Chiropractic and Back Pain

Numerous studies have shown that chiropractic can be an effective treatment for patients with low back pain. Now a new report¹ has looked further into the effectiveness of chiropractic by comparing it to physical therapy treatment, and, more significantly, studying the long-term benefits of chiropractic as measured by the annual number of office visits.

Most studies that look at long-term effects of treatment simply look at self-reported outcomes: level of pain and disability. This study took a different approach. By examining how much care patients sought after the initial study period, they could determine the effect each treatment method had on future health care consumption:

“Care seeking behavior by patients with low back pain is most commonly associated with increased pain and disability, meaning more care is sought when worse symptoms are experienced. The amount of health care utilized may therefore be used as a measure of patient health status, and thus may be compared between groups of patients to determine effectiveness of certain therapies.”

“Proctor et al.² determined that about 25% of patients with chronic, disabling, work-related musculoskeletal disorders pursue new health care services after completing a course of treatment, and among those who sought additional health care from a new provider, a subgroup of <15% accounted for a disproportionate share of lost worker productivity, more surgical procedures, and ongoing financial disputes. They further stated that in patients with chronic, disabling, work-related musculoskeletal disorders, post-treatment utilization of health care from a new provider is an important dimension of outcome…”

The authors started with 191 patients with low back pain. 107 patients received chiropractic care (flexion/distraction treatment, or FD) and 84 patients received active exercise therapy (EP) from physical therapists. All patients received treatment 2 to 4 times per week for four weeks. The study subjects were then followed for one year to assess outcomes. The authors found:

• 38% of the FD patients and 54% of the EP patients sought care for their back pain during the one-year follow-up.
• FD patients had an average of 2.2 visits to a health care provider after the treatment period, while EP patients had an average of 6 visits.

“We hypothesized that there would be no group difference in the average number of visits to any health care provider. The results demonstrated that actually there were significant group differences during the year after trial participation, with a higher number of visits to any health care provider and to a general practitioner in the EP group.”

The authors conclude:

“Based on one-year follow-up data imputed for complete analysis, participants who received physical therapy (exercise program) during a clinical trial attended a higher number of visits to any health care provider and to general practitioners during the year after care when compared to participants who received chiropractic care (flexion distraction) within the trial.”

1. Cambron JA, Gudavalli MR, McGregor M, et al. Amount of health care and self-care following a randomized clinical trial comparing flexion-distraction with exercise program for chronic low back pain. Chiropractic and Osteopathy 2006:14:19.
2. Proctor TJ, Mayer TG, Gatchel RJ, McGreary DD: Unremitting health care utilization outcomes of tertiary rehabilitation of patients with chronic musculoskeletal disorders. Journal of Bone and Joint Surgery 2004, 86A:62-69.