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New research published in the May 28, 2005 British Medical Journal suggests that surgery to relieve chronic lower back pain is no better than intensive rehabilitation and nearly twice as expensive. The study did not look at the benefits of chiropractic care, but did compare patients who underwent surgery for lower back pain and those who had rehabilitation led by physiotherapists.

Dr. Jeremy Fairbank, an orthopedic surgeon and lead researcher at the Nuffield Orthopaedic Center in Oxford, England, along with his co-researchers studied 349 chronic back pain sufferers, defined as pain lasting more than 12 months. Of the 349 patients, 176 had spinal fusion surgery while the remainder underwent intensive rehabilitation involving exercises and cognitive behavioral therapy.

Dr. Fairbank stated, "This is strong evidence that intensive rehabilitation is a good thing to do for people with chronic back pain who are thinking about having operations." The researchers concluded that there was no evidence that surgery was any better than the rehabilitation they compared the surgery to. However, there was a big difference in price with the surgical expense being nearly twice as expensive according to the study.

Helen Campbell of the University of Oxford summed up the results by commenting, "In the short term, compared with intensive rehabilitation, surgical stabilization of the spine as first line treatment for chronic low back pain patients who have already failed standard non-operative care seems not to be cost effective."

Chiropractic Care Lowers Health Care Costs, Study Shows A study published in the October 11, 2004 issue of the Archives of Internal Medicine showed that including chiropractic care into health plans actually reduces the health care expenditures for those in the plan as well as reducing the overall cost to the insurance company for that plan.

This study was a retrospective claims data analysis, where the records of 700,000 people with chiropractic coverage in their plan were compared to another 1 million people who did not have chiropractic coverage. The utilization records were then compared for a 4-year period to see if there were any differences in usage and expenses.

The purpose of this study was to ascertain the effect access to chiropractic care would have on the overall usage of health care resources as well as neuromusculoskeletal-specific conditions, (such as back pain) within a large managed-care system. The study noted that back pain accounts for more than $100 billion in annual health care costs in the US and is the second leading cause of doctor visits and hospitalizations.

The results showed that chiropractic care reduced costs across the board. For instance, total health care expenditures for plan members with chiropractic insurance coverage, was on average $1463, compared to $1671 for those without chiropractic coverage. As expected, there were also savings for those with specific back pain problems. The study showed that less x-rays were needed, less MRIs taken, and considerably less hospitalizations were needed for the members in the plan that included chiropractic over those where chiropractic was not included.

Comparing the health plans that include chiropractic to the ones that do not, the study found that:

  • Chiropractic care cut the cost of treating back pain by 28%.
  • Chiropractic care reduced hospitalizations among back pain patients by 41%.
  • Chiropractic care reduced back surgeries by 32%.
  • Chiropractic care reduced the cost of medical imaging, such as X-rays orMRIs, by 37%.

Taking into account that this study was published in a medical journal, the stated conclusion was striking. The researchers concluded, "Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care. Systematic access to managed chiropractic care not only may prove to be clinically beneficial but also may reduce overall health care costs."

British Study Touts Benefits of Chiropractic A study released by the British, Medical Research Council (MRC) showed that Chiropractic and exercise was effective for patients suffering from lower back pain. The British study used the term spinal manipulation, (more correctly termed adjustments), which they noted is the primary form of care performed by Doctors of Chiropractic. The study, published in the November 19, 2004 edition of the British Medical Journal, stated that when combined with an exercise program, these two offer an effective treatment for those suffering from back pain.

The trial study recruited more than 1,300 patients from across the UK, whose back pain had not improved after receiving what they termed the best care in general medical practice. These patients were then compared and assessed to judge the effectiveness of three different types of care.

The three types of care were:

  • A class-based physical exercise program. Spinal manipulation
  • A combined package of spinal manipulation followed by a program of exercise The results showed that to varying degrees all patients in the treatment groups reported improved back function and reduced pain over time. They noted that patients assigned to exercise classes in addition to general practice care reported a small benefit at three months but not at one year.
  • Those assigned to spinal manipulation in addition to general practice care reported a small to moderate benefit at three months and a small, on average, benefit at one year. However, the greatest improvement was found in the patients assigned to combined manipulation and exercise in addition to general practice care

Chiropractic Helps Patients With Acute Back Pain and Sciatica with Disc Protrusion A new study from Italy published in the March issue of The Spine Journal, showed that chiropractic care was effective in helping patients with acute back pain and sciatica with disc protrusion. This randomized double-blind clinical trial involved 102 ambulatory patients with at least moderate pain or radiating pain, who had an MRI study showing disc protrusion.

The patients were divided into two groups. One group received chiropractic adjustments 5 days per week by experienced chiropractors, with a maximum of 20 visits. The second group received what the study termed, "simulated manipulations" in order to have a group for comparison to those receiving real chiropractic care.

