Question
Hi, my husband has suffered from back pain more or less continuously for 6 years, he often has tingling and itching sensations in his legs and has limited movement.  He was initially hospitalised when his back went at work while lifting a computer but was released with no treatment other that pain killers which he has been on for years now (tilex and brufen initially and now cocodimal and diclophenac).  He has been advised by his doctor that a chiropractor wont be able to help him as his problem is muscular, instead he arranged for him to have core stability exercise sessions with an instructor to try and improve things.  Since my husband has been doing this his lower spine has started to make really loud popping noises when he moves and he is in more pain.  He has never been xrayed or scanned and i am worried that he isn't being given the correct treatment or even been diagnosed properly instead they just give him more pills.  Please can you give me your opinion of what might improve things for him, do you think a chiropractor or acupuncture might help?

Answer
Dear Sarah,

Sorry to say this, but you are like many other people, and the answers you have been given are common.  The medical doctors couldn't help your husband, so they just send you on your way with pain meds and tell you that a chiropractic physician can't help either...and they didn't even give you a diagnosis!  Sad and unfortunate, but I see this all the time.  Most medical physicians do not know how to properly diagnose or manage musculoskeletal conditions...as a matter of fact The journal of the American Medical Association published a study on this problem a few years ago and confirmed what I have just stated.  Here is the other problem...your physician doesn't know anything about chiropractic care...it really is unfortunate.

Concerning your husbands condition, it will be harder to treat due to the fact that it has been an ongoing problem, and the pain meds he has been prescribed will do nothing to help the problem, only cover up some of the symptoms, and have been proven to cause gastrointestinal bleeding as well as other co-morbidities.

Conversely, chiropractic physicians are specialists in musculoskeletal dysfunction, pain, and biomechanics of the spine...we are the experts when it comes to back pain, not to mention we have the best education in that field.  But don't take my word for it, check out the below research:

The Manga Report
The Ontario Ministry of Health commissioned Manga Report represents the largest analysis of scientific literature on the most effective and cost effective treatments for low back pain. After reviewing all of the international evidence on the management of low back pain, lead investigator Pran Manga, Ph.D., found the treatments provided by Doctors of Chiropractic were exceptionally safe - much safer than for standard medical treatments of similar conditions.

"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."

"Indeed, several existing medical therapies of low back pain are generally contraindicated on the basis of the existing clinical trials. There is also some evidence in the literature to suggest that spinal manipulations are less safe and less effective when performed by non-chiropractic professionals."

"Chiropractic manipulation is safer than medical management of low back pain. Chiropractic management is greatly superior to medical management in terms of scientific validity, safety, cost-effectiveness and patient satisfaction."

The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) - University of Ottawa, Canada.

The Agency on Health Care Policy and Research Study
On December 8, 1994, the Agency for Health Care Policy and Research (AHCPR) of the US Department of Health and Human Services released Clinical Practice Guidelines for the management of acute low back pain. Their guidelines were developed after extensive study of diagnostic and treatment methods for acute low back pain.

The guidelines were created by the AHCPR panel to provide primary care clinicians with information and recommended strategies for the assessment and treatment of acute low back problems. The AHCPR panel was made up of 23 members consisting of medical doctors, chiropractic physicians, nurses, experts in spinal research, physical therapists, an occupational therapist, a psychologist, and a consumer representative.

Their findings included:
The risk of serious complications from lumbar spinal manipulation is rare.
Conservative treatment such as spinal manipulation should be pursued in most cases before considering surgical intervention.
Prescription drugs such as oral steroids, antidepressant medications and colchicines are not recommended for acute low back problems.
Acute Low Back Problems in Adults. Clinical Practice Guidelines. Bigos S, et al. Agency for Health Care Policy and Research Publication No. 950642 (1994) - U.S. Department of Health and Human Services.

The New Zealand Commission Report
The government of New Zealand published a 377 page report which assessed the efficacy and safety of chiropractic care. The report was a result of almost 2 years of conducted hearings from recognized health care experts.

Principal findings:
"Chiropractors are the only health practitioners who are necessarily equipped by their education and training to carry out spinal manual therapy (spinal adjustments)."
"Chiropractors carry out spinal diagnosis and therapy at a sophisticated and refined level."
"Spinal manual therapy in the hands of a registered chiropractor is safe."
"The duration and training of a registered chiropractor is sufficient to enable him/her to determine whether there are contraindications to spinal manual therapy in a particular case, and whether that patient should have medical care instead of, or as well as, chiropractic care."

The U.S. Agency for Health Care Policy and Research
In 1994, The United States Agency for Health Care Policy and Research reviewed the many different care options for acute low-back pain. The research panel was looking at what would produce functional improvements as well as symptomatic improvements. They looked at over 100 studies that related to spinal manipulation, which is the non-specific, medical term used for Chiropractic adjustments. The Agency concluded Chiropractic Care was very helpful for people suffering from acute low-back pain. Chiropractic was the only option studied found to provide both symptomatic improvement and restoration of functional stability. The research panel included medical doctors, osteopaths, nurses and physical therapists. There were no chiropractors included on the panel.

