No Business Treating Chronic Spinal Pain

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

While the results of the most recent study on chronic spine pain1 demonstrate superior effectiveness for chiropractic (see "Chiropractic Best for Chronic Spine Pain" on the front page of this issue), perhaps even more can be learned by looking at the study from the participating patients' viewpoints. Let's consider the plight of a patient with chronic spine pain who is directed toward each of the three courses of treatment, and see what results most consumers can generally expect from each:

Medication Patients

In the study, 40 patients began taking nine weeks of medication in the hopes that their spinal pain would be alleviated. The drugs prescribed were limited to two nonsteroidal anti-inflamatories (NSAIDs) and an analgesic: Celebrex, Vioxx or paracetamol. Patients were given Celebrex unless they had already tried it. In that case, they were given Vioxx, unless they had tried that, too, in which case they received paracetamol. Interestingly enough, 16 of the 40 had already tried Celebrex, and five of those had also already tried Vioxx, all without relief of their pain.

As the nine-week treatment course progressed, 11 of the 40 gave up on drugs because they had no real effect on their pain. Seven other patients abandoned taking medication due to side-effects, such as "indigestion, abdominal pain or skin rash."

Of the 22 patients willing to take the drugs all nine weeks, only one found relief of his or her pain symptoms during the study period, and only one more experienced full pain relief by the end of the nine weeks. Of the 20 who finished drug treatment without achieving full pain relief, nine switched to another form of care.

So, if a group of patients begins taking NSAIDs or an analgesic for their spine pain, here are the likely results:

• 27.5% won't even finish a nine-week prescription, because it doesn't work for them.
• 17.5% will abandon the drugs due to side effects.
• 22.5% will switch to another form of care - after they spend nine weeks figuring out the drugs don't work.
• 5% will find relief during the nine weeks.
• 27.5% will continue to take the drugs, even though they haven't achieved complete pain relief.

These results are pretty sad, considering the tens of billions of dollars spent on back pain every year in the United States.

Acupuncture Patients

Now, let's consider the plight of the average chronic spine pain patient who seeks acupuncture care. In the study, a total of 32 patients* began nine weeks of acupuncture for their spinal pain. Of those, 10 changed treatments because it had little or no effect on their pain. (None changed due to side-effects.)

Of the remaining 22 patients who received acupuncture treatments twice a week for nine weeks, only one found relief of pain symptoms before the end of the treatment period, and only two more experienced full pain relief by the end of the nine weeks. Of the 19 who finished the acupuncture treatment without getting full pain relief, five switched to another form of care.

So, if a group of patients begins acupuncture treatment for their spine pain, here are the likely results:

• 31.25% won't finish nine weeks of acupuncture, because it doesn't work for them.
• 15.6% will switch to another form of care - after they spend nine weeks figuring out acupuncture doesn't work for them.
• 9.4% will find relief during the nine weeks.
• 43.75% will continue to use acupuncture, even though they haven't achieved complete pain relief.

Twice as many chronic spine pain patients can expect to find complete relief from acupuncture compared to drugs. This is slightly more encouraging, but it still translates to less than one out of 10 patients experiencing relief from pain.

Chiropractic Patients

Finally, we can see what the average chiropractic patient can hope for when visiting his or her doctor of chiropractic with chronic spine pain. In the study, a total of 33 patients* began nine weeks of chiropractic for their spinal pain. Of those, eight changed treatments because it had little or no effect for them (none changed due to side effects).

Of the remaining 25 patients who received chiropractic adjustments twice a week for nine weeks, eight found relief of their pain symptoms before the end of the treatment period, and one more experienced full pain relief by the end of the nine weeks. Of the 16 who finished their chiropractic care without achieving full pain relief, only two of those switched to another form of care.

So, if a group of patients begins chiropractic care for their spine pain, here are the likely results:

• 24.2% won't finish nine weeks of chiropractic, because it doesn't work for them.
• Only 6% will switch to another form of care after nine weeks of chiropractic that doesn't work for them.
• 27.3% will find relief during the nine weeks of treatment.
• 42.4% will continue to use chiropractic, even though they haven't achieved complete pain relief.

So, a patient with chronic spine pain is almost five-and-a-half times more times likely to enjoy complete relief of his or her pain with chiropractic than with drugs. That same patient is almost three more likely to enjoy complete pain relief from chiropractic than from acupuncture treatments.

More than two out of three (67.5%) chronic spine pain patients who begin taking NSAIDs or an analgesic for their pain will switch to some other form of care, due to side-effects or ineffectiveness. Almost half (46.85%) of those patients will switch from acupuncture to something else due to ineffectiveness. Only three out of 10 (30.2%) patients with chronic spine pain will switch from chiropractic due to ineffectiveness.

Considering these results, medical and osteopathic doctors have no business treating chronic spine pain with NSAIDs or analgesics. Only one in 20 of their patients can hope to find full pain relief, and over two-thirds will switch to something else, anyway. MDs and DOs would do much better just making a referral to a doctor of chiropractic.

Acupuncture will provide complete pain relief to only one in 10 of their chronic spinal pain patients, with almost half of their patients seeking another form of care. They also would be better off referring spine pain patients to chiropractors.

Better than one in for chiropractic patients will enjoy complete relief from their chronic spine pain, with another four in 10 remaining with chiropractic care because it is providing some pain relief and better range of motion.

When it comes to chronic spine pain, the choice is obvious: No other form of care has any business providing patient care except chiropractic.

• After deducting patients who were noncompliant or who moved out of the area.

Reference

1. Giles LGF, Muller R. Chronic spinal pain - a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine 2003;28:1490-1503.

DMP Jr.

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