Why Use a Chiropractor for Back Pain?
Monday, 9 September 2013 | Admin
Why use a chiropractor for back pain?
Written By email@example.com, On September 9, 2013
For Back Pain, Spinal Manipulation Holds Its Own
If you’re suffering from chronic lower back pain, a new review of existing research finds that spinal manipulation − the kind of hands-on regimen, that a chiropractor might perform on you, is as helpful as other common treatments like painkillers. Many people will welcome being able to manage back pain without relying on painkillers, which have major side-effects especially when used for chronic conditions like back pain.
Spinal manipulation is also safe, researchers found.
Surveys suggest that more than half of working Americans suffer from back pain each year. An estimated 25 percent of American adults reported that they suffered from back pain for at least a day within the last three months, according to a 2006 Centers for Disease Control and Prevention report.
Lower back pain is the fifth most common reason that people go to the doctor.
Patients frequently turn to painkillers, which can cause side effects and be addictive, or to physical therapy, which is time-consuming and expensive. The new review looks at a third option − spinal manipulation.
The effectiveness of this therapy has long been controversial, some proponents are slowly starting to accept the view it as effective for chronic low-back pain. The results of this review will support that view.
The findings appear in the latest issue of The Cochrane Library. The journal is a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
The researchers found that spinal manipulation worked about as well as the other treatments.
In general, most treatments for lower-back pain aren’t all that effective, even the ones we think that work like surgery, but some people respond better than others.
Right now the best we can say is that clinicians and patients have a number of moderately effective treatment options to consider, including exercise, manipulation, massage, cognitive behavioral therapy and some of the analgesic medications, and that it should be a decision between the clinician and patient.
Back pain still a major problem
Dr David Casey Market Harborough chiropractor wonders just how much have we really progressed in the treatment and management of low back pain in the last 30 years.
It has been over 30 years since the late orthopaedic surgeon Dr Alf Nachemson (world expert on low back pain and co-editor of Spine) authored the lead article in the inaugural issue of the journal Spine. In this article, he stated that in the great majority of patients with low back pain, no clear diagnosis or explanation for their pain could be found (Spine, 1976).
Neither has the level of GPs’ adherence to the European guidelines, nor the cost of low back pain to the patient and the State, been significantly improved over this time.
A prospective pilot study was conducted on consenting patients, attending one of nine participating GPs, found management of acute low back pain in a cohort of GPs was not consistent with European clinical guideline recommendations, and warrants higher levels of postgraduate education among GPs, as well as restructuring of primary care services, which should improve patient outcome and reduce costs.
The European Guidelines state
1) The lifetime prevalence of low back pain is up to 84%
2) After an initial episode of low back pain, 44-78% people suffer relapses of pain and 26-37%, relapses of work absence
3) It is estimated that 23% of back pain sufferers go onto develop chronic pain and 11-12 % of the population are disabled by low back pain and are unable to work, relying on benefits.
The lifetime prevalence of low back pain is reported as over 70% in industrialised countries (one-year prevalence is 15% to 45%, adult incidence 5% per year). Peak prevalence occurs between ages 35 and 55.
This would suggest a fundamental flaw in how we manage back pain exists.
This is because the patients symptoms often do not match the suspected pathology and x-ray together MRI investigations rarely improve this situation.
Pain is not attributable to pathology or neurological encroachment in about 85% of people, even with severe acute pain.
About 4% of people seen with low back pain in primary care have compression fractures, which might be suspected in osteoporosis.
About 1% has a cancer.
Ankylosing spondylitis and spinal infections are even more rare.
The prevalence of prolapsed intervertebral disc is about 1% to 3%.
All this makes it difficult to access the risk factors, so with all the achievments of modern medicine back pain is still poorly understood.
The most frequently reported incidents are associated heavy physical work, frequent bending, twisting, lifting, pulling and pushing, repetitive work, static postures and vibrations. All these factors are seen to cause back problems over years and years. Logically if we took some form of action earlier in theory we could at least prevent the accumulation of physical damage.
Recurrent and chronic back pain account for 75-85% of total workers absenteeism. Making low back pain the biggest problem to industry and the state at large. The estimated costs are in the hundreds of billions, but still no change in how back pain is managed over the last century.
Maybe if we were more proactive at an earlier stage could we reduce these costs and improve productivity?
Psychosocial factors increase the risk of a patient developing, or perpetuating, chronic pain and long-term disability including work-loss associated with low back pain.
1) Inappropriate attitudes and beliefs about back pain (for example, belief that back pain is harmful or potentially severely disabling or high expectation of passive treatments rather than a belief that active participation will help)
2) Inappropriate pain behaviour (for example, fear-avoidance behaviour and reduced activity levels);
3) Work-related problems or compensation issues (for example, poor work satisfaction);
4) Emotional problems (such as depression, anxiety, stress, tendency to low mood and withdrawal from social interaction).
Summary of recommendations has been developed over the many years of research.
* Case history and detailed physical examination should be carried out, not dismissing everything as a muscle spasm.
* If history taking indicates serious spinal pathology or nerve root syndrome, carry out more extensive physical examination including neurological screening when appropriate.
* Be aware of psychosocial factors, and review them in detail if there is no improvement
* Diagnostic imaging tests (including X-rays, CT and MRI) are not routinely indicated for non-specific low back pain;
* Reassess those patients who are not resolving within a few weeks after the first visit especially in those who are following a worsening course.
The aims of treatment for acute low back pain are to
Improve functional ability
Prevent recurrence and chronicity.
Spinal manipulation is now the mainstay treatment for patients who are failing to return to normal activities. Longterm back pain due to a fundamentally stiff back requires a manual treatment to unlock the stiffness and manipulation is the quickest way to achieve this.
Fundamentally we need to think more about how to maintain the function and prevent accumulating damage until permanent damage is done.
Some questions must be asked as we face into the future of treating low back pain.
If acute low back pain is as self limiting (recovers on its own) as most experts and clinical guidelines say it is, why are we spending so much money on it?
Given that low back pain guidelines recommend the same treatment for 85 per cent of sufferers, do all these people suffer from the same type of low back pain?
If so, then why are there so many different treatments utilised for the same problem?
If not, then how can we tell one type from another in order to determine the best treatment for each type?
And finally, with over 1,000 randomised controlled trials of back pain and disability, and dozens of systemic reviews and guidelines, why are we not finding explanations for low back pain’s prominence, its causes and its best treatments?
If you would like to ease back pain and prevent it in the future please call the
Chiropractic Clinic in Market Harborough of The Melton Mowbray Chiropractic Clinic where we attempt to follow all the above suggestions.