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Chiropractic Research Review

Maintenance Care for the Spine Reduces Low Back Pain, Disability Levels

It is estimated that in the United States, the annual costs associated with the treatment of low back pain (LBP) total approximately $100 billion. High recurrence rates and chronic disability are believed to play a large role in the overall cost of back pain; studies have shown that only a fraction of low-back pain patients remain pain free and recover completely from the disabilities associated with LBP, even one year after the problem first occurred.

One possible way to reduce the long-term effects of LBP pain is maintenance care (or preventive care), a form of treatment commonly prescribed by doctors of chiropractic. However, few, if any, studies have investigated the role maintenance care can play in reducing pain and disability associated with chronic LBP.

In this Journal of Manipulative and Physiological Therapeutics study, 30 patients with chronic, nonspecific low back pain lasting at least six months were separated into two groups. The first group received 12 treatments (three treatments per week, consisting of side-posture manipulations of the lumbar and sacroiliac joints) over a one-month period, but no treatments for the subsequent nine months. The second group also received 12 treatments over a one-month period, along with "maintenance spinal manipulation" every three weeks for the following nine months. To determine any difference between therapies, the authors measured pain and disability scores at baseline, and at one-month, four-month, seven-month and 10-month intervals.

Results: Patients in both groups experienced significant decreases in low back pain scores after the first series of treatments. According to the scientists, "the initial intensive phase of treatments yielded a significant reduction of 21 mm on the pain scale." The greatest difference, however, was seen in disability scores over the duration of the study. Analysis of the data showed that in patients who received maintenance spinal manipulation, "the disability scores were significantly lower after the 10-month period than before the initial phase of treatment" - an average of 16.6 points lower per patient. In the other group, however, "the mean disability scores went back to their pretreatment level."

Based on the results, the researchers concluded: "This study appears to confirm previous reports showing that LBP and disability scores are reduced after spinal manipulation. It also shows the positive effects of preventive chiropractic treatment in maintaining functional capacities and reducing the number and intensity of pain episodes after an acute phase of treatment. Maintenance chiropractic care involving spinal manipulation combined with other treatment modalities (exercises, pain management program) should be investigated. Such combined interventions may have a critical influence on pain, disability, and return to work."

Descarreaux M, Blouin JS, Drolet M, et al. Efficacy of preventive spinal manipulation for chronic low-back pain and related disabilities: a preliminary study. Journal of Manipulative and Physiological Therapeutics, October 2004;27(8):509-514.

Chiropractic Research Review

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