Dynamic Chiropractic - March 10, 1997, Volume 15, Issue 06|
Back Pain, What Works!
Book Review by G. Douglas Andersen, DC, DACBSP, CCN
When I received this book, I glanced on the back cover and noticed that the authors are both neurologists. I immediately went to the index and looked to see if the "c" word was in the book with the expectation that either it would be totally ignored or slammed, since that is what most MDs who write books on back pain do to our profession. I found chiropractic mentioned in chapter 3, "Types of Doctors and How to Choose a Good One." This chapter briefly discusses the education and types of treatment delivered by family practitioners, neurologists, physiatrists, rheumatologists, orthopedic surgeons, and neurosurgeons. Here is what they said about chiropractors and I quote:
"Chiropractors are doing something right. They have hoards of satisfied patients who swear by chiropractic and reject the advice of most medical physicians to avoid the chiropractic profession. We think chiropractic is a good therapeutic option for many patients with back pain. Over the years we have had experience with many chiropractors and receive numerous referrals from them. We also send patients to chiropractors on a regular basis.
Chiropractors go through a demanding and thorough training program. The graduate of chiropractic school leave with a grasp of anatomy of the spine and nervous system as well as various techniques relevant to spinal disorders. They are also taught when not to adjust patients (their emphasis). Despite sharing many thousands of patients with chiropractors, we are unable to report a single injury received by one of our patients while being adjusted."
In this section, the authors also had a paragraph on spine centers, and I quote:
"When you are suffering from low back pain, the idea of going to a 'spine center' sounds perfectly reasonable. We do not recommend this, however. While there are probably spine centers that provide efficient and quality care for low back pain, we have rarely had good experiences with these meccas. Often their greatest strengths are in their marketing strategies! Many of these institutions simply herd crowds of patients through a labyrinth of expensive studies and exposure to numerous medical specialists, none of whom has a guiding hand in any individual's treatment. At the end of the evaluation and therapy the patient gets an operation or is declared cured -- whether or not he or she agrees with that statement -- or else the patient is told that he or she must learn to live with the pain. Although a spine center represents a theoretical advantage in that you would like to see a number of different specialists, we believe you would be dissatisfied with the results."
The book has chapters on basic anatomy, examination including types of diagnostic imaging, and an exercise chapter (the longest in the book with pictures and descriptions of stretching and strengthening exercises). Also included are chapters on medications, surgery, and lifestyle issues such as sex, sports, and travel. Finally, there is a chapter on nonpharmacologic treatment of back pain. I was surprised that facet, trigger point, and epidural injections were included in this chapter and not the chapter on medication (if epidural steroid injections aren't pharmacology, I don't know what is). This chapter also contains brief descriptions on posture training, biofeedback, acupuncture, massage, ice, heat, and electrical modalities.
The largest section in the nonpharmacologic treatment chapter is a fair and balanced discussion about chiropractic, and it is a good read. I could easily write a whole article on this section alone. A couple of highlights include a statement that chiropractic has clearly been validated as a treatment for many musculoskeletal conditions in respected medical journals. They make a very good and underpublicized point that if a patient is not getting results with one chiropractor, they recommend trying another chiropractor instead of giving up on the entire profession. Finally, they point out that some MDs mistakenly dismiss our entire profession based on outrageous statements and claims by a few DCs (I just read a book by a chiropractor who states manipulation will lengthen the life span of humans and that subluxation can cause liver cancer), and that the more knowledgeable, ethical, and serious chiropractors watch this behavior aghast and embarrassed (amen!).
This easy-to-read book is a very honest look at the types of self-help and professional options a person with back pain has. It is also a quick review for DCs to answer patients' questions about different types of medication, surgery, and diagnostic imaging.