The results showed that those who got the real chiropractic care improved significantly over the group that received the simulated manipulations. In the group that received the chiropractic care, 55% were free of radiating pain in the follow ups compared to 20% of patients who got the simulated manipulations. Additionally, when measuring local pain, 28% of those who received real chiropractic were free of local pain, versus only 6% of those who got the simulated manipulation.

The results also showed improvements in days of pain with the group that received the real care reporting 6 less days of pain than those in the simulated care group. In addition to these benefits the group with the real care reported using less medications to help with the pain as a result of the chiropractic care.

In this study none of the patients in either group had any adverse effects, and one from each group did report no results at all and were listed as "treatment failures". The researchers conclusions were, "Active manipulations have more effect than simulated manipulations on pain relief for acute back pain and sciatica with disc protrusion."

Study Shows Chiropractic Better Than Muscle Relaxants for Low Back Pain A study published in the July / August 2004 peer-reviewed scientific journal, "Journal of Manipulative and Physiological Therapeutics", compared the effects of chiropractic adjustments to muscle relaxants in a group of patients with subacute low back pain.

This study defined subacute low back pain as lower back pain (LBP) with a duration of 2 to 12 weeks. The study noted that in the United States the incidence of low back pain is as high as 75% to 85% of the population being affected at some time in their lives. On a yearly basis, the study noted that between 15% to 20% of the adult population can expect to experience LBP in any given year.

In the study, conducted at Life University in Georgia, 192 subjects with LBP from 2 to 6 weeks were separated into three groups. One group received Chiropractic adjustments with placebo medication. The second group received muscle relaxants with sham (fake) adjustments. The third group was a control group and received both placebo medication as well as the sham (fake) adjustments. Care was rendered to the group for a 4 week period with evaluations being done at the 2 week and 4 week marks.

Results were measured in terms of patient reported pain, severity, disability and depression, as well as measured flexibility and the patients self usage of over the counter acetaminophen (Tylenol). The results of this short study showed that for the two primary indicators of pain and severity, the chiropractic group did better than the other two groups. No significant differences were seen for disability, depression, flexibility, or acetaminophen usage across groups in a study of this short a period of time. All three groups showed improvement in the areas of depression, disability and drug usage.

The authors of the study did note that a longer study could have yielded more differences in recovery. However, in the area of pain, a primary patient concern in subacute LBP cases, the group that received the chiropractic adjustments faired the best. Their comments were: "Statistically, the chiropractic group responded significantly better than the control group with respect to a decrease in pain scores."

Chiropractors Help Pregnant Women With Pain The above headline comes from the August 14, 2007 issue of the Dallas Morning Star. In this article, Special Contributor Kathleen Green, starts off by stating, " Moms-to-be once resigned themselves to nine months of misery. But, frankly, they've had enough." She continues, " More women are exploring options and seeking alternatives to ease back pain, headaches, exhaustion and much more. One place many are finding relief is at a chiropractor's office."

The article follows several chiropractors and their pregnant patients and views their reasons for choosing chiropractic and their results. One such patient was Teresa Seymour, who started chiropractic treatment during her first pregnancy with her daughter who is now 2 years old. Teresa said, "If there were times when I could feel that I was starting to get sore in the back, I would go to the chiropractor." During her second pregnancy, she reported, "Just picking up my daughter could knock a hip a little bit the wrong way and kind of pinch a nerve," she says. "I went to [my chiropractor], and he'd adjust my back and my hips."

The article interviews Dr. Ken Wilson, a chiropractor who sees a lot of pregnant women in his practice and estimates that about 20 percent of his patients are pregnant. He stated, "My focus has changed more to pregnant moms and kids nowadays. My wife had to go through the constant low back [pain] and headaches and really being uncomfortable all of the time. I wanted to help her personally."

Chris Burfield, an educational director with Dr. Wilson added, "When spinal bones get pulled out of place, those bones push up against or irritate the nerves. Those nerves will start to send pain signals off to the brain to let the brain know there's a problem."

Sara Townsley, a former high school science teacher received chiropractic care two years ago during her first pregnancy. She recalled, "If I do a lot of cleaning, like bathroom cleaning where I'm bending over, when I'm pregnant, that's usually when I have my sciatica." She continued, "Ella [her daughter] really sat on my hips, and it helped to have them aligned regularly to relieve some pressure and nerve pinching."

The article also interviews a medical physician, Dr. Walter Evans, an obstetrician-gynecologist in private practice at Presbyterian Hospital of Dallas. According to the article, Dr. Evans acknowledges a chiropractor's potential in prenatal care, sometimes referring patients with lower back pain to chiropractors. He states, "I've had good luck working with some chiropractors with patients who have low back pain during pregnancy.

Chiropractic is Cost-Effective in Treating Chronic Back Pain The above is a direct quote from a headline that appeared in of all places, the November 17, 2005, Medical News Today. The article, also picked up by UPI news and several other sources, was reporting on a new study published in the October 2005 issue of the scientific journal, The Journal of Manipulative and Physiological Therapeutics (JMPT).

