercise plan, and self-care education. Medical physicians gave care that included prescription drugs, an exercise plan, and self-care advice; roughly 25% of these patients were referred for physical therapy.

The primary outcomes measured were present pain severity, and functional disability, which were measured by questionnaires mailed to the patients at the above stated intervals.

The medical patients showed more severe baseline pain and disability when entering treatment, greater prevalence of pain radiating below the knee, and poorer general health status, than in patients treated by chiropractors. These differences were more pronounced in the chronic patients than in the acute patients.

A modest advantage was seen for DC care when compared with MD care in pain relief for the first 12 months. This difference was very small for acute LBP, but was greater for those with chronic LBP during the first year of treatment. There were no differences for patients cared for between 12 and 24 months. Trends in disability were similar to the pain trends, but were of smaller magnitude.

There was an advantage chiropractic care in chronic patients with pain radiating below the knee, and some small advantages were also seen in the acute patient group. Differences were also seen in chronic patients with no leg pain during the first 3 months of care. There were no differences in the 2 groups and the 2 types of medical care for pain radiating above the knee.

All patient groups saw clinically significant improvement in pain and disability over the course of treatment. Acute patients saw greater improvement, with many obtaining near complete relief of their symptoms. Most achieved symptom relief by 3 months, followed by a plateau through 12 months. This was followed by significant, clinical aggravation of pain at 12 to 24 months, with another plateau until 4 years. Little increase in disability was seen between 12 and 48 months.

Of note, at 3 years into the study, 45% to 75% of patients noted at least 30 days of pain during the previous year, even in those who had gained significant pain and disability relief through early intervention. 19% to 27% of chronic LBP patients noted daily pain during the previous year.

  • Early interevention reduces chronic pain. Those who received early intervention for acute lower back pain, at 3 years after the initial injury, reported fewer days of back pain than those who waited longer for intervention. This would support providing early intervention for patients with acute back pain, since outcomes were better than in those who delayed treatment.
  • Chiropractic is beneficial for certain kinds of pain. Chiropractic care was more effective than standard medical care in certain situations: during the first 12 months in patients with chronic lower back pain, and for the treatment of LBP with pain radiating below the knee. The majority of the relief was obtained during the first 3 months of treatment, and was sustained throughout the first year.

Haas M, Goldberg B, Aickin M, Ganger B, Attwood M. A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up. Journal of Manipulative and Physiological Therapeutics 2004;27(3):160-169.

18. February 2015 · Comments Off on Chiropractic Provides Quick Recovery in Spinal Degeneration Patients · Categories: Chiropractic Care, Latest News, Lower Back Pain

Chiropractic Provides Quick Recovery in Spinal Degeneration Patients

spineblackSpinal degeneration occurs when your discs start to lose some of their fluids, sometimes causing it to leak out through any cracks that are in their outer layer, possibly creating a bulge or rupture in the disc itself. While this can occur normally with wear and tear as you age, other factors can affect its progression as well; namely, doing hard physical labor and smoking. However, it can also begin as a result of an injury, such as slipping and falling or being involved in an auto accident.

The end result is typically pain, and sometimes osteoarthritis or spinal stenosis. As more and more pressure is put on the spinal column, it can also affect other areas of your body as your nerves can become impinged, making treating this issue a necessity for a higher quality of life. Fortunately, one study published in the Archives of Physical Medicine and Rehabilitation has found that chiropractic provides a quick recovery in patients with spinal degeneration—bringing hope to patients who are afflicted with this particular condition.

A group of researchers looked at 40 male participants in the 30 to 40 year age range that had been previously diagnosed with degenerative lumbar disease. They were divided evenly into two separate groups: one of which was the treatment group and one acting as a control group. The treatment group was then subjected to one spinal manipulation technique, whereas the control group received a placebo treatment.

To determine whether the treatment had any effect, researchers measured the subjects’ heights, perceived level of pain in their lower back, their neural mechanosensitivity, and their level of mobility. Some data was collected via manual tests conducted by researchers and some were collected by self-report of the study participant.

Researchers found that the treatment group noticed immediate improvements in “self-perceived pain, spinal mobility in flexion, hip flexion…and subjects’ full height.” Essentially, benefits were gained in every test area, even after just one treatment session.

Researchers further suggested that studies be conducted on women to determine if the same positive effects will be found. In the meantime, this is hopeful information for people suffering with spinal degeneration as relief may be just one chiropractic appointment away.

