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Dirty Little Secret About Lower Back Pain

The medical "debate" has been going on for years...is spinal adjusting (a.k.a. manipulation) effective for Low Back Pain?  In fact, you might have read or heard conflicting stories about the efficacy of chiropractic treatment.  In regards to those studies that did not show improvement with spinal adjustments, those studies have a significant flaw.  Those studies were based on a short treatment duration.  The treatments did not allow for reduction of pain, healing, and stabilization of the affected areas.  In other words, the treatment stopped when the patient would have started feeling better not allowing for enough time for the body to heal and the area to stabilize.  I hope this information will help clear up some misperceptions.

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The original Meade study (British Medical Journal 1990) demonstrated that chiropractic was much more effective for LBP than conventional medical care.  Then in 1993 the province of Ontario, Canada hired the esteemed health care economist Pran Manga, Ph.D. to examine the benefits of chiropractic care for low back pain (LBP) and to make a set of recommendations on how to contain and reduce health care costs.  His report A Study to Examine the Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain cited research demonstrating that: (1) chiropractic manipulation is safer than medical management for LBP;   (2) that spinal manipulation is less safe and effective when performed by non-chiropractic professionals;   (3) that there is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost-effective than medical management;   (4) and that there would be highly significant cost savings if more management of LBP was transferred from medical physicians to chiropractors.  He also stated that "A very good case can be made for making chiropractors the gatekeepers for management of low-back pain in the Workers' Compensation System in Ontario."

In 1994, many in medicine was horrified when the Agency for Health Care Policy and Research (AHCPR) confirmed the untested, questionable or harmful nature of many current medical therapies for LBP, and also stated that, of all forms of management they reviewed, only chiropractic care could both reduce pain AND improve function.

In 1995, Meade did a follow-up to his 1990 BMJ article, again publishing in the British Medical Journal. It demonstrated that those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals, especially for those who suffered from chronic (or long-term) low back pain!

A recent study in SPINE Journal reveals that health care expenditures for back pain sufferers was a staggering $90.7 billion in 1998, and that prescription drugs accounted for more than 15% of that figure! This is alarming, since muscle relaxants have been associated with slower recovery rates, and steroid injections offer minimal relief.   One needs to ask why drug costs continue to climb with a track record like that.  Even care by physical therapists has been shown to prolong recovery from low back pain.

A chronic pain study at the University Of Washington School Of Medicine recently compared which treatments were most effective at reducing pain for neuromuscular diseases and found that chiropractic scored the highest pain relief rating (7.33 out of 10), scoring higher than the relief provided by either nerve blocks (6.75) or opioid analgesics (6.37).

A recent 4-year retrospective study of 700,000 health plan members revealed that offering chiropractic services within a managed-care environment could save insurers 27% in back pain episode-related costs! The Cost-effectiveness Page documents many other studies with similar findings.

In December 2004, the British Medical Research Council published 2 papers in the British Medical Journal demonstrating both the efficacy and cost-effectiveness of chiropractic compared with medical management. These two papers revealed:

• Spinal Manipulation, with or without exercise, improved symptoms more than medical care did at both 3 and 12 months.

• The authors concluded: “We believe that this is the first study of physical therapy for low back pain to show convincingly that both manipulation alone and manipulation followed by exercise provide cost effective additions to care in general practice.”

The most recent in a long line of articles showing the clear superiority of chiropractic management was published in May of 2007. Clinical and cost utilization based on 70,274 member-months over a 7-year period demonstrated decreases of 60.2% in-hospital admissions, 59.0% less hospital days, 62.0% less outpatient surgeries and procedures, and 83% less pharmaceutical costs when compared with conventional medicine IPA performance.

  1. British Medical Journal 1990 (Jun 2); 300 (6737): 1431–1437, August 1993
  2. The Manga Report

Pran Manga, Ph.D.
Professor and Director, Masters in Health Administration Program, University of Ottawa; and President, Pr an Manga and Associates Inc., Ottawa.

Douglas E. Angus, M.A.
Adjunct Professor, University of Ottawa and Project Director, The Cost-Effectiveness of the Canadian Health Care System, Queen's - University of Ottawa Economic Projects.

Costa Papadopoulos, MHA
Health Care Consultant and Associate of Pran Manga and Associates, Inc.

William R. Swan, B. Comm
Consultant in Health Care Economics.

AHCPR Publication No. 95-0642:  December 1994