By Dr. Scott Rosenthal
It’s no secret that doctors of chiropractic and doctors of medicine have not always seen eye to eye. Go back several decades and the relationship may have been better characterized as hostile. Times are changing and chiropractic is gaining greater popularity as the medical community begins to see the same value in chiropractic care that patients have been enjoying for over a century. This has never been as evident as with the recent publication of the American College of Physicians (ACP) guidelines for treating low back pain in the prestigious Annals of Internal Medicine.
The American College of Physicians is the medical society for internal medicine specialists and the largest medical-specialty society in the world with 148,000 members. Back pain is one of the most common reasons for doctor visits and a leading cause of disability and lost time from work. It is also a condition for which patients frequently receive prescription medication—even those that are highly addictive and riddled with potential side-effects. Back pain accounts for hundreds of thousands of surgeries each year, many of which are avoidable and unnecessary. The cost of back pain on the American health care system is astronomical and partly why we suffer from such expensive health care costs.
The new ACP recommendations, based on the scientific evidence, encourage physicians and patients to seek NON-DRUG care such as that found commonly in chiropractic offices. According to the ACP president, Nitin S. Damle, MD, “Physicians should avoid prescribing unnecessary tests and costly and potentially harmful drugs, especially narcotics, for these patients.” The ACP guideline list includes spinal adjustments (“manipulation”), massage, low level laser therapy, exercise, yoga and stress reduction techniques.
How common is back pain?
Roughly one quarter of U.S. adults have experienced back pain lasting a minimum of one day over the past three months. Add in the hordes of children and young adults carrying heavy backpacks and hunching over school desks and hand-held electronics, and the number is larger. For many of the young athletes that I see (from dancers to football players), it is evident that the prevalence and severity of back pain can rival that seen in the older population. Back pain does not seem to discriminate between age, gender or level of activity.
How do other treatments compare to chiropractic care?
According to the medical Journal, The Back Letter (under the leadership of Executive Editor, Sam W. Wiesel, MD, Professor and Chairman, Department of Orthopaedic Surgery at Georgetown University Medical Center), up to 50 percent of back pain sufferers are prescribed an opioid. The January 2015 issue to states:
“Opioid therapy is causing grave harm to patients and to society”
“Opioids are impeding the effective treatment of low back pain”
Over 250,000 people elect to have the common back surgery, lumbar microdiskectomy, each year. This procedure consists of the surgical removal of a piece of the disk that is sandwiched between the spinal bones. A study published in the Journal of Manipulative and Physiological Therapeutics compared chiropractic care to lumbar microdiskectomy surgery. The results demonstrate why there is serious concern that many surgeries can and should be avoided:
60 percent of the patients who were considered surgical candidates improved EQUALLY with chiropractic care as those who received surgery
The research also found that the patients who eventually needed surgery had equal results, even when the surgery was delayed by undergoing chiropractic care first. In other words, it was fine to wait and try chiropractic first. The study's authors concluded that chiropractic care should be considered as a first line of care for herniated lumbar discs that cause sciatica.
Another study looking at nearly 2,000 state workers from Washington State over a three-year period found that surgical rates are greatly dictated by where the patient with back pain goes first for care.
43% of workers who saw a surgeon first got surgery
1.5% of workers with the same condition who saw a chiropractor first got surgery
Simply put, if you have back pain and you go see a surgeon first instead of a doctor of chiropractic, you just increased your chance for getting surgery by 29 times.
According to the American Medical Association, the U.S. health care system spends about as much each year on spine problems as it does on cancer, with a price tag of $87.6 billion each year! Add in lost productivity and missed time from work and this number climbs to $100 billion. 75 percent of spine care expense is associated with surgery, imaging, prescriptions, injections, evaluations and emergency room visits. These numbers are not only causing a serious burden on our nation’s budget, but adversely affecting the costs paid by you and your family for insurance.
Medical care, dominated by the use of drugs and surgery, is failing in the treatment of back pain. There has long been a misdirected focus on treating the symptoms and not the underlying condition. Back pain is often the result of your spinal and pelvic bones being out of alignment with muscular, connective and nerve tissue involvement. There are often areas that are fixated and inflexibly coupled with adjacent areas that are too moveable and unstable. To stabilize and prevent further injury (particularly to the delicate nerves that exit your spine), nature provides pain, inflammation and/or muscle spasms. These unpleasant reactions of your body are better thought of as an intelligent response used to compensate for an underlying problem rather than just a bunch of symptoms that need to be suppressed with drugs.
Of greater concern, masking symptoms with over-the-counter or prescription drugs can allow for the problem to worsen. It’s no different than muffling the ringing alarm during a fire. Ignore it and it will not go away! Consequences may be dire and end with harmful side-effects, addiction or unnecessary surgery.
Chiropractic: The lower-cost, drug-free, non-surgical option
Chiropractic care focuses on the causes of back pain. Correct the underlying issue and the pain, inflammation and spasms cease to exist once normal functions and balance is restored. Chiropractic has not only been shown to be successful, but costs less and reduces recurring back pain episodes down the road. Best of all, chiropractic is drug-free, prevents surgery and is among the safest forms of health care available.
Despite years of friction between the chiropractic and medical professions, the ACP guidelines are beginning to show that old tensions are softening. This is good news for patients, health care budget experts, and a society concerned about the harm and addictions associated with prescription medications.
I think I can speak on behalf of the chiropractic profession and state that we are more excited than ever to see other doctors appreciating and recognizing the value of the services we provide. We are particularly happy that our natural approach to healing will continue to grow and help all of you live a more comfortable, happier and fuller life!
Annals of Internal Medicine, 14 FEBRUARY 2017
J Manip Physiol Ther 33:576 (2010)
Spine (Phila Pa 1976). 2013 May 15;38(11):953-64
Journal of the American Medical Association. 2008; 299(6):656–664
Journal of the American Medical Association. 2016; 316 (24): 2627
Data retrieved from the UnitedHealthcare national commercial claims database, July 1, 2013−June 30, 2014. November 10, 2014
Journal of Occupational Rehabilitation, Volume 39, Issue 4, Pages 263–266 (May 2016)