Vieira-Pellenz F, Oliva-Pascual-Vaca A, Rodriquez-Blanco C, et al. Short-term effect of spinal manipulation on pain perception, spinal mobility, and full height recovery in male subjects with degenerative disk disease: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2014;95:1613-19.

18. February 2015 · Comments Off on How to Recover Faster from Low-Back Pain: Stay Active! · Categories: Chiropractic Care, Latest News, Lower Back Pain

How to Recover Faster from Low-Back Pain: Stay Active!

Low back pain patients who remain active are better off than those who are less active.

Researchers evaluated how patients recovered from low back pain in relation to their activity levels. Some patients were advised to “stay active” despite the pain while others were told to adjust their levels of activity based on their pain.Those who remained active ended up recovering more quickly and feeling less depressed. On the other hand, patients who adjusted their activity levels felt more depressed and were less mobile.

Researchers suggest that back pain patients remain active and continue their daily activities when possible. This will likely promote a positive outlook and increase your physical mobility to put you on the path towards recovery. Consult with a doctor in your area to learn more about how you can stay active even with back pain.

Olaya-Contreras, Patricia. Biopsychosocial analyses of acute and chronic pain, especially in the spine: The effect of distress on pain intensity and disability. Institute of Clinical Sciences at the Sahlgrenska Academy University of Gothenburg. 2011. 

28. October 2014 · Comments Off on Chiropractic Better Than Muscle Relaxants for Back Pain · Categories: Chiropractic Care, Lower Back Pain

Chiropractic Better Than Muscle Relaxants for Back Pain

Over ¾ of adult Americans experience lower back pain at some point in their lives, and nearly 1 in 5 experience it each year, making it important to determine which treatments are most effective. This double-blind study looked at the effectiveness of treating subacute lower back pain (LBP) with chiropractic adjustments when compared to treatment with muscle relaxants or a placebo (sugar pill).

The 146 subjects who completed the study were between 21 and 59 years old, with uncomplicated LBP lasting from 2 to 6 weeks at the start of the study. Those with underlying spinal disease or malformations were excluded. Each subject underwent chiropractic and radiographic evaluation at the initial evaluation visit. Pain was evaluated at the initial visit, and again at 2 weeks and 4 weeks.

Pain was evaluated using the Visual Analog Scale (VAS), the Oswestry Low Back Pain Disability Questionnaire, and the Zung Self-rating for Depression scale. Shober’s test for lumbar flexibility was also given at the initial visit and again at 2 weeks.

At the initial visit, subjects were assigned to one of three groups with treatment administered over a period of 2 weeks:

  • Chiropractic adjustments and placebo pill
  • Muscle relaxants and sham adjustments
  • Placebo pill and sham adjustments (control group)

All subjects were also allowed to take acetaminophen to evaluate the need for additional self-medication.

7 chiropractic adjustments were given over the 2-week treatment period to the chiropractic adjustment group. Adjustments were tailored to the patient’s needs, and included upper cervical and lumbar (neck and back), sacral (lower back) or pelvic adjustments.

Sham treatments were designed to mimic normal visit length, dialog and procedures without the actual adjustment occurring.

Practitioners administered cyclobenzaprine HCL (5 mg), carisprodol (350 mg), and methocarbamol (750 mg) in bottles labeled “A,” “B,” and “C” to treat the subjects in the muscle relaxant group. Usage and dosage were determined by the medical practitioner’s clinical judgment, with the combination of medications determined by effectiveness and adverse reactions. Subjects could halve or double the dosage in bottles “A” and “B,” or switch to bottle “C” for bottle “A” if excessive drowsiness occurred, and were instructed to discontinue medication if side effects were severe. Acetaminophen was also offered in a bottle labeled “D.” The placebo groups were given exactly the same instructions, only their bottles contained placebos.

While the study was meant to be blind (the subjects would not be able to tell if they were receiving real or sham adjustments or medications), there was a higher tendency for the groups that received true chiropractic treatment and that received the muscle relaxants to perceive that treatment was given, and a higher perception in the sham treatment group that treatment was not given. This could be due to the effectiveness of the treatment, however.

During the 4 weeks of the study, pain was significantly reduced in all groups. Initially, the group that received chiropractic adjustment had overall higher baseline VAS scores, but after treatment, their scores were lower than the other groups, indicating an even more impressive level of improvement in the chiropractic subjects.

