As stated last month, the prevalence
of low back pain (LBP) is REALLY high! In fact, it’s the second most common
cause of disability among adults in the United States (US) and a very common
reason for lost days at work. The total cost of back pain in the US, including
treatment and lost productivity, ranges between $100 billion to $200 billion a
year! Is low back pain on the rise, staying the same, or lessening? Let’s take
a look!
In the past two decades, the use of
health care services for chronic LBP (that means LBP > 3 months) has
substantially increased. When reviewing studies reporting insurance claims
information, researchers note a significant increase in the use of spinal injections,
surgery, and narcotic prescriptions. There has been an increase in the use of
spinal manipulation by chiropractors as well, along with increased physical
therapy services and primary care physician driven non-narcotic prescriptions.
In general, LBP sufferers who are chronic (vs. acute) are the group using most
of these services and incurring the majority of costs. The reported utilization
of the above mentioned services was only 3.9% in 1992 compared to 10.2% in
2006, just 11 years later. The question now becomes, why is this? Possible
reasons for this increase health care use in chronic LBP sufferers may be: 1)
There are simply more people suffering from chronic LBP; 2) More chronic LBP
patients are deciding to seek care or treatment where previously they “just
accepted and lived with it” and didn’t pursue treatment; or, 3) A combination
of these factors. Regardless of which of the above three is most accurate, the
most important issue is, what can we do to help chronic back pain
sufferers?
As we’ve discussed in the past, an
anti-inflammatory diet, exercise within YOUR personal tolerance level, not
smoking, getting enough sleep, and obtaining chiropractic adjustments every two
weeks are well documented methods of “controlling” chronic LBP (as there really
ISN’T a “cure” in many cases). You may be surprised to hear that maintenance
care has good literature support for controlling chronic LBP. In the 8/15/11
issue of SPINE (Vol. 36, No. 18, pp1427-1437), two Medical Doctors (MDs) penned
the article, “Does Maintained Spinal Manipulation Therapy for Chronic
Nonspecific Low Back Pain Result in Better Long-Term Outcomes?” Here, they took
60 patients with chronic LBP (cLBP) and randomly assigned them into one of
three groups: 1) 12 treatments of sham (fake) SMT (spinal manipulation) have
over a one month period; 2) 12 treatments, over a one month period but no
treatment for the following nine months; or 3) 12 treatments for one month AND
then SMT every two weeks for the following nine months. To measure the differences
between the three groups, they measured pain, disability, generic health
status, and back-specific patient satisfaction at baseline, 1-, 4-, 7-, and
10-month time intervals. They found only the patients in the second and third
groups experienced significantly lower pain and disability scores vs. the first
group after the first month of treatments (at three times a week). BUT, only
the third group showed more improvement at the 10-month evaluation. Also, by
the tenth month, the pain and disability scores returned back to nearly the
initial baseline/initial level in group two. The authors concluded that, “To
obtain long-term benefit, this study suggests maintenance SM after the initial
intensive manipulative therapy.” Other studies have reported fewer medical
tests, lower costs, fewer doctor visits, less work absenteeism, and a higher
quality of life when maintenance chiropractic visits are utilized. The question
is, WHEN
will insurance companies and general practitioners start RECOMMENDING
chiropractic maintenance care for chronic LBP patients?
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