Chiropractic or Nerve Root Injections for Lumbar Herniated Disc?
Dear Patients & Friends:
What should you do when you have back and leg pain with an MRI confirmed lumbar disc herniation? Should you go to a chiropractor? Have an epidural or nerve root injection? Get back surgery?
Those are questions faced by millions of Americans every year, since studies confirm back pain continues to be the leading cause of musculoskeletal disability, affecting 70% of all individuals at some time, accounting for billions in lost worker productivity and wages, and causing significant pain and suffering.
In the most recent research of the question, performed by chiropractic and medical scientists and published in the May 2013 issue of the Journal of Manipulative and Physiological Therapeutics, 102 age- and sex-matched patients with MR confirmed herniated lumbar discs were treated with either guided nerve root injections (NRI) with a steroid drug, or chiropractic spinal manipulation.
Of patients receiving chiropractic, 76.5% reported being “much better” or “better” after one month of therapy, while 62.7% of the NRI group reported the same levels of improvement. Also, only 2 percent of chiropractor treated patients had their pain worsen after a month of care, while 6 percent of patients receiving lumbar nerve root injections had their pain worsen. Costs were less for the spinal manipulation treated patients as well.
While the study is small, on the heels of other large scale efforts demonstrating that even patients with complicated and chronic back pain have better improvement from 1-3 years after a month of chiropractic care, than patients randomized to physical therapy or rehabilitation, the evidence again supports the idea that at a minimum all patients with even serious complicated back problems should have access to chiropractic, if not direct access early on in their care. Furthermore, several large studies in the past decade point to the limitations of back surgery.
So for a society bent on saving money for serious back problems the answer seems plain enough. Consider chiropractic (with exercise, ice and medical co-management including medications when indicated) first, more expensive interventions such as guided nerve root or epidural injections second, and surgery last.
Robert A. Leach, DC, MS, FICC(h), CHES
To read the latest research comparing chiropractic spinal manipulation with guided epidural injections, from the Departments of Chiropractic and Radiology, Orthopaedic University Hospital Balgrist, Zürich, Switzerland.
To read the latest from the online JAMA Network about chiropractic: http://jama.jamanetwork.com/article.aspx?articleid=1681414
The first ever US government guidelines on treatment of low back pain were released in 1994 and concluded that spinal manipulation (but not physical therapy procedures) was “safe and effective” for acute low back pain, while only 1 in 100 benefit from back surgery: http://www.ncbi.nlm.nih.gov/books/NBK52408/