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Chiropractic vs. Medical for Low Back Pain

Posted May 06 2009 1:33pm

Among low back pain (LBP) sufferers who seek the services of a health care provider, an estimated 70% choose either a medical doctor or a doctor of chiropractic for care. In this study designed to compare the relative effectiveness of chiropractic vs. medical management of LBP patients, 2,870 adult patients with low back pain of mechanical origin (acute or chronic) were enrolled over a two-year period from the practices of 51 chiropractic clinics and 14 general practice community clinics in the area surrounding Portland, Oregon. At baseline and at various intervals over the next four years, patients rated the intensity of their current pain levels on a pain scale of 0-100, and completed a questionnaire designed to measure the effects of their pain on functional disability.

Results: The greatest degree of improvement was seen within three months of the initial treatment of back pain, with a “modest advantage” seen for chiropractic care over medical care of chronic pain patients in the first 12 months. At the one- and three-month intervals, “clinical importance” was achieved with chiropractic care administered to chronic LBP patients; comparing chiropractic vs. medical care, the average difference in pain scores was 12.2 points at one month and 10.5 points at three months, favoring chiropractic care.

In a separate analysis that categorized differences in care by leg pain, “a potentially clinically important advantage” for chiropractic care in chronic patients with pain radiating below the knee was also seen in the first 12 months following care. In this case, again comparing chiropractic vs. medical care, average differences in favor of chiropractic ranged between 18.3 points and 21.7 points in the first year for pain, and between 9.0 points and 13.9 points over the first three years for disability, using the pain scale.

“Our study supports the generalizability of systematic reviews of the efficacy of spinal manipulation for pain and functional disability to the effectiveness of chiropractic care in clinical practice,” the authors noted in their conclusion. “In terms of relative effectiveness, chiropractic care demonstrated advantage over medical care for chronic patients in the first year, particularly for those with leg pain radiating below the knee.”

Haas M, Goldberg B, Aickin M, et al. A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up. Journal of Manipulative and Physiological Therapeutics 2004;27:160-169.

Dr. Gray’s Comments: Most of you know that I have developed a great working relationship with the local medical community… I am not an anti-medical kinda guy. There are times and conditions when traditional medicine is the treatment of choice. However, there are also times when chiropractic should be the first treatment of choice. Volumes of research have proven this case with regards to lower back pain. There have been many recent studies showing the same superior effectiveness with regards to neck pain and headaches, as well. As we become more inquisitive about ways to decrease the cost of health care, increasing amounts of research are proving the effectiveness and cost savings associated with chiropractic and other natural, non-invasive forms of treatment.

Not sure where I heard the following comparison, but I’ve always liked it. It’s not negative towards medicine, but sheds a little light on the differences in philosophy between chiropractic and medicine:

The conflict between medicine and chiropractic can be summed up quite simply:

  • Medicine believes that disease causes a lack of health.
  • Chiropractic believes that a lack of health is expressed as disease.

Therefore, Medicine treats “the disease,” while chiropractic addresses causes for a lack of health. Medicine primarily treats the symptoms of sick people, and Chiropractic primarily tries to treat the cause which has led to the symptoms.

Among low back pain (LBP) sufferers who seek the services of a health care provider, an estimated 70% choose either a medical doctor or a doctor of chiropractic for care. In this study designed to compare the relative effectiveness of chiropractic vs. medical management of LBP patients, 2,870 adult patients with low back pain of mechanical origin (acute or chronic) were enrolled over a two-year period from the practices of 51 chiropractic clinics and 14 general practice community clinics in the area surrounding Portland, Oregon. At baseline and at various intervals over the next four years, patients rated the intensity of their current pain levels on a pain scale of 0-100, and completed a questionnaire designed to measure the effects of their pain on functional disability.

Results: The greatest degree of improvement was seen within three months of the initial treatment of back pain, with a “modest advantage” seen for chiropractic care over medical care of chronic pain patients in the first 12 months. At the one- and three-month intervals, “clinical importance” was achieved with chiropractic care administered to chronic LBP patients; comparing chiropractic vs. medical care, the average difference in pain scores was 12.2 points at one month and 10.5 points at three months, favoring chiropractic care.

In a separate analysis that categorized differences in care by leg pain, “a potentially clinically important advantage” for chiropractic care in chronic patients with pain radiating below the knee was also seen in the first 12 months following care. In this case, again comparing chiropractic vs. medical care, average differences in favor of chiropractic ranged between 18.3 points and 21.7 points in the first year for pain, and between 9.0 points and 13.9 points over the first three years for disability, using the pain scale.

“Our study supports the generalizability of systematic reviews of the efficacy of spinal manipulation for pain and functional disability to the effectiveness of chiropractic care in clinical practice,” the authors noted in their conclusion. “In terms of relative effectiveness, chiropractic care demonstrated advantage over medical care for chronic patients in the first year, particularly for those with leg pain radiating below the knee.”

Haas M, Goldberg B, Aickin M, et al. A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up. Journal of Manipulative and Physiological Therapeutics 2004;27:160-169.

Dr. Gray’s Comments: Most of you know that I have developed a great working relationship with the local medical community… I am not an anti-medical kinda guy. There are times and conditions when traditional medicine is the treatment of choice. However, there are also times when chiropractic should be the first treatment of choice. Volumes of research have proven this case with regards to lower back pain. There have been many recent studies showing the same superior effectiveness with regards to neck pain and headaches, as well. As we become more inquisitive about ways to decrease the cost of health care, increasing amounts of research are proving the effectiveness and cost savings associated with chiropractic and other natural, non-invasive forms of treatment.

Not sure where I heard the following comparison, but I’ve always liked it. It’s not negative towards medicine, but sheds a little light on the differences in philosophy between chiropractic and medicine:

The conflict between medicine and chiropractic can be summed up quite simply:

  • Medicine believes that disease causes a lack of health.
  • Chiropractic believes that a lack of health is expressed as disease.

Therefore, Medicine treats “the disease,” while chiropractic addresses causes for a lack of health. Medicine primarily treats the symptoms of sick people, and Chiropractic primarily tries to treat the cause which has led to the symptoms.

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