Low Back Pain

A Systematic Review and Meta-analysis of Efficacy, Cost-effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-back Pain

By Frank M. Painter|January 2, 2012|Low Back Pain, Neck Pain, Spinal Manipulation|

A Systematic Review and Meta-analysis of Efficacy, Cost-effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-back Pain

SOURCE: Evid Based Complement Alternat Med [Epub 2011 Nov 24]

Andrea D. Furlan, Fatemeh Yazdi, Alexander Tsertsvadze, * Anita Gross, Maurits Van Tulder, Lina Santaguida, Joel Gagnier, Carlo Ammendolia, Trish Dryden, Steve Doucette, Becky Skidmore, Raymond Daniel, Thomas Ostermann, and Sophia Tsouros

Clinical Epidemiology Methods Centre,
Ottawa Hospital Research Institute,
University of Ottawa Evidence-Based Practice Center,
Box 208, Ottawa, ON, Canada K1H 8L6

Background: Back pain is a common problem and a major cause of disability and health care utilization.

Purpose: To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain.

Data Sources: Records without language restriction from various databases up to February 2010.

Data Extraction: The efficacy outcomes of interest were pain intensity and disability.

Data Synthesis: Reports of 147 randomized trials and 5 non-randomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically non-significant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature.

Conclusions: CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments.

Introduction:

Back pain is a general term that includes neck, thoracic, and lower-back spinal pain. In the majority of cases, the aetiology of back pain is unknown and therefore is considered as “nonspecific back pain”. Back pain is considered “specific” if its aetiology is known (e.g., radiculopathy, discogenic disease). Although back pain is usually self-limited and resolves within a few weeks, approximately 10% of the subjects develop chronic pain, which imposes large burden to the health-care system, absence from work, and lost productivity [1]. In a recent study, the direct costs of back pain related to physician services, medical devices, medications, hospital services, and diagnostic tests were estimated to be US$ 91 billion or US$ 46 per capita [2]. Indirect costs related to employment and household activities were estimated to be between US$ 7 billion and US$ 20 billion, or between US$25 and US$ 71 per capita, respectively [3–5]. One study published in 2007 showed that the 3-month prevalence of back and/or neck pain in USA was 31% (low-back pain: 34 million, neck pain: nine million, both back and neck pain: 19 million) [6]. (more…)

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Application of a Diagnosis-Based Clinical Decision Guide in Patients with Low Back Pain

By Frank M. Painter|October 22, 2011|Evidence-based Medicine, Low Back Pain, Research|

Application of a Diagnosis-Based Clinical Decision Guide
in Patients with Low Back Pain

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2011 (Oct 22); 19: 26

By Donald R Murphy, DC, DACAN, and Eric L Hurwitz, DC, PhD

Rhode Island Spine Center, 600 Pawtucket Avenue, Pawtucket, RI 02860 USA

BACKGROUND

Low back pain (LBP) affects approximately 80% of adults at some time in life [1] and occurs in all ages [2, 3]. Despite billions being spent on various diagnostic and treatment approaches, the prevalence and disability related to LBP has continued to increase [4]. There has been a recent movement toward comparative effectiveness research [5], i.e., research that determines which treatment approaches are most effective for a given patient population. In addition, there is increased recognition of the importance of practice-based research which generates data in a “real world” environment as a tool for conducting comparative effectiveness research [6, 7]. This movement calls for greater participation of private practice environments in clinical research [7].

One of the reasons often given for the meager benefits that have been found with various LBP treatments is that these treatments are generally applied generically, without regard for specific characteristics of each patient, whereas the LBP population is a heterogeneous group, requiring individualized care [8]. Developing a strategy by which treatments can be targeted to the specific needs of patients has been identified as a research priority [9, 10].

There are more articles like this @ our:

Low Back Pain Page and the

A Clinical Model for the Diagnosis and Management Page

(more…)

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Neurophysiologic Effects of Spinal Manipulationin Patients With Chronic Low Back Pain

By Frank M. Painter|September 22, 2011|Chiropractic Care, Low Back Pain, Neurology|

Neurophysiologic Effects of Spinal Manipulation in Patients With Chronic Low Back Pain

The Chiro.Org Blog

SOURCE: Musculoskelet Disord. 2011 (Jul 22); 12: 170

Brian C Clark, David A Goss Jr,
Stevan Walkowski, Richard L Hoffman,
Andrew Ross, and James S Thomas

Ohio Musculoskeletal and Neurological Institute (OMNI),
Ohio University,
236 Irvine Hall,
Athens, OH 45701, USA.

