Back Pain

At the beginning of his book, The Back Pain Revolution, the British orthopedic surgeon Gordon Waddell wrote:

“Back pain is a 20th century medical disaster”.

Waddel G. The Back Pain Revolution. Churchill Livingstone, Edinburgh, 1998

Most of the chiropractic research that has been done to date has been documenting the success chiropractic has had in helping people with back pain. There is now a massive amount of research that has been done into back pain and this research has been summarised in Government Guidelines from many countries including Australia.

Back Pain Guidelines from Denmark (1999)

Manual Therapy is generally recommended for patients with acute pain and functional; limitations, for exacerbations, as one element of a broader strategy for chronic low back pain problems, as an element of conservative care for many people with nerve root irritation/disc problems

Therapies not recommended methods are, corsets, traction and ultrasound/laser/short wave therapy.

If the 10 000 patients treated annually for disc herniation received good conservative care approx 7 500 would not require surgery or hospitalisation.

Manniche C et al. Low-back Pain: Frequency Management and Prevention from an HAD Perspective. Danish Health Technology Assessment 1999; 1(1)

American Back Pain Guidelines (AHCPR)

Two treatment options where recommended for patients with non-specific back pain, spinal manipulation and non-prescription medications.

Bigos S, Bowyer O, Braen G et al. (1994) Acute Low Back Pain in Adults. Clinical Practice Guidelines No14. AHCPR Publication No. 950642. Rockville, MD; Agency for Health Care Policy and Research, Public health Service, U.S. Department of Health and Human Services .

UK Clinical Guidelines for the Management of Acute Low Back Pain

These guidelines were sponsored by a professional association for general medical practitioners. They reviewed and accepted the findings (US Guidelines) and had this to say:

“consider manipulative treatment within the first six weeks”

They recommended manipulative treatment because of it’s effectiveness in terms of pain relief, better activity levels and higher patient satisfaction. The also said,

“…..the risks of manipulation for low back pain are very low provided patients are selected and assessed properly and it is carried out by a trained therapist or practitioner.”

This review also emphasised the importance of early activation in the management of LBP.

Waddell G, Feder G et al (1996) Low Back Pain Evidence Review, London: Royal College of General Practitioners

Effectiveness and Cost Effectiveness of Chiropractic Care for LBP: The Manga Report

Faced with out of control health care costs for which low back pain was a major contributor the Ontario government commissioned health economists to provide a report on,

“The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low Back Pain”.

This report became know as the Manga Report. They had this to say:

“In our view, the constellation of evidence of:

(a) the effectiveness and cost effectiveness of chiropractic management of low back pain.

(b) the untested, questionable or harmful nature of many current medical therapies.

(d) the safety of chiropractic care.

(e) the higher satisfaction levels expressed by patients of chiropractors, together offers an overwhelming case in favour of much greater use of chiropractic services in the management of low-back pain.

There should be a shift in policy to encourage and prefer chiropractic services for most patients with low-back pain ... a very good case can be made for making chiropractors the gatekeepers for management of low-back pain in the worker’s compensation system.”

Manga P, Angus D et al (1993) The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low Back Pain, Pran Manga and Associates, University of Ottawa, Canada

The cost of chiropractic care compared to medical care for similar conditions in the US.

Cost of Chiropractic Compared Medicine

Researchers compared health insurance information between chiropractic and medical patients (N=395,641) and concluded:

"Patients receiving chiropractic care experienced “significantly lower health care costs … on the order of $1000 each over the 2-year period” than those who received only medical care”

Stano M (1993) A Comparison of Health Care Costs for Chiropractic and Medical Patients JMPT 16:291/299

The Second Manga Report

Commissioned by the Ontario Chiropractic Association in 1998.

There is now “considerable empirical support for the cost-effectiveness and the safety of chiropractic management of musculoskeletal disorders”, so much so that doubling the proportion of the Ontario public who visit chiropractors for these problems from 10% to 20% will lead to direct annual savings of $348 million to the Ontario health care system and indirect savings of $1.85 billion per year.

The report recommended achieving this by reducing the copayment expected from patients by increasing the government contribution from $10 to $20 per consultation. The average consultation cost was $30.

Manga P Angus D (1998) Enhanced Chiropractic Coverage Under OHIP as a Means of Reducing Health Care Costs, Attaining Better Health Outcomes and Improving the Public’s Access to Cost-Effective Health Services, University of Ottawa, Ontario, Canada

Chronic Back Pain

The strongest evidence is on acute pain patients but a 1997 study supported the use of chiropractic for chronic low back pain and said…

“(There is now) strong evidence of the effectiveness of manipulation for patients with chronic low-back pain”

Van Tulder MW, Koes BW, Bouter LM Conservative Treatment of Acute and Chronic Nonspecific Low-Back Pain, Spine 1997;22:2128-2156.

Chiropractic and Exercise

“In our view…the effectiveness and cost effectiveness of chiropractic management of LBP….higher satisfaction rates… together offers and overwhelming case in much greater use of chiropractic services in the management of LBP”

Erhard RE, Delitto A et al (1994) Relative Effectiveness of an Exercise Program and a Combined Program of Manipulation and Flexion and Extension Exercises in Patients with Acute Low-Back Syndrome, Physical Therapy 74(12):1093-1100.