Chronic Back Pain: 12 to 18 Adjustments Improves Outcome
Dear Patients & Friends:
Patients with chronic low back pain that received at least 3 chiropractic adjustments per week for four to six weeks had better outcomes than patients randomized to control or to only 6 treatments, according to a recent study.
Writing in the October 16, 2013 issue of the prestigious orthopedic journal Spine, chiropractic scientists Haas and co-workers found that 100 patients had less pain and disability if they were randomized to 12 or 18 chiropractic sessions, instead of 0 or 6.
However, without follow up care the effect was negligible 12-months later unless patients had at least 18 chiropractic sessions over a 6 week period. Those patients experienced significantly less pain and disability even a year later.
Prior chiropractic research has shown that patients randomized to monthly follow up sessions have more sustained outcomes 6 months later.
In actual practice, chiropractors generally encourage and teach patients to use daily exercise and stretches, work modification, and follow up monthly or bimonthly “maintenance” adjustments to attain an optimal treatment response. However, many insurance companies and Medicare do not pay for the monthly follow up sessions, and over time patients may be less compliant with follow up stretches and exercise.
The present research tends to support a larger study by Meade and co-workers published in the British Medical Journal, that demonstrated that even three years later there was greater satisfaction, less back disability and fewer drop-outs in patients randomized to chiropractic as opposed to a month of physical therapy sessions in hospital, and the effect was greatest for those who hurt the most and who had hurt the longest.
In general the evidence supports the notion that more chiropractic sessions are indicated for longer periods to achieve best results when treating chronic back pain. These patients also benefit from our progressive strength and stretch training, and staying active is essential for best long term improvement as well.
Robert A. Leach, DC, MS, FICC(h), CHES
Chiropractic scientist Mitch Haas and co-workers at the Center for Outcome Studies, University of Western States performed the first full-scale trial to determine the number of chiropractic visits indicated for the treatment of chronic lower back pain: http://www.ncbi.nlm.nih.gov/pubmed/24139233
In a study of over 700 patients, Dr. Meade, then Director of the British Medical Research Council found less disability scores after patients were referred to outpatient chiropractic as opposed to physical therapy in hospitals in England: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2550426/
T.W. Meade, professor and MRC epidemiologist at the Wolfson Institute of Preventive Medicine in London, concluded that patient satisfaction with chiropractic continued even three years after the initial chiropractic encounters: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116161/
Earlier this year the American Academy of Family Physicians guidelines issued to family physicians specifically endorsed use of chiropractic as part of the initial treatment of herniated discs, that should also include anti-inflammatory medications, stretches and staying active: http://familydoctor.org/familydoctor/en/diseases-conditions/herniated-disk.printerview.all.html