The AHCPR Findings

The results published in 1994 by the United States Agency for Health Care Policy Research, reviewed the many treatments for acute low back pain in adults. The panel consisted of medical doctors, osteopaths, nurses, physical therapists, and others familiar with the treatment of low back pain. The results of their five-year study concluded that relief "can be accomplished most safely with non-prescription medication and/or spinal manipulation."

What Works & What Doesn't

The panel screened over one hundred published studies relating to spinal manipulation. Using the criteria of symptomatic and functional improvement, the researchers concluded that spinal manipulation is helpful for patients with acute low back pain.

Perhaps more significant were treatments found to be ineffective and of unproven value. The panel found no evidence of benefit from physical therapy, massage, traction, ultra-sound, laser treatment, transcutaneous electrical nerve stimulation, or biofeedback techniques.

More invasive procedures were dismissed as well. There was little evidence to support the use of injections, muscle relaxers, steroids, acupuncture, or early surgical intervention. The panel found that even prolonged bed rest (more than 4 days), should be avoided.

Upon review of countless controlled randomized clinical trials, the panel concluded that restoration of spinal biomechanics, using methods like those used by chiropractic doctors, to be helpful and highly recommended.

The Manga Report

In 1993, the Ontario Ministry of Health funded a Canadian research project to study if chiropractic could help lower the costs of work-related injuries or improve the rehabilitation of disabled or injured workers.

This study specifically explored the effectiveness of chiropractic management of low back pain. Based on a historical review of the most significant clinical studies, the panel of researchers concluded that the approaches employed by chiropractic doctors were more effective than traditional forms of treatment. In fact, they found the most commonly used medical treatments have questionable value.

Very Persuasive Evidence

Besides revealing that chiropractic patients were able to return to work more quickly than those who received traditional treatment, chiropractic patients reported a high level of satisfaction with their care.

One of the most persuasive findings was the issue of safety. The study concluded that chiropractic care is safer than medical management of low back pain.

Based on the evidence, the researchers recommended that chiropractic services be fully covered under the Ontario Health Insurance Plan. Further, they concluded that chiropractic doctors should be engaged at the highest levels to assess policy and review standards and care recommendations for workers with back injuries.

The Virginia Assessment

This 1992 study was conducted to determine the value of including chiropractic in Virginia's mandated health care coverage. The research was conducted by a professor of economics and preventive medicine. Because chiropractic care could help avoid more costly types of treatment, it was concluded that mandating chiropractic coverage could actually reduce costs.

Chiropractic Compared Favorably

The researchers conducted a thorough investigation between chiropractic and traditional medical treatment. While their primary focus was on the costs associated with including chiropractic coverage, they explored safety issues, efficacy, wage loss, and treatment frequency. Before reaching their conclusions they reviewed 35 different comparisons.

A concern explored in their research was whether expanding coverage to include chiropractic would increase costs to the state. This concern seemed to unfounded.

The evidence they present shows that chiropractic care provides substantial benefits at a relatively low cost. They concluded that adding chiropractic benefits would have a very small impact on health insurance expenditures and might actually lower overall health care costs.

The British Study

A three year British study involved 741 patients. Roughly half received traditional medical treatment and the other half received chiropractic care. The 1990 report observed that patients seen by chiropractic doctors were significantly better within six months and remained so during the two year follow-up period. This, and other evidence, led researchers to conclude that chiropractic care compares more favorably than traditional outpatient hospital treatment.

Long Term Results

Published in the prestigious British Medical Journal, this study is especially important due to its size and independent nature. Besides revealing the effectiveness of chiropractic in the short-term, the lasting effect of treatment two and three years later was significant.

Researchers used the Oswestry Pain Disability Questionnaire and the results of objective range of motion testing to confirm their findings. The patients' progress was measured by their ability to walk, lift, sit, and conduct their lives. Not only did the chiropractic patients experience better results for a longer period of time, they missed less time from work.

Based upon patients consulting chiropractic doctors instead of receiving hospital treatment, the researchers concluded that reduced absenteeism could save millions in lost production each year. Because of its effectiveness and long-term benefits, they recommended that including chiropractic in the British National Health Service should be considered

· REFERENCES ·

Bigos, S., Bowyer, O., Braen, G., et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No. 14. AHCPR Publication No 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. December, 1994.

The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain, Pran Manga, Ph.D., Douglas Angus, M.A., Costa Papadopoulos, M. H.A., William Swan, B. A. Funded by the Ontario Ministry of Health, August, 1993, Page 104.

Leonard G. Schifrin, Chancellor Professor of Economics and Preventive Medicine, The College of William and Mary, Williamsburg, Virginia.

Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment , T.W. Meade, Sandra Dyer, Wendy Browne, Joy Townsend, A.O. Frank, British Medical Journal, Volume 300, 2 June 1990, Pages 1431-1437.

© 1999 Back Talk Systems, Inc.