Dr. Gray's Straight Talk

Honest and blunt healthcare discussion and advice.

Chiropractic vs. Medical for Low Back Pain

Posted by Dr. Gray on Monday, April 27, 2009

Among low back pain (LBP) sufferers who seek the services of a health care provider, an estimated 70% choose either a medical doctor or a doctor of chiropractic for care. In this study designed to compare the relative effectiveness of chiropractic vs. medical management of LBP patients, 2,870 adult patients with low back pain of mechanical origin (acute or chronic) were enrolled over a two-year period from the practices of 51 chiropractic clinics and 14 general practice community clinics in the area surrounding Portland, Oregon. At baseline and at various intervals over the next four years, patients rated the intensity of their current pain levels on a pain scale of 0-100, and completed a questionnaire designed to measure the effects of their pain on functional disability.

Results: The greatest degree of improvement was seen within three months of the initial treatment of back pain, with a “modest advantage” seen for chiropractic care over medical care of chronic pain patients in the first 12 months. At the one- and three-month intervals, “clinical importance” was achieved with chiropractic care administered to chronic LBP patients; comparing chiropractic vs. medical care, the average difference in pain scores was 12.2 points at one month and 10.5 points at three months, favoring chiropractic care.

In a separate analysis that categorized differences in care by leg pain, “a potentially clinically important advantage” for chiropractic care in chronic patients with pain radiating below the knee was also seen in the first 12 months following care. In this case, again comparing chiropractic vs. medical care, average differences in favor of chiropractic ranged between 18.3 points and 21.7 points in the first year for pain, and between 9.0 points and 13.9 points over the first three years for disability, using the pain scale.

“Our study supports the generalizability of systematic reviews of the efficacy of spinal manipulation for pain and functional disability to the effectiveness of chiropractic care in clinical practice,” the authors noted in their conclusion. “In terms of relative effectiveness, chiropractic care demonstrated advantage over medical care for chronic patients in the first year, particularly for those with leg pain radiating below the knee.”

Haas M, Goldberg B, Aickin M, et al. A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up. Journal of Manipulative and Physiological Therapeutics 2004;27:160-169.

Dr. Gray’s Comments: Most of you know that I have developed a great working relationship with the local medical community… I am not an anti-medical kinda guy. There are times and conditions when traditional medicine is the treatment of choice. However, there are also times when chiropractic should be the first treatment of choice. Volumes of research have proven this case with regards to lower back pain. There have been many recent studies showing the same superior effectiveness with regards to neck pain and headaches, as well. As we become more inquisitive about ways to decrease the cost of health care, increasing amounts of research are proving the effectiveness and cost savings associated with chiropractic and other natural, non-invasive forms of treatment.

Not sure where I heard the following comparison, but I’ve always liked it. It’s not negative towards medicine, but sheds a little light on the differences in philosophy between chiropractic and medicine:

The conflict between medicine and chiropractic can be summed up quite simply:

  • Medicine believes that disease causes a lack of health.
  • Chiropractic believes that a lack of health is expressed as disease.

Therefore, Medicine treats “the disease,” while chiropractic addresses causes for a lack of health. Medicine primarily treats the symptoms of sick people, and Chiropractic primarily tries to treat the cause which has led to the symptoms.


8 Responses to “Chiropractic vs. Medical for Low Back Pain”

  1. cmnacnud said

    These are great studies. It is great to keep pointing them out because they are not yet common knowledge. I can only hope that when they are common knowledge the referrals will be just as common as the knowledge.

    If someone comes into my practice with back pain and I find out it’s because of their kidneys I would send them over to one of my MD friends, because kidney infections or disease of any kind is not my expertise. I may treat them concurrently to help their body be at it’s best to heal its self. But I would not manage a kidney issue.

    When a patient goes into an emergency room with whiplash, after the ER rules out fractures and all that they can effectively treat they should have the same thought that I had about kidneys, hey this isn’t my area of expertise I should send them to a chiropractor. I dream of the day when that is common.

    Till then keep finding these studies and posting them Dr. Gray. I was actually at WSCC when they put this one out. It was exciting news throughout the school then.

  2. I think both are important. Chiropractic back pain treatment is effective like conventional medicine in relieving pain. Chiropractic care naturally reduces the stress on the muscles, allowing them to loosen and this also reduces the pressure on the bones. Many sicknesses can be treated with chiropractic. I believe in chiropractic treatment as it is really works. Consulting Back Pain Doctor Bergen County, New Jersey for chiropractic care.

    • Dr. Gray said

      Dr. Dorkin,

      Beyond relieving stress on muscles and bones, chiropractic improves the overall function of the neuromusculoskeletal system. By removing interference from the normal function of body processes, healing is facilitated and optimized. However, I think the benefits of chiropractic care go beyond the mere application of chiropractic and physiotherapeutic treatment.

      Due to our emphasis on the entire body as a whole, and our philosophical differences, chiropractors are more apt to engage in instruction and monitoring of home exercise/stretching regimens, proper biomechanics, proper nutrition, and spiritual/mental well-being. This is not universal, of course, but frankly, most MD’s do not have the time nor expertise to address these issues. I don’t want that to sound like I am diminishing the capabilities or education of MD’s, I only seek to point out a distinction in practice focus and specialty.

      Thank you for your comments.

  3. John Peak said

    Nice article! I think I will forward this on to my chiropractor if you don’t mind.

  4. […] Chiropractic vs. Medical for Low Back Pain […]

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