As Chiropractors we often see great results looking after people experiencing low back pain, with many patients feeling better and returning to their normal activities quickly. Recent research in the USA is confirming these successful outcomes and helping to shape treatment guidelines.
A new study published online May 18 in JAMA Network Open, has shown that adding chiropractic care to standard medical management of low back pain (LBP) in a military population reduced patient-reported pain and disability and improved satisfaction scores compared with standard treatment alone.
In addition, the new data aligns with recent guidelines from the American College of Physicians that recommend inclusion of spinal manipulation, among other nondrug treatments, as first-line therapy for acute and chronic low-back pain.
The study involved 750 active-duty US service members aged 18-50 years with LBP from three military facilities.
Patients were screened over three years, 2012-2015, and 250 patients from each of the study sites received usual medical care along with chiropractic care (375 participants) or usual medical care alone (375 participants). Usual medical care was defined as any care recommended or prescribed by non-chiropractic military clinicians to treat LBP – this included self-management advice, drug treatment, physiotherapy or referral to a pain clinic.
Patients in the chiropractic care group received standard treatment plus up to 12 chiropractic visits for spinal manipulative therapy (also known as “adjustments”) of the low back and adjacent regions during the 6-week treatment period. Additional therapies, such as rehabilitative exercise, ultrasound therapy, electrotherapy, ice and heat and other manual therapies, could also be included in chiropractic care.
The primary outcomes of self-reported pain intensity and disability favoured usual care combined with chiropractic care compared to usual care alone. This was found at week 6 and at week 12 of the study.
Secondary outcomes showed that overall, at weeks 6 and 12, participants in the chiropractic combined treatment group reported significantly lower mean worst pain intensity within the last 24 hours and symptom irritation levels.
Patients receiving combined care had significantly better global perceived improvement at 6 weeks at all sites, significantly greater mean satisfaction with care at 6 weeks at all sites and significantly less pain medication use at week 6 and week 12.
Although limited by the nonspecific nature of LBP and treatment variations across care sites, “[t]his trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary health care for LBP, as currently recommended in existing guidelines,” the authors write. They note that further research is needed to understand longer-term outcomes and to assess how differences among patients and interventions influence outcomes.
In an accompanying editorial, Daniel C. Cherkin, MA, PhD, from Kaiser Permanente Washington Health Research Institute in Seattle, Washington states, although it may be more complex than adding chiropractic to usual care, “true integration of chiropractic care into the military health care system involving professional communication and referrals between chiropractors and medical personnel has the potential for more effectively and efficiently serving patients and for providing models for other integrated health care systems in civilian settings to follow.”
This confirms the positivity of the integrative model of care available at CCSCC where we happily work with your medical practitioner to achieve the best outcomes.
Christine M. Goertz, DC, PhD; Cynthia R. Long, PhD; Robert D. Vining, DC; Katherine A. Pohlman, DC, MS; Joan Walter, JD, PA; Ian Coulter, PhD. Effect of Usual Medical Care Plus Chiropractic Care vs usual Medical care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial JAMA Network Open. 2018;1(1):e180105 Published online May 18, 2018.
Innovating to Improve Care for Low back Pain in the Military: Chiropractic Care Passes Muster. Daniel C. Cherkin, MA, PhD. JAMA Network Open. 2018; 1(1):e180106 Published online May 18, 2018.