Low Back Pain
In 1997 The British Journal of Bone and Joint Surgery found that a single chiropractic adjustment caused immediate significant changes in the reflexes of patients with disk herniation. The authors reported that "It may be concluded that spinal [adjustments] may promote relief from [abnormal nerve function] by the offending disk herniation."

The May 15, 1997 issue of Spine reports on a study that shows nearly 1 in 5 fourteen-sixteen year-olds have back pain and many of them report that the pain is chronic. 18 percent of the 14-16 year olds reported back pain that interfered with school work or leisure activities during the previous 12 months. 26 percent of the boys and 33 percent of the girls reported that the pain was recurrent or chronic. It should be noted that as the children got older, the incidents of pain increased. The authors concluded that a significant part of the low back pain children report is recurrent or chronic by the time they are 14. Chiropractic Physicians have always encouraged early detection and correction of spinal problems before they become chronic. This study shows that spinal problems do indeed start early in life and if they go uncorrected, get worse.

Fibromyalgia (Chronic Pain)
The May 2000 issue of the Journal of Manipulative and Physiological Therapeutics reports that 60 percent of a group of patients with Fibromyalgia responded very well to chiropractic care. The patients in the study had Fibromyalgia for more than 3 months and were adult members of a regional Fibromyalgia association. Each participant was adjusted during 30 visits with self-administered assessments taken at the beginning of the study, after 15 visits, 30 visits and 30 days after completion of the study. Researchers were looking for improvement in three areas: Pain Intensity, Fatigue Level, Sleep Quality. 15 women completed the trial. 9 of them (60%) were classified as "respondents". Respondents were those participants who experienced at least a 50 percent improvement in pain intensity over the course of the study. After 30 visits, the respondents showed an average lessening of 77.2 percent in pain intensity and an improvement of 63.5 percent in sleep quality and 74.8 percent in fatigue level. The improvement in all three areas continued after 1 month without chiropractic care.

A similar study in 1986 and reported in the American Journal of Medicine found that 45.9 percent of people who had Fibromyalgia and went to a chiropractor experienced moderate to great improvement. In the same study, anti-depressant medication benefited only 36.3 percent of those studied and exercise was limited to a 31.8 percent rate of improvement.

Whiplash
In 1996, a retrospective Study on 28 chronic whiplash patients was reported in the journal Injury; 27(9). Their initial treatments included anti-inflammatories, soft collars, and physiotherapy. These patients were referred for Chiropractic adjustments at an average of 15.5 months (range 3-44 months) after their initial injury. Chiropractic treatment included "specific spinal manipulation, proprioceptive neuromuscular facilitation and cryotherapy. Spinal manipulation is a high-velocity low-amplitude thrust to a specific vertebral segment aimed at increasing the range of movement in the individual facet joint, breaking down adhesions and stimulating production of synovial fluid." Following Chiropractic treatment, 93 percent of the patients had improved." The results of this retrospective study would suggest that benefits can occur in over 90 percent of patients undergoing chiropractic treatment for chronic 'whiplash' injury."

The Journal of Orthopaedic Medicine 21(1) in 1999 investigated if patients with chronic whiplash would benefit from chiropractic treatment. The 93 patients all underwent spinal manipulation performed by a chiropractic physician. Referral for chiropractic treatment was a mean of 1.2-7 months (0-82 months) after injury. Patients were in 3 groups according to severity of injury, and underwent a mean of 19.3 treatments (range 1-53) over a period of 4.1 months. Results: Group 1, (50 patients), 36 patients (72%) gained benefit from chiropractic spinal adjustments, 12 (24%) became asymptomatic, and 12 (24%) improved by 2 grades. Group 2, (32 patients), 30 patients (94%) responded positively to chiropractic manipulation with 12 (38%) becoming asymptomatic and 13 (43%) improving by two grades. [This is a remarkable response considering these patients had neurological involvement.] Group 3, (11 patients), with severe symptomatology, 3 (27%) improved following chiropractic treatment and 1 improved by two grades. The authors concluded that Chiropractic is the only proven effective treatment in chronic cases.

Obviously, I think that you should seek out the care of a good chiropractic physician in your community, and maybe you should copy some of the research I have presented and give it to your medical physician so he may become better informed.  Lastly Sarah, I have included a link for you to appreciate the similarities of a chiropractors education in comparison to a medical doctors...i think it is important for you to see that we actually complete more coursework than our medical counterparts...especially in the realm of diagnosis and orthopedics.  please see below:

http://suncoasthealthcare.net/chiropracticinformation/chiropracticeducation.html

Good luck with your husband's care.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net