Dr. Andrew Arnold discusses the evidence regarding chiropractic treatment for low back pain

Introduction:

Chiropractors are regulated health professionals licensed to treat type M conditions or musculo-skeletal, including low back pain.

Chronic low back pain along with chronic neck pain are the most common types of chronic pain and chiropractic spinal manipulation is a common non-pharmacologic treatment. [5]

Whilst clinical anecdotal evidence supports the chiropractor treating low back pain, reasonable evidence based research is variable and limited.

Back pain is frequent and, as such, is responsible for a high healthcare expenditure and losses in work productivity. For this reason, it is a major problem!

The evidence regarding chiropractic treatment for low back pain

The evidence supports that doctors of chiropractic are well suited to diagnose, treat, co-manage, and manage the treatment of patients with low back pain disorders. [1]

There are many non-surgical treatments available, however, to date the reasonable evidence base is sparse. Data are insufficient concerning the efficacy of spinal manipulation for chronic low-back pain. Research has concluded chiropractic spinal manipulation is effective in some subgroups of patients, e.g. particularly those with short term, uncomplicated, acute low-back pain. [7]

It is ‘one of the few treatments recommended in clinical-practice guidelines on the care of adults with low back pain in the United States.’ [6]

One study concluded, a multi-modality approach to low back pain treatment that includes chiropractic manipulation treatment alongside and other commonly active interventions including home advice and exercise prescription is an effective treatment approach for both acute and chronic back pain irrespective of referred pain impacting the legs.[2]

It has also been observed that when chiropractic care is combined with typical medical care there was a moderate improvement in the intensity of low back pain in the short term. [4]

Other research demonstrated concerning the chiropractic treatment of low back pain, there was a ‘modest improvement in pain and function up to 6 weeks. [8]

Of note, there has been speculation amongst other professions Chiropractic manipulation treatment for low back pain may be associated with a risk for acute lumbar disc herniation, however, there is a lack of any reasonable evidence-based research to support this premise. [9]

One study compared the rate of improvement both in pain amelioration and function with low back pain at variable time intervals: 0-2 weeks vs 2-4 and 4-12 weeks. It was found those with symptoms within the 0-2 week range were much more likely to show an improvement by the end of week 1, month 1 and at the end of 6 months as compared to those people presenting with symptoms in the 2-4 week range.[10]

Another systematic review demonstrated that ‘acupuncture, acupressure and chiropractic may all have a favourable effect on self-reported pain and functional limitations.’ [12]

In yet another study, a review of adults presenting with uncomplicated low back pain indicated that the need for opioid prescriptions was greatly reduced. [3,11]

Death rates regarding unfavourable drug events and side effects is increasing in the USA, specifically pain medications or analgesics.

This study also supported the preposition that chiropractic manipulation treatment for low back pain could lead to a ‘reduced risk of an adverse drug events, i.e. 51% lower among those receiving chiropractic treatment as compared to non-recipients. [11]

Conclusion:

Chiropractic treatment for low back pain is effective and common-place, however, further research is warranted to support this premise.

About the author:

Dr. Andrew Arnold is a registered Chiropractor at Cranbourne Family Chiropractic and Wellness Ctr.

References:

[1] Globel G et al., Clinical Practice Guideline: Chiropractic Care for Low Back Pain, Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 1, January 2016, Pages 1-22,https://www.sciencedirect.com/science/article/abs/pii/S0161475415001840

[2] Bussieres A et al., Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative, Journal of Manipulative and Physiological Therapeutics, Volume 41, Issue 4, May 2018, pages 265-293, https://www.sciencedirect.com/science/article/abs/pii/S0161475417302361

[3] Whedon J et al., Association Between Utilization of Chiropractic Services for Treatment of Low-Back Pain and Use of Prescription Opioids, The Journal of Alternative and Complementary MedicineVol. 24, No. 6Original Article, Published Online:1 Jun 2018https://doi.org/10.1089/acm.2017.0131,https://www.liebertpub.com/doi/abs/10.1089/acm.2017.0131

[4] Goertz, C et al., Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members with low back pain, Physical Medicine and Rehabilitation: A Comparative Effectiveness Clinical Trial, May 18, 2018, JAMA Netw Open. 2018;1(1):e180105. doi:10.1001/jamanetworkopen.2018.0105, https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2680417

[5] Herman M et al., Characteristics of Chiropractic Patients Are Treated for Chronic Low Back and Neck Pain, Journal of Manipulative and Physiological Therapeutics, Volume 41, Issue 6, July–August 2018, Pages 445-455, https://doi.org/10.1016/j.jmpt.2018.02.001

[6] Cherkin D et al., A Comparison of Physical Therapy, Chiropractic Manipulation, and Provision of an Educational Booklet for the Treatment of Patients with Low Back Pain, October 8, 1998, N Engl J Med 1998; 339:1021-1029, DOI: 10.1056/NEJM199810083391502, https://www.nejm.org/doi/full/10.1056/NEJM199810083391502

[7] Shekelle P et al., Spinal Manipulation for Low-Back Pain, Annals of Internal Medicine, Review1, October 1992

https://doi.org/10.7326/0003-4819-117-7-590

[8] Paige N et al., Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back, PainSystematic Review and Meta-analysis, JAMA. 2017;317(14):1451-1460. doi:10.1001/jama.2017.3086, April 11, 2017, https://jamanetwork.com/journals/jama/article-abstract/2616395

[9] Hincapie C et al., Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study, European Spine Journal volume 27, pages1517–1525(2018), Published: 18 September 2017, https://link.springer.com/article/10.1007/s00586-017-5295-0

[10] Mantel K et al., Exploring the Definition of Acute Low Back Pain: A Prospective Observational Cohort Study Comparing Outcomes of Chiropractic Patients With 0-2, 2-4, and 4-12 Weeks of Symptoms, Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 3, March–April 2016, Pages 141-149, https://www.sciencedirect.com/science/article/abs/pii/S016147541600052X

[11] Whedon M et al., Association Between Utilization of Chiropractic Services for Treatment of Low Back Pain and Risk of Adverse Drug Events, Journal of Manipulative and Physiological Therapeutics, Volume 41, Issue 5, June 2018, Pages 383-388, https://doi.org/10.1016/j.jmpt.2018.01.004

[12] Yeganeh Hamid M et al., The effectiveness of acupuncture, acupressure and chiropractic interventions on treatment of chronic nonspecific low back pain in Iran: A systematic review and meta-analysis, Complementary Therapies in Clinical Practice, Volume 27, May 2017, Pages 11-18, https://www.sciencedirect.com/science/article/abs/pii/S1744388116302006

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