The change in reported pain among the 3 groups was statistically significant: subjects in the chiropractic group reported greater pain reduction than the control group. While scores on the Oswestry Disability Index improved for all groups over the 4 weeks studied, the greatest improvement in scores occurred in the chiropractic group.

Depression and Shober (lumbar flexibility) scores improved in all 3 groups during the 4 weeks, with no difference between the groups.

GIS evaluations (which measure the physician’s assessment of improvement) showed that patients given chiropractic adjustments improved more than subjects who received muscle relaxants or placebos did.

The authors concluded:

“Chiropractic was more beneficial than placebo in reducing pain and more beneficial than either placebo or muscle relaxants in reducing GIS.”

Hoiriis KT, Pfleger B, McDuffie FC, et al. A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. Journal of Manipulative and Physiological Therapeutics 2004;27:388-398.

28. October 2014 · Comments Off on Chiropractic Beats Physical Therapy for Back Pain · Categories: Chiropractic Care, Latest News, Lower Back Pain

Chiropractic Beats Physical Therapy for Back Pain

Chiropractic Helps Patients Avoid Back Surgery, Study Shows

Many people are sent to physical therapists for back pain, but a recent study finds that chiropractic patients have better results.

Numerous studies have shown that chiropractic can be an effective treatment for patients with low back pain. Now a new report has looked further into the effectiveness of chiropractic by comparing it to physical therapy treatment, and, more significantly, studying the long-term benefits of chiropractic as measured by the annual number of office visits.

Most studies that look at long-term effects of treatment simply look at self-reported outcomes: level of pain and disability. This study took a different approach. By examining how much care patients sought after the initial study period, they could determine the effect each treatment method had on future health care consumption:

“Care seeking behavior by patients with low back pain is most commonly associated with increased pain and disability, meaning more care is sought when worse symptoms are experienced. The amount of health care utilized may therefore be used as a measure of patient health status, and thus may be compared between groups of patients to determine effectiveness of certain therapies.”

The authors started with 191 patients with low back pain. 107 patients received chiropractic care and 84 patients received active exercise therapy  from physical therapists. All patients received treatment 2 to 4 times per week for four weeks. The study subjects were then followed for one year to assess outcomes. The authors found:

38% of the chiropractic care patients and 54% of the physical therapy patients sought care for their back pain during the one-year follow-up. Chiropractic patients had an average of 2.2 visits to a health care provider after the treatment period, while physical therapy patients had an average of 6 visits.

“We hypothesized that there would be no group difference in the average number of visits to any health care provider. The results demonstrated that actually there were significant group differences during the year after trial participation, with a higher number of visits to any health care provider and to a general practitioner in the EP group.”

The authors conclude:

“Based on one-year follow-up data imputed for complete analysis, participants who received physical therapy (exercise program) during a clinical trial attended a higher number of visits to any health care provider and to general practitioners during the year after care when compared to participants who received chiropractic care (flexion distraction) within the trial.”

  1. Cambron JA, Gudavalli MR, McGregor M, et al. Amount of health care and self-care following a randomized clinical trial comparing flexion-distraction with exercise program for chronic low back pain. Chiropractic and Osteopathy 2006:14:19.
  2. Proctor TJ, Mayer TG, Gatchel RJ, McGreary DD: Unremitting health care utilization outcomes of tertiary rehabilitation of patients with chronic musculoskeletal disorders. Journal of Bone and Joint Surgery 2004, 86A:62-69.
18. March 2014 · Comments Off on 90% of Herniated Discs Improve with Chiropractic · Categories: Chiropractic Care, Latest News, Lower Back Pain

90% of Herniated Discs Improve with Chiropractic

 90% of Herniated Discs Improve with Chiropractic A new study confirms the vast majority of patients with lumbar disc herniation can find relief with chiropractic care. The findings show that 90% of patients report substantial improvements within three months of receiving their first chiropractic adjustment.

The results are encouraging, since more research is raising questions about the safety and effectiveness of epidural steroid injections for the long-term management of lumbar disc herniation (LDH) and sciatica. The study, published in the Journal of Manipulative and Physiologic Therapeutics, shows that both chronic and acute herniated discs can be effectively treated by chiropractors.

Researchers conducted a study of 148 patients with MRI-confirmed lumbar disc herniation causing back pain, sciatica, and radiating leg symptoms. The majority of patients (79) suffered from chronic LDH, lasting longer than three months. Thirty seven patients had LDH for fewer than four weeks at the start of the study.

