Dec
Back pain is a pervasive issue, with approximately 85% of people experiencing back pain that prompts a visit to a doctor at some point in their lives. Despite its prevalence, identifying the precise cause of back pain can be challenging, and there isn’t a universally agreed-upon optimal treatment for most cases of low back pain. As a result, recommendations from doctors can vary.
“Standard care” for back pain typically involves a combination of rest, stretching and exercise, application of heat, pain relievers, and allowing time for recovery. Additionally, some healthcare providers may suggest exploring chiropractic care as part of the treatment plan.
The encouraging news is that, regardless of the recommended treatment, the majority of individuals experiencing recent-onset back pain show improvement within a few weeks, and sometimes even within a few days. This highlights the generally favorable prognosis for many cases of acute back pain.
What’s the role of chiropractic care?
When it comes to back pain, healthcare providers may take different approaches in recommending treatment. While some doctors promptly refer individuals with back pain to physical therapists, others may see acupuncturists, massage therapists, or chiropractors on their own. The role of chiropractic care in managing back pain remains a topic of debate among experts, and the available high-quality studies on this approach are limited.
Key questions surround the role of chiropractic care in back pain management. Should it be a standard part of initial care, or is it more appropriate for individuals who don’t respond well to other treatments? Are there specific groups of people more likely to benefit from chiropractic care?
These questions are not merely academic; they hold significant implications for healthcare, especially considering the substantial economic burden of low back pain, estimated at up to $200 billion annually in the US. Furthermore, given the opioid crisis, there is a pressing need for effective, safe, and non-opioid alternatives for treating low back pain.
A recent study on chiropractic care for low back pain
A 2018 study published in JAMA Network Open adds to the ongoing discussion on the effectiveness of chiropractic care in treating low back pain. The study involved 750 active-duty military personnel experiencing back pain. Participants were randomly assigned to receive either usual care (which included medications, self-care, and physical therapy) or usual care combined with up to 12 chiropractic treatments.
Key findings after six weeks of treatment for those receiving chiropractic care included:
1. Reduced pain intensity
2. Less disability and more improvement in function
3. Higher satisfaction with treatment
4. Reduced need for pain medication.
Although no serious side effects were reported, approximately 10% of those receiving chiropractic care reported adverse effects, primarily stiffness in joints or muscles. In comparison, 5% of those receiving usual care had similar complaints.
All studies have limitations
While the 2018 study indicates potential benefits of chiropractic care for low back pain, certain aspects of the study make it challenging to draw definitive conclusions:
1. Duration of the study: The six-week duration may not be sufficient to assess the long-term effectiveness of chiropractic care, especially for those with chronic back pain.
2. Small differences in improvement: The observed differences in improvement between chiropractic and usual care were relatively small, raising questions about the clinical significance and cost-effectiveness of chiropractic care.
3. Heterogeneous study population: The study included individuals with various durations and types of low back pain, making it challenging to generalize the results to specific subgroups or conditions.
4. Demographic characteristics: The study population consisted mainly of young, healthy, and fit individuals, predominantly male military recruits. This demographic profile may not represent the broader population with diverse characteristics and health statuses.
5. Knowledge of treatment received: Participants were aware of the treatment they were receiving, introducing the potential for a placebo effect. The added time and attention given during chiropractic sessions could also contribute to the observed response.
6. Selection bias: The study included only individuals willing to receive chiropractic care, introducing a potential bias in the participant pool.
7. Variation in care: Both the usual care and chiropractic care groups received varied treatments within each category, making it challenging to isolate the specific effects of chiropractic manipulation.
Considering these factors, it remains important to interpret the study results cautiously and acknowledge the need for further research to explore the effectiveness of chiropractic care in different populations and over longer durations.
Bottom line
The recent study provides some support for the effectiveness of chiropractic care in treating low back pain. However, it’s crucial to acknowledge the study’s limitations, including the short duration of the trial, small differences in improvement, and the potential for side effects associated with chiropractic care. Additionally, the cost of chiropractic treatments should be considered, although insurance coverage for such care is becoming more prevalent.
Given the complexity of low back pain and the variability in individual responses to different treatments, it’s essential to approach chiropractic care as one of several available options. Continued research is necessary to better understand its long-term effectiveness, identify specific subgroups that may benefit most, and address potential side effects.
In clinical practice, healthcare providers often consider a range of interventions based on individual patient characteristics, preferences, and the available evidence. As research evolves, the understanding of the role of chiropractic care in the overall management of low back pain will likely become clearer.
