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Chiropractic Research Review

Do DCs and MDs Manage the Same Types of Low Back Pain Patients?

Understanding the various characteristics of patients with chronic low back pain (LBP) that present to the chiropractor's office may assist with better patient management. Chronic low back pain sufferers are among those who account for the greatest usage of health care resources.

Primary care medical physicians (MD) and chiropractic physicians (DC) treat most of these patients.

To observe patient characteristics and physician practice activities for patients with chronic LBP treated by DCs and MDs, a practice-based study has been conducted. Fourteen general medical practices and 51 DC community-based clinics examined 2,945 patients with LBP of mechanical origin; 835 experienced chronic LBP. Patients were followed for 12 months. The results showed that MDs treated younger patients who had lower incomes; care was often paid for by a third party; baseline pain and disability were slightly greater. Patients treated by MDs had one fourth as many visits as patients treated by DCs. The primary treatment approach were prescription medications by MDs and spinal manipulation by DCs. Physiotherapy, self-care education, exercise, and postural advice were characteristics of low back pain management in both provider groups. The majority of patients experienced recurrences of low back pain (patients treated by MD physicians, 59.3%; patients treated by DC physicians, 76.4%). Only 6.7% of patients treated by MDs and 10.9% treated by DCs reported one resolved episode during the year.

Conclusion: Differences in sociodemographics, pain intensity, and functional disability may characterize patients with chronic low back pain seeking care from primary care MD physicians from those seeking care from DC physicians. Although the primary treatment modalities differ, the practice activities of MD physicians and DC physicians have much in common. Long-term results suggest that chronic back pain is difficult to treat for both provider types.

Nyiendo J, Haas M, Goldberg B, et al. patient characteristics and physicians' practice activities for patients with chronic low back pain: a practice-based study of primary care and chiropractic physicians. Journal of Manipulative and Physiological Therapeutics 2001:24(2), pp. 92-99. Reprints: Tel: (800) 325-4177 (ext.4350); Fax: (314) 432-1380.

Chiropractic Research Review

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