Chiropractic and Back Pain

Back pain is a difficult and expensive health problem. Finding the most effective treatment for patients with back pain is a priority in this age of managed care.

This new study, conducted in Australia, was designed to look at the long-term effectiveness of three different treatment modalities in 62 patients. Subjects were evenly divided between men (53.2%) and woman (47%), with an average age of 39 (range 29-46).

The study was a randomized, clinical trial that divided subjects into one of 3 exclusive, standardized treatment protocols:

Medication: (19 subjects originally; 12 sought other treatment, with 7 subjects at final follow-up). This group was given Celebrex 200 - 400 mg/day, unless this medication had been previously tried; the next medication regime of choice was Vioxx 12.5 -25 mg/day; followed by Acetaminophen 500 mg, 2-6/day.

Acupuncture: (20 subjects originally; 6 sought other treatment with 14 subjects at final follow-up). This was performed with Chinese acupuncture needles during 20-minute appointments.

Spinal Manipulation: (23 subjects originally; 4 sought other treatment with 19 subjects at final follow-up). High-velocity, low amplitude spinal manipulative thrust to a joint was performed by a chiropractor during two 20-minute visits a week, until pain relief or lack of symptoms was achieved.

Extensive subjective follow-up questionnaires were administered to assess the effectiveness of treatment. These included the Visual Analogue Scale (VAS) for pain intensity; the Owestry questionnaire for low-back and thoracic spinal pain; the Neck Disability Index for neck pain; and the Short Form-36 Health Survey Questionnaire.
           
The overall results of the extended study tend to favor spinal manipulation in its effectiveness as a treatment modality for chronic spinal pain, followed by needle acupuncture, when neither is contraindicated. Both seemed to achieve long-term benefits for those treated, unlike medication alone, which did not provide these benefits.

Below is a table that summarizes the long-term effectiveness of the 3 types of treatment:

This is also shown by the large dropout rate from the group treated alone by medication, who pursued additional forms of treatment, while the spinal manipulation group had the lowest percentage of those seeking additional treatment modalities (and by inference, appeared to experience the highest satisfaction).

The medication-only group actually saw deterioration in several variables; the improvement in the General Health variable seen in this group could be related to their not being required to come in for weekly or bi-weekly clinic visits, as the other treatment groups had to.

The study authors conclude, “Overall, patients who have chronic mechanical spinal pain syndromes and received spinal manipulation gained significant broad-based beneficial short-term and long-term outcomes. For patients receiving acupuncture, improvements were also observed, although without reaching statistical significance (with a single exception). For patients receiving medication, the findings were less favorable.”

This study is extremely relevant for clinicians working with patients with chronic pain, especially after the recently uncovered problems associated with Cox-2 inhibitors, such as Celebrex and Vioxx. This study shows that chiropractic can be an effective, safe treatment for these patients.

Muller R, Giles LGF. Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes.  Journal of Manipulative and Physiological Therapeutics 2005; 28(1):3-11.