Chiropractic adjustments were just as effective as epidural injections for patients with back pain in a new study -- without the risks and at lower cost.
The findings show that chiropractic can significantly reduce pain in patients with lumbar disc herniation, and is less expensive than medical treatment.
Lumbar epidural injections are frequently used for back pain and sciatica in patients with lumbar disc herniation, failed back surgery syndrome, and spinal stenosis. During the procedure, a physician injects a high dose of pain medication, and sometimes steroids, into the area of the lumbar spine around the damaged nerve. This temporarily reduces inflammation and pain.
Although the injections are widely used, controversy lingers due to the lack of a studies with placebo controls, and questions about the effects of steroids versus anesthetic alone. Side effects of steroids include a weakening of muscles and spinal bones around the affected nerve and a disruption of the body's natural hormone balance. It's also unclear whether epidural injections are more effective than other conservative treatments for lumbar disc herniation.
While a number of studies have established the efficacy of chiropractic for low-back pain, fewer have tested its comparative effectiveness with other treatments for lumbar disc herniation.
In a new study from the Journal of Manual and Physiological Therapeutics, researchers from Switzerland compared the effects of chiropractic spinal manipulative therapy (SMT) and epidural nerve root injections (NRI). The study included 102 with symptomatic, MRI-confirmed lumbar disc herniation who were treated with either SMT or NRI.
After one month of treatment, both groups experienced significant improvements. Of the patients under chiropractic care, 76.5% said they were "much better" or "better" compared to 62.7% of NRI patients. Sixty percent of chiropractic patients had a significant reduction in pain compared to 53% of NRI patients. These slight differences were not statistically significant.
While none of the chiropractic patients received surgery, three of the NRI patients eventually opted for an operation.
Since the treatments were considered equally effective, the cost analysis became even more important for comparing both treatments, the researchers pointed out. On average, one month of chiropractic adjustments was less expensive than NRI ($558 vs. $729). Their analysis included only the "minimum cost" of NRIs, and did not take into account other costs that are frequently tacked on like additional consultations with clinicians, multiple injections, or possible surgery. Additionally, treatment cost for chiropractic patients may have been slightly higher than normal since they were required to receive an MRI to be in the study. Many chiropractic patients do not receive MRI because imaging guidelines do not recommend MRIs for patients with lumbar disc herniation in most cases. In contrast, MRIs are typically performed before injections or other more invasive procedures.
Although randomized trials are needed to confirm these results, the authors concluded that, "There were no significant differences in outcomes between the more universally accepted treatment procedure of NRI compared to SMT."
This study suggest that patients can experience substantial relief from chiropractic care without worrying about the side effects of steroids or drugs. It may even save them money, since research suggests that chiropractic patients have lower annual medical costs compared to patients under traditional care.
Peterson, CK, et al. Symptomatic Magnetic Resonance Imaging-confirmed lumbar disk herniation patients: a comparative effectiveness prospective observational study of 2 age- and sex-matched cohorts treated with either high-velocity, low-amplitude spinal manipulative therapy or imaging-guided lumbar nerve root injections. Journal of Manipulative and Physiological Therapeutics 2013; doi: 10.1016/j.jmpt.2013.04.005.
Many people are aware that chiropractic is an effective way to relieve a number pain conditions, but a growing body of research suggests it can also improve immunity.
Previous studies have shown that spinal adjustments can affect specific immune responses in both healthy participants and back-pain patients. However there have been no major literature reviews of the overall effect of chiropractic on immunity. In a recent presentation at the 9th Chiropractic, Osteopathy, and Physiotherapy Annual Conference in the UK, Jack Neil of the Anglo-European College of Chiropractic analyzed the existing literature on spinal manipulative therapy (SMT) and immune responses.
After reviewing the research up to January 2012, Neil confirmed that spinal adjustments are associated with a central anti-inflammatory response. Research suggests that SMT may lead to a down regulating of pro-inflammatory cytokines and an increase in antibodies involved in the immune response. At the same time, SMT may increase the production of tiny cells called leukocytes which support the white blood cells in fighting off a threat. SMT may also affect Natural Killer cells, interleukin-2 activity, TNF-a levels, cortisol, and b-endorphin levels.
The mechanisms behind these processes are still unclear however. There is not enough research yet to know whether these inflammatory changes correlate with an improvement in symptoms."Most research to date has focused on asymptomatic patients with short-term improvements. The challenge now is to clinically observe long-term health benefits in symptomatic patients," Neil concluded.
Although more research is needed, current evidence suggests that chiropractic adjustments can produce positive changes in the immune system. These immunological changes may explain why chiropractic can reduce inflammation and pain while supporting overall wellness.
Neil J. Manipulative therapy and immune response: A literature review of the chiropractic and osteopathic evidence. Clinical Chiropractic 2012;15(3):186.
