THE BACK PAIN FILES: CHIROPRACTIC CARE AS THE FIRST LINE OF TREATMENT

May 1, 2013

By Dr. Michelle Lim, D.C.

“America spends more than $80 billion a year on back pain treatments. But many specialists say less treatment is usually more effective… In fact, there’s evidence that many standard treatments for back pain — surgery, spinal injections and painkillers — are often ineffective and can even worsen and prolong the problem.” -NPR.com

Dr. Richard Deyo, an authority on evidence-based medicine at Oregon Health Sciences University who has studied treatment of back pain, says “there’s good reason to think that we are overprescribing painkillers, overprescribing injections, and overprescribing back surgery.”

He blames it on the ready availability of advanced technology. With the accessibility of MRI scans, physicians are able to visualize a cross-section of the spine and more often than not, find abnormalities in the scan.  With a direct image of bulging and degenerated discs, he believes this is the reason invasive treatments for back pain have been on the rise in recent years.  Physicians see things that warrant attention and attribute these findings to the cause of back pain, but Dr. Deyo believes this may be fatally misleading.  Most likely this is not the cause of pain.

Lots of people who are pain-free actually have terrible-looking MRIs. And among those who have MRI abnormalities and pain, many specialists question whether the abnormality is really the cause of the pain, and whether fixing it can make the pain go away.  “Research is showing that the pain often has nothing to do with the mechanics of the spine, but with the way the nervous system is behaving, according to physiatrist Dr. James Rainville of New England Baptist Hospital in Boston.” -NPR.com

Published in the journal Spine, pressure pain thresholds were tested in 20 patients with chronic lower back pain and 20 healthy individuals.  The authors found that patients with back pain had reduced pressure pain thresholds than healthy patients.  The study suggested that these patients suffered from hyperalgesia, or a hypersensitivity to pain, which is indicative of central sensitization.  Central sensitization occurs when the entire central nervous system becomes overly sensitive to pain and is quick to react at the slightest sign of a threat.

As Doctors of Chiropractic, we can help with central sensitization by restoring balance to an overactive nervous system.  Chiropractors can calm flare-ups in chronic pain by correcting any spinal dysfunction that can be contributing to or causing symptoms.

A 2011 study published in the Journal of Occupational Environmental Medicine suggested that chiropractic patients back pain had a lower risk for recurring symptoms compared to patients under standard medical care or care provided by a physical therapist.  

Chiropractors have been advocating conservative care for years and the evidence is in the research.  According to the Journal of American Medical Association, in an article on low back pain, “surgery is not usually needed and should only be considered if more conservative therapies fail”.  

Some research suggests that 1 in 5 patients who have surgery for back pain end up having more surgery.  The information in JAMA reinforces the American Chiropractic Association’s (ACA) position that conservative care options should serve as a first line of defense against pain, including chiropractic care.  

In a randomized trial by researchers at an outpatient rehabilitation department in Italy involving 210 patients with chronic, non-specific low back pain, they concluded that spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up rather than either back school (back exercises) or individual physiotherapy.

Another randomized, double-blinded, placebo-controlled, parallel trial published in Spine, 2013 found that a subgroup of patients with acute nonspecific LBP (low back pain) responded better to spinal manipulation significantly better than non steroidal anti-inflammatory drug diclofenac and was clinically superior to placebo. 

Furthermore, The Journal of Manipulative and Physiological Therapeutics have shown lower overall episode costs for treatment of low back pain if they had initiated care with a DC (Doctor of Chiropractic), when compared to those who initiated with an MD.  

So not only is Chiropractic considered conservative care, but it is overall cost-effective and reduces the likelihood of recurring back pain.  There’s no adverse side effects and it works with your body rather than against it, by relying on the body’s own ability to heal itself.  If you have back pain, you should seek chiropractic care before getting corticosteroid shots, painkillers or scheduling surgery.  Those are quick and easy band-aids that may or may not alleviate the pain, but may not always correct the source of the problem.  It’s time to rethink the model of health and choose care that resonates with you.  Are you willing to put your life at risk and alter your body for pain that may or may not go away and can be treated with conservative Chiropractic care?

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