Unfortunately the following saga is way too typical in our office. Last month I saw a new patient who had severe low back pain (LBP) for over 2 years. The pain was so severe she was living on pain meds, going right home from work and going to bed. She was not participating in life and was extremely frustrated. She had seen her Primary Care Physician (PCP) from the onset of her pain. She was referred to multiple specialists for advanced testing, injections and more medications, none of which gave her any real relief or hope.
Finally after two (2) years, at the repeated encouragement of Lyn Rome, her hair stylist, she came into my office, explained in detail all she had been through and the frustration of living with pain. My exam ruled out all the “red flags” or pathological causes of her pain. My diagnosis was dysfunction of her left Sacro-iliac joint and sciatic nerve entrapment. Simply put, the largest joint in her body (in the butt area) was stuck and the longest and thickest nerve in the body which goes from the low back to the toes was not gliding properly. Of course she also had muscles spasms because her muscles were short and tight to protect the joint that was not moving, setting up a visors cycle of pain that kept perpetuating itself.
I felt confident I could help her, but since she was skeptical and nervous from her prior medical treatments I recommended a 2 week trial of chiropractic care to see how she would respond. I wish all of my patients responded so quickly, but after 2 treatments she had significant decrease in pain, stopped the pain meds and didn’t have to go right to bed after work. Obviously the trial of care was successful and she is on the road to recovery.
Two (2) years of her life was wasted because of ignorance (or bias) on the part of her PCP. Unfortunately this is a scenario I see all the time at our office, but it shouldn’t be that way. Any competent medical doctor who keeps up with the literature should know that chiropractic care has been well documented as an effective treatment for LBP. (It is not the only condition we treat, but the most researched). There really is no excuse for collaboration between your PCP and the chiropractic profession for the best interest of the patient, especially for the treatment of LBP.
Now there is even more proof! In the May 2018, on-line edition of the JAMA (Journal of the American Medical Association), a new studies found that “usual medical care plus chiropractic care reported a statistically significant improvement in low back pain intensity and disability at 6 weeks compared with those who received usual care alone.” In a study of 750 people, from the ages of 18-50, the addition of including chiropractic care documented statistically significant improvement included less reported pain, less disability, more patient satisfaction and less pain medications used. Across the board including chiropractic care reduced pain and suffering.The conclusion of this study states, “this trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines”. Note the words…as currently recommended in existing guidelines.
The number one cause of disability worldwide is LBP! At least 20% of Americans will have LBP lasting at least 1 day over the next 3 months. LBP is the 2nd reason why patients visit their PCP. The direct cost of LBP in 2010 was $34 billion, and adding in lost work and productivity costs the US economy up to $200 Billion. At the present time only 8-14% of the US population receives chiropractic care annually. So why aren’t PCPs referring to chiropractors. Getting historical, there have been excellent studies validating chiropractic care and multiple government reports recommend a greater utilization of chiropractic care.
As far back as 1993 the Ontario Ministry of Health published what is called the Manga Report. The Manga Report’s conclusion was to make chiropractors the gatekeepers for treating LBP for many reasons concluding: “On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain. Many medical therapies are of questionable validity or are clearly inadequate; there is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic (doctor-induced) complications for low back pain patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low back pain; and there is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management.”
Then in 1994, the US Agency on Health Care Policy and Research (AHCPR) released Clinical Guidelines for Management of Acute Low Back Pain. These Guidelines were created an expert panel to provide PCPs with recommendations on the assessment and treatment of LBP. Again the conclusions included:
• Conservative treatment such as spinal manipulation should be pursued in most before cases considering surgical intervention;
• Prescription drugs such as oral steroids, antidepressant medications and colchicine are not recommended for acute low back problems.
The benefits of chiropractic care both in human suffering level and economic savings is well documented and recommended by multiple government agencies. I still don’t understand why the chiropractic profession is not getting more referrals from the medical profession. Going back to the patient in the first paragraph, in her words she lost 2 years of her life and had lost hope of ever being able to function and doing the most basic activities like walking with her husband or sitting in a restaurant. My bias is that she should have been referred for chiropractic care after the pain lasted for 2 weeks while following her PCPs advice. When the pain persisted and multiple therapies failed, at the very least her PCP could have said I don’t know much about chiropractic health care, but since you are not feeling better why don’t you give it a try.
I don’t fault the present generation of medical doctors. Chiropractic care is not part of their educational curriculum. I have seen this first hand. For eight (8) years family practice residents first at University of Vermont and then Tufts had a one (1) day rotation at my office. I asked each resident in all your years of medical school and residency how much did they learn about chiropractic health care. The answer across the board was “nothing”. Then I’d ask how much did they learn about the musculoskeletal system? The answer across the board this time was “not much”. Then I’d ask my final question which was how many vertebrae are in the spine? In 8 years only 1 Family Practice Resident was able to rattle off the correct answer which is 24.
Then the medical resident spent the day with me watching me interact and treat my patients. At the end of the day across the residents would say how impressed they were. They didn’t realize the scope of chiropractic practice and the benefits of manipulation. My advice was always the same. When you finish your residencies and hang up your shingle to practice, meet a few chiropractors in your community, find one or two that you feel comfortable with and refer your patients to them. Unfortunately this type of rotation at a chiropractic office was and still is a rare event in the training of medical residents.
Hopefully you have read down this far. The only way your PCP is going to know about this new study (and historical guidelines) is if you share this article with them. Please email your PCP and attach this article. Ask if he/she has read the new JAMA study on the significant benefits of including chiropractic care in collaboration with “usual medical care” for patients with low back pain? If not the link is here: Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial
Sharing this article with your PCP this will help build bridges between the two professions and the winner is you, the consumer of health care.
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