It’s a scenario we’ve seen over and over again: a person presents for chiropractic care citing concerns relating to low back pain or neck pain but ends up disclosing other health concerns that are not related to that initial complaint. They may not think chiropractic can help, or it may not be top of mind when they first presented, but when examined, the real story comes out.
We’ve seen it in anecdotal evidence through case reports, and no doubt chiropractors see it in practice all the time. It’s a thing called multimorbidity – more than one chronic condition occurring in an individual at the same time. While multimorbidity is not unique to chiropractic, in that it happens all the time in many health-related settings, the common thread we observe quite often is that the neck or back pain the person presents for may not be the primary concern after the initial examination and history are done.
But what does the data say about it?
Recently, a paper published in the journal Chiropractic and Manual Therapies examined the important issue of low back pain and multimorbidity to establish the prevalence in chiropractic practice and investigate if this affects a person’s experience of pain. The results were quite interesting.
It was a significant study, too, with more than two-thousand participants included at the baseline and with questionnaires given at multiple time points (Baseline, two weeks, three months and 12 months). At the end of the study’s data collection, 64% of respondents had completed all the questionnaires, thus offering up a trove of data to draw meaning from.
All participants involved in the study were over 18 years of age, and had presented to one of ten chiropractic clinics in central Denmark. They had all presented with a new episode of low back pain. People who presented with a non-musculoskeletal cause of their back pain were excluded from the study. Interestingly, the sample group was 56% male and had an average age of 46.
The study turned up some enlightening findings when it came to co-morbid or multimorbid conditions. Some 19% of respondents reported hypertension, and 15% reported osteoarthritis. These were the most common conditions reported alongside low back pain. Additionally, 49% of the total sample group – that’s some 1024 people – reported “at least one chronic condition and 421 (20%) had multimorbidity,” with the latter defined as two or more chronic conditions.
However, the study sought not just to understand the prevalence of comorbidities or multimorbidity occurring alongside low back pain. Researchers wanted to understand how it impacted pain, too. They found that the presence of multimorbidity was associated with increased odds of poor self-rated health, poor physical fitness, poor muscular strength, poor endurance and poor balance. (The full statistical breakdown is available at the reference below).
Beyond the condition-related data alone, there was some good news for chiropractic. All participants reported improvements in their conditions over time and fewer used pain medication. This was regardless of their pain intensity at the onset of care or the presence of other chronic conditions.
Some other interesting takeaways were present in the study, though:
- Patients with hypertension combined with multimorbidity showed “a poorer recovery than patients with high LBP [low back pain] intensity but without chronic diseases.
- More patients with multimorbidity used pain medication for low back pain at the one-year follow-up than those without chronic diseases.
The researchers noted that “Generally speaking, people with multimorbidity and co-occurring musculoskeletal pain report high levels of disability, as well as more mental health problems, physical inactivity and obesity.” Thus, the results were not necessarily surprising and did line up with other studies pertaining to multimorbidity performed on differing sample groups.
However, the study did drive home the message that when we are caring for people with low back pain, there is a 20-49% chance that there is something else going on, and that there are likely to be health-related issues pertaining to fitness, strength, endurance and balance nestled in there with the pain and chronic illness issues they may have presented with. It’s a reminder that we are caring for the whole person, and the whole person often has more going on than what they presented at our clinics for help with.
Rafn, B.S., Hartvigsen, J., Siersma, V. et al. Multimorbidity in patients with low back pain in Danish chiropractic practice: a cohort study. Chiropr Man Therap 31, 8 (2023). https://doi.org/10.1186/s12998-023-00475-3