Research Topics/Information

BRONTFORT. G., ET AL. ,SPINAL ADJUSTMENTS, MEDICATION OR HOME EXERCISE WITH ADVICE FOR ACUTE AND SUBACUTE NECK PAIN. A RANDOMIZED TRIAL. ANN INTERN MED. JANUARY 3,2012 VOL. 156 NO.1

BACKGROUND: Mechanical neck pain is a common condition that effects an estimated 70% of persons at some point in their lives. Little research exsists to guide the choice of therapy for acute and subacute neck pain.

OBJECTIVE: To determine the relative efficacy of spinal manipulation therapy(SMT), medication, and home exercise with advice(HEA) for acute and subacute neck pain in both the short and long term .

DESIGN: Randomized, controlled trial.(ClinicalTrials.gov registration number: NCT00029770)

PARTICIPANTS: 272 persons aged 18 to 65 years who had nonspecific neck pain for 2 to 12 weeks.

INTERVENTION: 12 Weeks of Spinal Adjustments, medication, or HEA.

MEASURMENTS: The primary outcome was participant-related pain, measured at 2, 4, 8, 12, 26, and 52 weeks after randomization. Secondary measures were self-reported disability, global improvement, medication use, satisfaction, general health status(Short Form-36 Health survey physical and mental health scales), and adverse events. Blinded evaluation of neck motion was performed at 4 and 12 weeks.

RESULTS: For pain, Spinal adjustments had a statistically significant advantage over medication after 8, 12, 26, and 52 weeks(P? 0.010), and HEA was superior to medication at 26 weeks(P=0.02). No important differences in pain were found between SMT and HEA at any time point. Results for most of the secondary outcomes were similar to those of the primary outcome.

LIMITATIONS: Participants and providers could not be blinded. No Specific criteria for defining clinically important group differences were pre-specified or available from the literature.

CONCLUSION: For participants with acute and subacute neck pain, Spinal adjustments were more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points.

AUSTRALIAN SYMPOSIUM ON NECK PAIN

The symposium summarised the key findings of the Bone and Joint Decade Task Force on Neck Pain and its associated disorders. Approximately 10% participants were Chiropractors. Other attendees included GP’s, Spinal surgeons, rehabilitation specialists, physiotherapists, insurance representatives.

The speakers were A/Prof Linda Carroll, (PhD psychologist/ epidemiologist), Dr Pierre Cote (DC, PhD Chiropractor/epidemiologist) and Dr David Hall (MBBS, FRACS, Spinal Surgeon).

The Neck Pain Taskforce in their review made the following findings in Adelaide November 2008;

  1. Neck pain is widespread and is now often regarded as recurrent episodic condition.
  2. Neck pain is multi-factorial (more than a single cause).
  3. Degenerative changes on X-rays are not predictive of neck pain.
  4. Recommended a 4 grade classification system;
    • Grade 1: pan with no/ little interference daily activities.
    • Grade 2: pain that limits daily activities.
    • Grade 3: pain with radiculopathy.
    • Grade 4: fracture or serious pathology.
  5. Informed patient preferences are essential keys to treatment decisions and success.

According to the Task Force, research reviewing over 30,000 papers, “manipulation” was on the list of treatments to benefit Grade 1 or 2 neck pain. All effective non-surgical interventions were found to have equally low risks. Treatments that were considered unlikely to be beneficial included ultrasound, TENS, steroid injections in facet joints, and cervical collars.

A discussion ensured around the likelihood of stroke (VBA) with cervical manipulation. It was clearly stated by the researchers in front of all delegates (90% non-chiropractors), that the research shows that the risk of stroke is exactly the same following a visit to the GP as it is following a visit to the Chiropractor. A good opportunity for cross-discipline education.

BACK PAIN (Chiropractors Association of Australia)

INTERESTING FACTS, STATISTICS AND INFORMATION ABOUT BACK PAIN

  • In the Western world 80% of the population will experience disabling low-back pain during their lives.
  • Of the total Australian population in 2004-05, 15% reported having back problems. This equates to 3 million people [1].
  • People with back problems report high levels of psychological distress [2].
  • In national healthcare systems throughout the world, back pain is common, poorly managed and very expensive – both in terms of direct treatment costs, and the indirect costs of disability and lost productivity [3].

