Back Pain

"Back pain is a 20th century medical disaster".
-Gordon Waddell, M.D., British Orthopedic Surgeon

Government guidelines have now been established for back pain in the United States, Britian, Australia, New Zealand, Denmark and Sweden, advocating the use of manipulation for most cases of back pain. The findings are based on scientific evidence that manipulation is more effective, cost-efficient and has higher patient satisfaction rates than standard medical care.

Back pain is the number one reason why people seek chiropractic care. It is estimated that 85% of the population will be disabled by an attack of back pain during their lives, currently 7% of the adult population is suffering back pain that has lasted two weeks or more. It is the most frequent and expensive health care problem and the most common cause of work loss and disability.

A common myth is that back pain is self-limiting and most patients will get better without care in a month. This has been the standard of care in general medical practice, with the use of medications, bed rest and a "wait and see approach".

Research in the U.K. shows that the idea that back pain is self-limiting is based on a misinterpretation of earlier evidence. The original 1973 study was based on whether patients made follow-up visits to their general practitioner, not whether they actually got better.

Another study by Croft found that of 463 patients with a new episode of back pain, 275 (59%) did not have a further consultation with their general practitioner, and only 38 (8%) had a repeat visit after 3 months. All patients were visited by a research nurse within a week of their first visit, then again at 3 and 12 months. Although most did not return to their family doctor, only 21% had recovered withing 3 months, and only 25% by 12 months. Of special note, of those patients disabled by pain at their first visit, only 18% (1 in 5) had fully recovered by 12 months.

Back pain should not be seen as having mainly short-term symptoms, most of which get better, and a smaller number of chronic long-term problems. It should be seen as a chronic problem with episodes of acute pain and disability, and other times no pain or disability.

Source: "The Chiropractic Profession", David Chapman-Smith


The Timeline

• In 1993, The Manga Report, the first government-commissioned report by health economists looking at the cost effectiveness of chiropractic services, recommends a primary role for chiropractors with back pain patients on grounds of safety, cost-effectiveness and patient preference, and concludes this will save hundreds of millions annually in direct health care costs and work disability payments.
  
  
• In 1994, government-sponsored expert panels developing evidence-based guidelines for the management of patients with back pain in the U.S. (Agency for Health Care Policy and Research) and the U.K. (Clinical Standards Advisory Group) provide the first authoritative reports that manipulation is a proven and preferred treatment approach for most patients.
  
  
• In 1996, government commences offical funding support for an ongoing agenda for chiropractic research. To continue this agenda the Consortial Center for Chiropractic Research is formed in 1997, comprising chiropractic schools, university research departments and federal government agencies, and is based at Palmer College of Chiropractic.
  
  
• In 1998, the second Manga Report, was updated and found that there is now "considerable empirical support for the cost-effectiveness and the safety of chiropractic management of musculoskeletal disorders", so much so that it would lead to direct annual savings of $348 million to the Onario Healtcare System and indirect savings of $1.85 billion per year.
  
  
• In 2000, Denmarks, National Board of Health, published clinical guidelines for the prevention and management of low-back pain. This was a 14 member multidisciplinary panel which recommends a more prominent role for chiropractors, more than any other guidelines yet published. Muscle relaxants "have no place in the treatment of low-back pain" because "the possible clinical benefit is overshadowed by the risk of physical and psychological dependency even after short periods of usage."
  
  

Source: The Chiropractic Report, David Chapman-Smith, LL.B. (Hons.), Sep., 1998, Vol 12, No.5; Sep. 2000, Vol. 14, No.5