Lower Back Pain Study


		CHIROPRACTIC MANAGEMENT OF LOW BACK PAIN A study funded by the Ontario Ministry of Health (Canada) Published August 17, 1993 A review of the evidence
	EFFECTIVENESS 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 lower back pain. ... the percentage of chiropractic patients who were “very satisfied” with the care they received for low back pain was three times higher than that for patients of family physicians. There should be a shift in policy now to encourage the utilization of chiropractic services for the management of LBP, given the impressive body of evidence on the effectiveness and comparative cost effectiveness of these services, and on high levels of patient satisfaction. Chiropractors treat patients with many conditions, often in an apparently competent and cost-effective manner. In our review, we came across many studies that support the effectiveness of chiropractic care for headache and migraine, neck pain, referred and radiating pain, and a variety of other ailments. SAFETY Chiropractic manipulation is far safer than medical care for lower back pain. A review of educational programs suggests that chiropractors are not only the practitioners best qualified to perform spinal manipulation, but they are also the only ones who generally receive adequate training to do so. There is also some evidence in the literature to suggest that manipulations are less safe and less effective when performed by non-chiropractic professionals. BED REST ...rest, particularly prolonged bed rest, may be the most harmful treatment ever devised and a potent cause of iatrogenic (i.e. doctor caused) disability. The most commonly prescribed medical treatment for LBP is bed rest and medication. COST EFFECTIVENESS There seems to be a comprehensive body of evidence, which can fairly be described as overwhelming, for the cost-effectiveness of chiropractic over medical management of patients with low back pain. ... there was “little doubt that medical treatment for patients with comparable diagnostic codes is considerably more costly than chiropractic treatment.” There would be highly significant cost savings if more management of LBP was transferred from physicians to chiropractors. By every test of cost and effectiveness, the general weight of evidence shows chiropractic to provide important therapeutic benefits, at economical costs. Additionally, these benefits are achieved with apparently minimal, even negligible impacts on the costs of health insurance. A very good case can be made for making chiropractors the gatekeepers for management of low back pain in the worker’s compensation system in Ontario. RECOMMENDATIONS Chiropractic services should be fully integrated into the health care system. Hospital privileges should be extended to all chiropractors for the purposes of treatment of their own patients who have been hospitalized for other reasons, and for access to diagnostic facilities... Perhaps the most important change the government should initiate immediately is offer full coverage under the Ontario Health Insurance Plan for the cost of chiropractic care for patients with low back pain.