Background

Low back pain (LBP) is one of the most common reasons for seeking medical care and accounts for over 3.7 million physician visits per year in the United States alone. Ninety percent of adults will experience LBP in their lifetime, 50% will experience recurrent back pain, and 10% will develop chronic pain and related disability [1-4]. According to the most recent national survey more than 18 million Americans over the age of 18 years received manipulative therapies in 2007 at a total annual out of pocket cost of $3.9 billion with back pain being the most common clinical complaint of these individuals [5].

Over the past decade there has been growing scientific evidence supporting the clinical efficacy [6-10] and effectiveness [11,12] of manual therapies in treating LBP. While clinical evidence supporting the efficacy and effectiveness of manual therapies has emerged, less scientific evidence has been offered to explain the effects and mechanisms underlying these treatments. The lack of a mechanistic underpinning hinders acceptance by the wider scientific and health-care communities, and it also limits the development of rational strategies for using manipulative therapies.

You may also enjoy the
Low Back Pain and Chiropractic Page

(more…)

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Steroid Injections Offer Little Relief for Lower Back Pain

By Frank M. Painter|August 21, 2011|Low Back Pain|

Steroid Injections Offer Little Relief for Lower Back Pain

The Chiro.Org Blog

SOURCE: Amer Acad Orthop Surgeons March 10-14 · San Francisco, CA

“Effects of Epidural Steroids in the Lumbar Spine: A Double Blind Randomized Control Trial”

Podium Presentation

By Andrew Skelly

SAN FRANCISCO – A randomized, controlled trial has shown an epidural or translaminar steroid injection is ineffective for the relief of lower back pain.

“I’m not saying that steroids don’t work. I’m just saying there’s definite reason to question whether they work or not,” Dr. Daniel Steinitz, an orthopedic surgeon at Belleville General Hospital in Ontario, said in an interview after his presentation at the American Academy of Orthopedic Surgeons meeting here.

Dr. Steinitz, who worked on the study during his residency at McGill University in Montreal, said steroid injections for lumbar pain are popular but research on their use over the past 40 years has produced conflicting results. Nor is the procedure benign, with dural puncture leading to headache being one of the more common complications. (more…)

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Are Chiropractors Protecting Patients From Medical Care?

By Frank M. Painter|May 23, 2011|Low Back Pain|

Are Chiropractors Protecting Patients From Medical Care?

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

By Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher

“Chiropractors might be preventing some of their patients from receiving procedures of unproven cost utility value or dubious efficacy.”

This quote comes from the latest study revealing chiropractic’s superiority to “traditional medical approaches.” Titled “Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence,” the study was published in the April 2011 issue of the Journal of Occupational and Environmental Medicine. [1]

The study compares “physical therapy, chiropractic and (medical) physician services” as they relate to disability and health maintenance. As our front-page article underscores, investigators found that “the likelihood of recurrent disability due to LBP (low back pain) for recipients of services during the health maintenance care period by all other provider groups was consistently worse when compared with recipients of health maintenance care by chiropractors.”

The authors state that “by visiting only or mostly a chiropractor or becoming a chiropractic loyalist, the patients do not receive other traditional medical approaches.” While this is obvious, it is no less significant because those who do receive traditional medical care experienced a greater likelihood of recurrent disability. (more…)

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The Evidence-based Rap, or What’s Wrong With My Pain Meds?

By Frank M. Painter|April 23, 2011|Low Back Pain, Research, Safety|

The Evidence-based Rap, or What’s Wrong With My Pain Meds?

The Chiro.Org Blog

SOURCE: A Chiro.Org Editorial

Based on: A Systematic Review on the Effectiveness of Pharmacological Interventions for Chronic Non-specific Low-back Pain ~ FULL TEXT
Eur Spine J. 2011 (Jan); 20 (1): 40–50

OK, maybe this isn’t a genuine Rap, and I’m not rhyming-Simon, but somebody needs to bust-a-cap on the pain-med industry, because they hold themselves to a much lower standard than they expect my profession to maintain.

Fortunately (and, to the rescue) comes this study from the Dutch Institute for Health Care Improvement. They actually *busted a cap*, by deciding to explore “the effectiveness of pharmacological interventions [i.e., non-steroid anti-inflammatory drugs (NSAIDs), muscle relaxants, antidepressants, and opioids] for non-specific chronic low-back pain (LBP)”.

This article is a real eye-opener!

I say Bravo, because these drugs are medicine’s sole conservative approach for managing LBP. This Blog has previously published numerous (and recent) studies suggesting that chiropractic management for low back pain is orders of magnitude more effective for pain relief, and is also significantly more cost-effective than standard medical management. [1-8] (more…)

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