Research Abstracts:
Spinal
Manipulation, Exercise Trump Drugs for Neck Pain
January 5, 2012 — Spinal
manipulation therapy (SMT) and exercises that patients can learn to do at home
are more effective than medication for relieving neck pain, both in the short
and long term, according to results from a new study published in the January 3, 2012,
issue of the Annals of Internal Medicine.
“Doesn’t surprise me a bit,” Dr. Lee Green, professor of family medicine at the University of Michigan told ABC News. “Neck pain is a mechanical problem, and it makes sense that mechanical treatment works better than a chemical one.”
A Nonsurgical Approach to the Management of Patients With Lumbar Radiculopathy Secondary to Herniated Disk: A Prospective Observational Cohort Study With Follow-Up
J Manipulative Physiol Ther 2009 (Nov); 32 (9): 723–733
A randomized trial by researchers at an outpatient rehabilitation department in Italy involving 210 patients with chronic, nonspecific low back pain compared the effects of spinal manipulation, physiotherapy and back school. The participants were 210 patients (140 women and 70 men) with chronic, non-specific low back pain, average age 59. Back school and individual physiotherapy were scheduled as 15 1-hour-sessions for 3 weeks. Back school included group exercise and education/ergonomics. Individual physiotherapy included exercise, passive mobilization and soft-tissue treatment. Spinal manipulation included 4-6 20-minute sessions once-a-week. Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.
Manipulation or Microdiskectomy for Sciatica? A Prospective Randomized Clinical Study
J Manipulative Physiol Ther. 2010 (Oct); 33 (8): 576–584
One hundred twenty patients presenting through elective referral by primary care physicians to neurosurgical spine surgeons were consecutively screened for symptoms of unilateral lumbar radiculopathy secondary to LDH at L3-4, L4-5, or L5-S1. Forty consecutive consenting patients who met inclusion criteria (patients must have failed at least 3 months of nonoperative management including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy, and/or acupuncture) were randomized to either surgical microdiskectomy or standardized chiropractic spinal manipulation. Crossover to the alternate treatment was allowed after 3 months. Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.
Federal Government Panel Endorses Spinal Manipulation For Acute Low Back Problems
A comprehensive federal government study performed by the Agency for Health Care Policy and Research (AHCPR) of the U.S. Department of Health and Human Services determined that spinal manipulation is a recommended and efficacious form of initial treatment for acute low back problems in adults. In its clinical practice guideline, the 23-member panel consisting of medical doctors, nurses, doctors of chiropractic, osteopaths, physical therapists, an occupational therapist, experts in spine research, a psychologist and a consumer representative, concluded that expensive tests, prescription drugs and surgical procedures used to diagnose and treat acute low back pain are largely ineffective. Rather, experts recommend spinal manipulation, a procedure performed by doctors of chiropractic, as being an effective treatment for low back conditions.
Bigos, et. al, Acute Low Back Problems in Adults, Clinical Practice Guidelines, AHCPR, U.S. Department of Health and Human Services,
Rockville, MD, December 1994.
Chiropractic Management of Low-Back Pain is More Cost-Effective Than Medical Management
This study commissioned by the Ministry of Health in Ontario, Canada concluded that chiropractic management is greatly superior to medical management in terms of scientific validity, safety, cost-effectiveness and patient satisfaction. According to the study results “there would be highly significant cost savings if more management of low back pain was transferred from physicians to chiropractors”. There is also good empirical evidence that patients are very satisfied with chiropractic management of low back pain and considerably less satisfied with physician management.
Manga, et al. The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain. Ministry of Health, Government of
Ontario, September 1993.
Fewer Work Days Lost With Chiropractic Management
This workers’ compensation study published in the Chiropractic Journal of Australia compared chiropractic and medical management of 1,996 cases of work-related mechanical low back pain. The number of compensation days (paid days off from work) taken by claimants was found to be significantly lower an average of 6.26 days for chiropractic patients and 25.56 days for medical patients. The average cost of compensation for chiropractic management was $392 and for medical management, $1,569 or four times greater than chiropractic management.
Findings included:
1. A significant reduction was seen in the number of claimants requiring compensation days when chiropractic care was chosen.
2. Fewer compensation days were taken by claimants who chose chiropractic care.
3. More patients progressed to chronic status when medical care was chosen.
4. The average payment per claim was greater with medical management.
“Mechanical Low-Back Pain: A Comparison of Medical and Chiropractic Management Within the Victorian WorkCare Scheme,” Ebrall, P. S. Chiropractic Journal of Australia, June 1992, 22:2, 47-53.
Mandated Insurance for Chiropractic is Cost-Effective
The College of William &. Mary and the Medical College of Virginia found in January of 1992 that mandating chiropractic care does not increase insurance costs, and may even reduce insurance costs. Chiropractic is a growing component of the health care sector and is widely
used by the population. By every test of cost and effectiveness, the general weight of evidence shows chiropractic to provide important therapeutic benefits, at economical costs. Additionally, these benefits are achieved with minimal, even negligible, impacts on the costs of health insurance.
“Mandated Health Insurance Coverage for Chiropractic Treatment: An Economic Assessment, with Implications for the Commonwealth of
Virginia.” Schifrin, L.G., The College of William and Mary, Williamsburg, Virginia, and Medical College of Virginia, Richmond, Virginia, January 1992.
Chiropractic May Be First Choice For Several Low-Back Conditions
The University of Richmond conducted an economic analysis in January of 1992, which concluded that chiropractic care is a lower cost option for prominent back-related ailments. One explanation for this is the lower insurance coverage of chiropractic care. If chiropractic
care is insured to the extent other specialties are stipulated, it may emerge as a first option for patients with certain medical conditions. This could result in a decrease in overall treatment costs for these conditions.
“A Comparison of the Costs of Chiropractors versus Alternative Medical Practitioners,” Dean, DH, Schmidt, R.M., University of Richmond, Richmond, Virginia, 13 January 1992.
Medical Society Recognizes Chiropractic Adjustment and Manipulation - “Accepted and Well-Established”
The North American Spine Society’s Diagnostic and Therapeutic Committee has included chiropractic adjustment and manipulation in their general guide of common clinical procedures for doctors treating patients with lumbosacral spinal disorders. The North American
Spine Society (NASS) is a prestigious medical organization that publishes the monthly professional journal, Spine.The Committee’s recommended list of procedures appears in the October 1991 issue of Spine, and categorizes chiropractic adjustment and
manipulation as a “Phase I - Non-Operative Therapeutic Procedure generally accepted, well established and widely used” for lumbosacral conditions.This medically oriented spine care organization’s formal recognition and acceptance of chiropractic procedures signals the final episode in the long history of mistrust and misunderstanding fostered by organized medicine.
“Common Diagnostic and Therapeutic Procedures of the Lumbosacral Spine,” The North American Spine Society - Ad Hoc Committee of Diagnostic and Therapeutic Procedures. Spine, October 1991; 16:10, 1161-1167.
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