In this study 2780 patients with mechanical low-back pain referred themselves to 60 doctors of chiropractic and 111 medical doctors. These cases were reviewed for effectiveness of care and for costs. One of the articles noted that back pain care in the United States alone is estimated to reach $48 billion this year, and, at any given time, 80 percent of the U.S. population suffers from back pain.

The results of the study showed several interesting facts. With regards to the outcomes, the study showed that both the acute and chronic patients showed better outcomes in pain and disability reduction and higher satisfaction with their care after undergoing chiropractic care, as compared to medical care.

The costs of the care for the medical and chiropractic showed different results depending on the usage. Without adding the costs of any over-the-counter drugs, hospitalization, or surgical costs, when you simply compared the costs of in-office chiropractic to in-office medical care, the chiropractic care was slightly more expensive. If you then add in the additional costs for any referrals made by the chiropractor or the medical doctor, the chiropractic care costs for chronic patients were then 16 percent lower than medical care costs.

The authors of the study, noting that the satisfaction for the chiropractic care was higher, and the overall total costs were lower, made a concluding statement urging more chiropractic utilization in the health care system. They stated, "With their mission to increase value and respond to patient preferences, health care organizations and policy makers need to reevaluate the appropriateness of chiropractic as a treatment option for low-back pain."

Chiropractic Research

Numerous studies have shown that chiropractic treatment is both safe and effective. The following are excerpts from a few of the more recent studies. By examining the research supporting chiropractic care, you will find that chiropractic offers tremendous potential in meeting today's health care challenges.

For Acute and Chronic Pain

"Patients with chronic low-back pain treated by chiropractors showed greater improvement and satisfaction at one month than patients treated by family physicians. Satisfaction scores were higher for chiropractic patients. A higher proportion of chiropractic patients (56 percent vs. 13 percent) reported that their low-back pain was better or much better, whereas nearly one-third of medical patients reported their low-back pain was worse or much worse."

- Nyiendo et al (2000), Journal of Manipulative and Physiological Therapeutics

In a Randomized controlled trial, 183 patients with neck pain were randomly allocated to manual therapy (spinal mobilization), physiotherapy (mainly exercise) or general practitioner care (counseling, education and drugs) in a 52-week study. The clinical outcomes measures showed that manual therapy resulted in faster recovery than physiotherapy and general practitioner care. Moreover, total costs of the manual therapy-treated patients were about one-third of the costs of physiotherapy or general practitioner care.

-- Korthals-de Bos et al (2003), British Medical Journal

In Comparison to Other Treatment Alternatives "Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction; clinically important differences in pain and disability improvement were found for chronic patients."

- Haas et al (2005), Journal of Manipulative and Physiological Therapeutics

"In our randomized, controlled trial, we compared the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner in patients with nonspecific neck pain. The success rate at seven weeks was twice as high for the manual therapy group (68.3 percent) as for the continued care group (general practitioner). Manual therapy scored better than physical therapy on all outcome measures. Patients receiving manual therapy had fewer absences from work than patients receiving physical therapy or continued care, and manual therapy and physical therapy each resulted in statistically significant less analgesic use than continued care."

- Hoving et al (2002), Annals of Internal Medicine

For Headaches

"Cervical spine manipulation was associated with significant improvement in headache outcomes in trials involving patients with neck pain and/or neck dysfunction and headache."

-- Duke Evidence Report, McCrory, Penzlen, Hasselblad, Gray (2001)

"The results of this study show that spinal manipulative therapy is an effective treatment for tension headaches. . . Four weeks after cessation of treatment . . . the patients who received spinal manipulative therapy experienced a sustained therapeutic benefit in all major outcomes in contrast to the patients that received amitriptyline therapy, who reverted to baseline values."

-- Journal of Manipulative and Physiological Therapeutics, Boline et al. (1995)

Cost Effectiveness

"Chiropractic care appeared relatively cost-effective for the treatment of chronic low-back pain. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulative efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis."

- Haas et al (2005), Journal of Manipulative and Physiological Therapeutics

Patient Satisfaction

"Chiropractic patients were found to be more satisfied with their back care providers after four weeks of treatment than were medical patients. Results from observational studies suggested that back pain patients are more satisfied with chiropractic care than with medical care. Additionally, studies conclude that patients are more satisfied with chiropractic care than they were with physical therapy after six weeks."

-- Hertzman-Miller et al (2002), American Journal of Public Health

Popularity of Chiropractic

"Chiropractic is the largest, most regulated, and best recognized of the complementary and alternative medicine (CAM) professions. CAM patient surveys show that chiropractors are used more often than any other alternative provider group and patient satisfaction with chiropractic care is very high. There is steadily increasing patient use of chiropractic in the United States, which has tripled in the past two decades."

- Meeker, Haldeman (2002), Annals of Internal Medicine