Medical doctors are increasingly ignoring the recommended guidelines for treating back pain, a new study from the Journal of American Medical Association finds.
Researchers from the Beth Israel Deaconess Medical Center in Boston examined records for 23,918 doctor visits related to back pain between 1999 and 2000. They discovered that medical doctors are actually getting worse at employing evidence-based treatments.
Current guidelines from the American Medical Association recommend that acute back pain be treated first with conservative, active treatments like chiropractic care and exercise rehabilitation. Over-the-counter non-steroidal anti-inflammatory drugs can be used to ease short-term pain, rather than narcotics like Oxycontin which can actually make matters worse, according to recent research.
However researchers found that physicians are overprescribing narcotics and overusing expensive testing.
During the study period, prescriptions for narcotics grew from 19.3% to 29.1%, reflecting a national trend of growing opioid use. Lead researcher, Dr. John Mafi, explained that during the 1990s medical doctors were widely accused of ignoring patients' pain. While some of the criticism was valid, many physicians overreacted by doling out more serious painkillers. Now around 43% of patients with back pain show signs of substance abuse disorders, Mafi and his colleagues found.
Doctors are also relying too heavily on imaging techniques no longer deemed necessary for every type of spinal pain. Use of MRI and CT scans grew from 7.2% to 11.3% during the study period, despite research demonstrating such scans are not always useful for many cases of back and neck pain. Although these scans do not harm the patient, they typically don't find anything wrong, and can cost around $1,000 per a scan.
That may be why patients under standard medical care tend have more medical costs associated with their back pain treatment compared to chiropractic patients, according to a recent study. Chiropractic patients can also expect to receive evidence-based treatments like exercise therapy and spinal adjustments. A study of military personnel with back pain earlier this year found that those treated by a chiropractor had better results compared to patients treated with standard medical care alone.
Mafi JN, et al. Worsening trends in the management and treatment of back pain. JAMA 2013; doi:10.1001/jamainternmed.2013.8992.
Spinal manipulation therapy is a widely-accepted method for treating back pain, neck pain, and headaches. Although previous studies have pointed to the safety of chiropractic neck adjustments, there has been some concern about the effect of the forces applied during spinal manipulation of the neck. It has been argued that there is the possibility of damaging the internal carotid artery (ICA) by such force. Previously, little was known about the strains sustained by the ICA during spinal manipulation therapy. In a recent study, researchers sought to examine the mechanics of the ICA during neck manipulation to determine whether spinal manipulation causes strains in excess of those experienced during normal everyday movements.
The researchers measured strains applied to the internal carotid artery (ICA) during neck spinal manipulation treatments. Peak and average ICA strains were measured in 6 cadaver spines during cervical spinal manipulation performed by chiropractic doctors. These number were compared with the corresponding strain experienced during diagnostic testing of the head and neck to simulate normal everyday movements.
The researchers found that ICA strains were no different during chiropractic manipulation of the neck than during normal everyday movements. Therefore, cervical spinal manipulation performed by trained chiropractors does not appear to place undue strain on the ICA.
Earlier research has also demonstrated the safety of chiropractic neck adjustments. In an extensive literature review from the medical journal Spine, researchers analyzed data from 28,807 chiropractic patients receiving a total of 50, 276 adjustments of the cervical spine. Among the thousands of adjustments made, the only negative side effect reported was temporary, mild dizziness; no serious side effects were reported.
Herzog W, Tang C, Leonard T. Internal Carotid Artery Strains During High-Speed, Low-Amplitude Spinal Manipulations of the Neck. Journal of Manipulative and Physiological Therapeutics 2012; pii: S0161-4754(12)00156-X. doi: 10.1016/j.jmpt.2012.09.005.
Whiplash injuries are an expensive and painful problem in the US. Experts estimate that we spend $29 billion per year in treating the pain and disability that can result from a rear-end collision.
But there are steps you can take to protect yourself from whiplash injury. The key to good whiplash protection is your head restraint. Numerous studies have shown that most people have an improperly adjusted head restraint, commonly called a head rest.
Whiplash injury occurs when your torso moves in one direction while your head moves in another direction. This can put hundreds of pounds of force on the delicate ligaments of your neck.
The key to good head restraint positioning is to eliminate or reduce the amount of space that your head can move. By doing that, it reduces the strain put on your neck. Your head restraint needs to be placed so that the back of your head is level with the middle of the restraint, and your seat needs to be positioned so that your head is very close. You want to have a maximum of 2.5 inches between your head and the restraint.
While car crashes are often out of your control, you can properly adjust your head restraint to reduce the chance of neck injury during a rear-end collision.
If you've already been injured in a crash, it's important to get treatment right away. Research suggests that chiropractors can provide effective treatments for many patients with whiplash-associated disorders.
Freeman MD, et al. A review and methodologic critique of the literature refuting whiplash syndrome. Spine 1999; 24 (1): 86-96.