Chiropractors treated the patients with specific spinal manipulations based on individual characteristics, including results from the MRI that demonstrated the area and type of herniated disc. After two weeks, most patients (70%) had significantly improved disability and pain. By the three-month mark, 90.5% had substantial improvements in disability and pain, and that percentage stabilized at the six-month and one-year evaluations.

The researchers pointed out that these improvements cannot be attributed to natural history alone. Earlier studies have suggested that that typical prognosis for acute disc herniation is favorable, with 36% showing significant improvements after two weeks. However the acute patients in this study had faster improvements, with 80% significantly improved after two weeks, and 94.5% after three months.

Other studies have shown that chiropractic care can also assist patients suffering from recurrent lumbar disc herniation also called failed back pain surgery syndrome. Cumulatively this research suggests that patients can benefit from chiropractic for LDH, regardless whether their herniated disc is acute, chronic, or recurrent.

 

Reference

Lee, Serafin. Outcomes of acute and chronic patients with magnetic resonance imaging-confirmed symptomatic lumbar disc herniation receiving high-velocity, low-amplitude spinal manipulation therapy: a prospective observational cohort study with one year follow-up. Journal of Manipulative and Physiologic Therapeutics 2014. doi 10.1016/j.jmpt.2013.12.011. http://www.jmptonline.org/article/S0161-4754(14)00034-7/abstract.

31. December 2013 · Comments Off on Top 10 chiropractic research studies of 2013 · Categories: Chiropractic Care, Latest News, Lower Back Pain, Neck Pain

Here are the top 10 chiropractic research studies of 2013.

1. Immediate Benefits of Chiropractic Visible on MRI: For the first time, researchers used MRI to document changes in spinal gapping immediately after a chiropractic adjustment.

 2. AMA Recommends Chiropractic Before Resorting to Surgery: The Journal of the American Medical Association released new guidelines for back pain treatment that encouraged patients to seek chiropractic and physical therapy before resorting to surgery.

3.Chiropractic as Effective as Epidural Injections for Lumbar Disc Herniation: Patients with lumbar disc herniation were randomly assigned to receive either nerve root  injections or chiropractic care. Overall, 76% of chiropractic patients reported feeling “better” or “much better” after treatment compared to just 62.5% of injection patients.

4. Chiropractic Lowers Blood Pressure: Hypertensive patients had reduced diastolic blood pressure readings after receiving chiropractic adjustments in a new study.

5. Chiropractic Best Option for SI Joint Pain: Chiropractic care was better than physical therapy or injections of corticosteroids for sacroiliac joint dysfunction.

6. Neck Adjustments Immediately Improve Joint Position Sense: Cervical manipulation was shown to improve joint position sense, which could assist in improving mobility in patients with neck pain.

7. Chiropractic Better than Medical Care Alone for Back Pain: Military personnel with back pain had a significantly better chance of recovery when they received a combined treatment of chiropractic and medical care, compared to those who only received medical care.

8. Spinal Adjustments Relieve Muscle Pain Instantly: Patients with myofascial pain experienced immediate improvements in pressure pain thresholds after receiving chiropractic adjustments.

9. Cervical Disc Herniation Eased by Chiropractic: A study of patients with cervical radiculopathy showed that 85% experienced significant reductions in pain and disability after receiving chiropractic care for three months.

10. Chiropractic Thaws Frozen Shoulder Syndrome: Patients had a 78% improvement in pain after receiving chiropractic care for frozen shoulder syndrome. In another study of patients treated with manipulation under anesthesia, patients had significant reductions in nighttime pain and shoulder stiffness.

04. June 2013 · Comments Off on Chiropractic Beats Epidural Injections for Disc Herniations · Categories: Chiropractic Care, Lower Back Pain

Chiropractic Beats Epidural Injections for Disc Herniations

Chiropractic adjustments were just as effective as epidural injections for patients with back pain in a new study — without the risks and at lower cost.

The findings show that chiropractic can significantly reduce pain in patients with lumbar disc herniation, and is less expensive than medical treatment.

Lumbar epidural injections are frequently used for back pain and sciatica in patients with lumbar disc herniation, failed back surgery syndrome, and spinal stenosis. During the procedure, a physician injects a high dose of pain medication, and sometimes steroids, into the area of lumbar spine around the damaged nerve. This temporarily reduces inflammation and pain.

