A recent comparative study has examined the effects of adding chiropractic care to usual medical care for low back pain in US service members. The result is the least shocking thing any chiropractor could read: adding chiropractic care to usual medical care yields better results and decreases pain and disability at the six week mark. Whilst it might be an unsurprising outcome for chiropractors, it does give us data to rest on when urging public policy-makers to see chiropractors as part of the solution for low back pain.
With the US opioid crisis showing no signs of slowing, and with the direct costs of back pain amounting to $34 billion dollars (annually) in the US alone, an evaluation of non-pharmacological means of managing low back pain was deemed necessary [1]. Chiropractic care is a common low back pain management method, but a recent comparative-effectiveness clinical trial sought to examine how well patients responded when chiropractic care was added to usual medical care when it came to low back pain.
The sample was taken from US military personnel aged between 18 and 50. The study was conducted at two large military medical centres and at one smaller hospital at a military training site. Once researchers ensured that none of the exclusion criteria were present, the 750 remaining participants were sorted into a “usual medical care (UMC)” group, and a “Usual medical care plus chiropractic care (UMC+C)” group.
The UMC group options included “self-management advice, pharmacologic pain management, physical therapy, or pain clinic referral.” This
group was asked to avoid chiropractic care, whereas the UMC+C group received as many as 12 chiropractic visits during the course of the study.
For both groups, the frequency of treatment was determined individually “based on the participants diagnosis or condition, response to care, and scheduling availability [1].” In the UMC+C group, decisions as to the specifics of care were left to the chiropractors discretion. So too were additional therapeutic procedures such as exercise, superficial heat and other manual therapies.
The data showed some interesting results. 102 members of the UMC group did not see a clinician. 273 participants did, and the mean number of visits was 2.6. Meanwhile, over at the UMC+C group, 109 participants did not visit a UMC clinician. Of the 350 participants who did visit a chiropractor during the study, the mean number of visits was 4.7.
Whilst there were significant improvements in both groups, adjusted mean differences between groups overall were consistently in favour of the UMC+C group compared with UMC alone at the six week mark across all three sites [1].
In fact, the study reached a conclusion that “Chiropractic care, when added to usual medical care, resulted in moderate short-term improvements in low back pain intensity and disability in active-duty military personnel [1].” Further research is needed to understand long term impacts.
This won’t be surprising news for the chiropractic tribe. But the study does offer evidence that chiropractic care has a place in multidisciplinary approaches to handling the burden of low back pain. The Secretary-General of the World Federation of Chiropractic, Dr Richard Brown, has been quoted as saying:
“This research further strengthens the evidence that the addition of chiropractic care has significant value when it comes to managing low back pain. The fact that patients experience less pain and reduced disability, not to mention a greater sense of satisfaction with their care, should serve as a strong signal to policy makers that chiropractors can be recruited as part of the solution to such a prevalent condition [2].”
He then called on governments and policy makers globally to rethink their strategy on managing low back pain [2].
The study is believed to be the largest of its kind, and contains the most diverse sample of participants, which gives the results significant real-world applicability. We hope this data helps drive the conversation around non-pharmacological interventions for low back pain.
The full paper can be downloaded at the reference provided below [1].
References
[1] Goertz C, Longg C, Vining R, Pohlman K, Wlater J and Coulter I (2018) “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,” JAMA Network Open, 208;1(1): DOI:10.1001/jamanetworkopen.2018.0105
[2] Staff Writer (2018), “Less Pain, less disability when chiropractic added to usual care for back pain, says new study,” World Federation of Chiropractic – WFC, Sunday May 20, 2018 https://www.facebook.com/notes/world-federation-of-chiropractic-wfc/less-pain-less-disability-when-chiropractic-added-to-usual-care-for-back-pain-sa/1569873583134885/ retrieved 24 May 2018