Prevent Injury, Adjust your Headrest. CAA South Central Ontario. http://www.caasco.com/insurance/auto-vehicle-insurance/adjust-your-headrest.jsp.
How to Adjust Your Head Restraint. The Royal Society for the Prevention of Accidents. http://www.rospa.com/roadsafety/info/adjust_head_restraints.pdf.
Many headaches arise from cervical musculoskeletal disorders. Often, conservative therapies are recommended as the first treatment for cervicogenic headache, but it was previously unclear which treatments were the most effective. Should patients be prescribed a set of exercises and physical therapy sessions, chiropractic adjustments, or both? Will one lead to better outcomes?
A 2002 study sought to answer these questions by examining the effectiveness of a combination treatment involving both chiropractic adjustments and an exercise program. Two-hundred participants with chronic, moderate intensity cervicogenic headaches were assigned to one of four groups: spinal adjustments, exercise therapy, combined therapy, and a control group. Over six weeks of treatment, they reported their headache frequency, intensity, duration, pain, medication intake, and satisfaction with treatment. Researchers also measured physical outcomes such as pain on neck movement and a photographic measure of posture.
The study showed that all three active treatments (chiropractic adjustments, exercise, and a combination of both) were effective for improving the symptoms of cervicogenic headache, with benefits maintained at least 12 months following treatment. There was no statistical evidence of an additive effect when both chiropractic manipulation and exercise therapy were used simultaneously. Despite patients receiving combined treatments experienced the same clinical benefits as patients in the stand-alone treatment groups, a greater proportion of participants in the combined treatment group experienced good or excellent outcomes. This supports the use of combined treatments for the management of cervicogenic headaches.
Jull G, Trott P, Potter H, et al. A randomized controlled trail of exercise and manipulative therapy for cervicogenic headache. Spine 2002; 27(17):1835-1843.
Everything Is Connected
Back pain is very seldom limited to the back, especially if it goes untreated for too long. Many patients also report that they start to develop problems with their legs and hips over time.
In the study, researchers set out to see if there was a correlation between reported low back pain and future osteoarthritis related problems such as hip or knee trouble. The population-based cohort study indicated that there was a higher incidence of hip osteoarthritis in patients with previously reported low back pain. They did not find a significant correlation with low back pain and future osteoarthritis of the knee joints.
What This Means for You
What does this mean for you if you suffer from low back pain? Though there could be a bigger risk for you to have hip troubles later in life if you suffer from low back pain now, this is not set in stone provided you take measures to care for your lower back as well as your overall bone and muscle health.
Primarily, you need to address whatever is causing your low back pain so it doesn't lead to problems with your hip joints due to overcompensation and unusual wear and tear. Spinal adjustments can help realign the spine and diminish future degeneration of your lower back.
Remember that a strong body can better resist injury and degeneration. Cardio, strength training, balance exercises and stretching for flexibility can keep your body strong and at ideal body weight. Your chiropractor or other healthcare provider can also give you advice on healthy eating habits to ensure optimum nutrition.
Stupar M, Cote P, French MR, Hawker GA. The Association Between Low Back Pain and Osteoarthritis of the Hip and Knee: A Population-Based Cohort Study Journal of Manipulative and Physiological Therapeutics 2010;33(5):349-54.
Recent research suggests that a multimodal chiropractic treatment can effectively ease radicular pain.
Radiculopathy, or radicular pain, is a condition related to compression of the spinal nerve roots. This nerve impingement can lead to pain, numbness, tingling, or weakness in parts of the body far from the original source. Radiculopathy is often disabling, and there is little information regarding the most effective course of treatment, though both surgical and non-surgical approaches are common.
A recent review examined the outcomes of conservative, non-surgical treatment of patients with radiculopathy. This review involved 162 patients with a diagnosis of radiculopathy who were treated with chiropractic spinal adjustments, neuromobilization, and exercise stabilization. The frequency and duration of care were determined on an individual patient, though most patients underwent treatment 2 to 3 times per week.
85.5% of the patients experienced resolution of their radicular complaints, after undergoing an average of 9 treatment sessions. Patients experienced an average change in numeric pain scale of 4.2 between the initial and final visit. 23 cases were considered unresolved; those patients were referred for steroid injection, further medication management, or surgery. The researchers concluded that the conservative management strategy explored here produced favorable outcomes for most radiculopathy patients.
This study adds to the knowledge surrounding radiculopathy treatments by demonstrating that a conservative approach utilizing spinal adjustments, in combination with neuromobilization and stabilization exercise, may be effective for the majority of patients with radicular pain.
Christensen KD, Buswell K. Chiropractic outcomes managing radiculopathy in a hospital setting: a retrospective review of 162 patients. Journal of Chiropractic Medicine 2008; 7 (3): 115-25.