Although the injections are widely used, controversy lingers due to the lack of a studies with placebo controls, and questions about the effects of steroids versus anesthetic alone. Side effects of steroids include a weakening of muscles and spinal bones around the affected nerve and a  disruption of the body’s natural hormone balance. It’s also unclear whether epidural injections are more effective than other conservative treatments for lumbar disc herniation.

While a number of studies have established the efficacy of chiropractic for low-back pain, fewer have tested its comparative effective with other treatments for lumbar disc herniation.

In a new study from the Journal of Manual and Physiological Therapeutics, researchers from Switzerland compared the effects of chiropractic spinal manipulative therapy (SMT) and epidural nerve root injections (NRI). The study included 102 with symptomatic, MRI-confirmed lumbar disc herniation who were treated with either SMT or NRI.

After one month of treatment, both groups experienced significant improvements. Of the patients under chiropractic care, 76.5% said they were “much better” or  “better” compared to 62.7% of NRI patients. Sixty percent of chiropractic patients had a significant reduction in pain compared to 53% of NRI patients. These slight differences were not statistically significant.

While none of the chiropractic patients received surgery, three of the NRI patients eventually opted for an operation.

Since the treatments were considered equally effective, the cost analysis became even more important for comparing both treatments, the researchers pointed out.  On average, one month of chiropractic adjustments was less expensive than NRI ($558 vs. $729). Their analysis included only the “minimum cost” of NRIs, and did not take into account other costs that are frequently tacked on like additional consultations with clinicians, multiple injections, or possible surgery. Additionally, treatment cost for chiropractic patients may have been slightly higher than normal since they were required to receive in MRI to be in the study. Many chiropractic patients do not receive MRI because imaging guidelines do not recommend MRIs for patients with lumbar disc herniation in most cases. In contrast, MRIs are typically performed before injections or other more invasive procedures.

Although randomized trials are needed to confirm these results, the authors concluded that, “There were no significant differences in outcomes between the more universally accepted treatment procedure of NRI compared to SMT.”

This study suggest that patients can experience substantial relief from chiropractic care without worrying about the side effects of steroids or drugs. It may even save them money, since research suggests that chiropractic patients have lower annual medical costs compared to patients under traditional care.

 

Reference

Peterson, CK, et al. Symptomatic Magnetic Resonance Imaging-confirmed lumbar disk herniation patients: a comparative effectiveness prospective observational study of 2 age- and sex-matched cohorts treated with either high-velocity, low-amplitude spinal manipulative therapy or imaging-guided lumbar nerve root injections. Journal of Manipulative and Physiological Therapeutics 2013;May 22.

 

27. June 2012 · Comments Off on Risk factors for medical complication after spine surgery. · Categories: Chiropractic Care, Latest News, Lower Back Pain

Risk factors for medical complication after spine surgery: a multivariate analysis of 1,591 patients.  The Spine Journal; 2012; 12: 197–206. Lee MJ, MD et al.
A multivariate analysis of prospectively collected data to determine significant risk factors for complications for all Pts (n=1,591) who underwent spine surgery (cervical, thoracic, & lumbar) in our 2 institutions at the University of Washington – Jan 1, 2003 to Dec 31, 2004.  Pts were followed for at least 2 yrs after surgery.
The cumulative incidences of complication after spine surgery per organ system are as follows:
Cardiac = 8.4%;
Pulmonary = 13%;
GI = 3.9%;
Neurological = 7.35%;
Hematological = 10.75%;
Urological = 9.18%.
Total Complication Rate: 52.58%.
The occurrence of cardiac or respiratory complications after spine surgery was significantly associated with death within 2 yrs: 4.11 fold increase of death with cardiac complications, 10.76 fold increase of death with pulmonary complications.
Surgical invasiveness & age were significant risk factors for complications in five of the six organ systems evaluated.

Commentary: This chilling review of the complications form spinal surgeries demonstrates that there are many and frequent serious risks to these invasive procedures. These invasive surgeries, while being effective in appropriate patients, are neither simple nor necessarily benign and are associated with significant serious morbidity or mortality. The statistic that the total complication rate is 52.58% is shocking. It is also worth noting that the University of Washington’s Department of Orthopedics and Sports Medicine is regarded as an excellent institution. Perhaps, complications from surgeries performed at less esteemed hospitals may be significantly worse.