WHO SUFFERS BACK PAIN?

  • In Australia, adult males have a higher prevalence of back problems than females [4]. However, women seek care for lower back pain more often than men [5].
  • Back pain does not only affect adults, According to a study undertaken in Odense University in Denmark, the steepest increase in the first episode of back pain for adolescent boys and girls was in the ages 12-14, and that over 50% of young women had experienced back pain by age 18 and young men by age 20 [6].
  • Back problems were reported in 24% of persons in the 65-75 year age group in 2004-05. Prevalence of back problems then declined with age with 18% of persons aged 75 years and over reporting the condition [7].
  • According to the most recent Australian Bureau of Statistics Yearbook, the proportion of people who reported back pain, back problems and disc disorders increased rapidly after early teenage years from 1% among 10-14years, to 23% among people aged 40-44years [8].

CAUSES OF LOWER BACK PAIN

Most low back pain is triggered by some combination of overuse, muscle strain, and injury to the muscles, ligaments, and discs that support the spine. Many experts believe that over time muscle strain can lead to an overall imbalance in the spinal structure. This leads to a constant tension on the muscles, ligaments, bones, and discs, making the back more prone to injury or reinjury. (http://www.webmd.com/back-pain/tc/low-back-pain-cause).

CHIROPRACTIC CARE; SAFE, SUCCESSFUL AND COST EFFECTIVE TREATMENT FOR BACK PAIN

  • Chiropractors are the leading specialists for spine related health conditions, and are uniquely positioned to manage a broad range of issues including musculoskeletal conditions, the reduction of healthcare expeditures and lost productivity in the workplace [9].
  • Research undertaken in Canada has identified that Chiropractic care for patients with musculoskeletal conditions would lead to direct annual savings of $348million to th Ontario Healthcare System and indirect savings of 1.85 billion per year [10].
  • A national Survey on back pain released in Canada, is one of many studies that have reported that patients increasingly choose and prefer chiropractic care for the common and disabling complaint of back pain. Chiropractic was the most popular choice for those who consulted a healthcare practitioner for their back pain, and also received a much higher patient satisfaction level than other treatment approaches [11].

REFERENCES

  1. Australian Bureau of Statistics. (2006). Musculoskeletal Condiions in Australia: A Snapshot, 2004-05. (No. 4823.0.55.001). Canberra, Australian Capital Territory.
  2. Australian Bureau of Statistics. (2006). Musculoskeletal Condiions in Australia: A Snapshot, 2004-05. (No. 4823.0.55.001). Canberra, Australian Capital Territory.
  3. Back Pain Guidelines From Denmark: A New Level of Acceptance and Integration of Chiropractic Services. (2000). The Chiropractic Report, 14(5), 1-8.
  4. Australian Bureau of Statistics (2007). Year Book Australia, 2007. (No 1301.0). Canberra, Australian Capital Territory.
  5. Walker, B.F., Muller, R., & Grant, W.D. (2004). Low Back Pain in Australian Adults. Health Provider Utilization and Care Seeking. Journal of Manipulative and Physiological Therapeutics, 27(5), 327-335.
  6. Leboeuf-Yde, C, Kyvik, KO (1998). At What Age Does Low Back Pain Become a Common Problem? A Study of 29.424 Individuals Aged 12-41 Years, Spine, 23(2), 228-234.
  7. Australian Bureau of Statistics. (2006). Musculoskeleal Conditions in Australia: A Snapshot, 2004-05. (No. 4823.0.55.001). Canberra, Australian Capital Territory.
  8. Australian Bureau of Statistics (2007). Year Book Australia, 2007. (No 1301.0). Canberra, Australian Capital Territory.
  9. Dillon, J.L.. (1988). Health Economics and Chiropractic. Annals Swiss Chiropractic Association, VII, 7-17.
  10. Manga, P., & Angus, D. (1998). Enhanced chiropractic coverage under OHIP as a means of reducing healthcare costs, attaining better health outcomes and improving the public’s access to cost-effective health services. Ontario, Canada: University of Ottawa.
  11. Environics Research Group Limited. (2003). Survey of Canadian Adults: Back Pain. Toronto, Canada.