Hope for Chronic Pain

doctor-said-it-would-go-away-2-flip[originally published in KCN, June 2005]

Pain, in its purest form, serves a very definite purpose:  it acts as sign, or a signal, to alert us of a problem.  It also serves to prevent us from doing things that would, perhaps, make our problem worse.  So pain, in a weird kind of way, is a “good” thing.  But what about pain “gone bad”  — pain that doesn’t go away or comes and goes on an all too regular basis?  Well, at the risk of sounding trite, then the pain really is a “pain.”  And what escalates this “pain” even more is that its one of the biggest challenges practitioners across the health care spectrum face on a daily basis.  We label it “chronic pain.”  Plaguing  approximately 35% of our country, chronic pain is responsible for categorizing 50 million Americans as partially or totally disabled.  What’s more, we don’t really have an adequate way of explaining it or even identifying its true source, let alone finding effective ways to treat it —  not a very comforting thought for those buried under a mountain of chronic pain.  And while all this may seem dismal, a couple of researchers from “Down Under” have very good reason to offer hope of an effective treatment option that just might help make pain “gone bad”… gone.

Assuming that most readers of this column do not have issues of the medical journal Spine laying around on their coffee tables, let me tell you about this very intriguing study that graced the pages of the July 15, 2003 edition.  The study, conducted in an Australian public hospital, compared medication, acupuncture, and spinal manipulation for the treatment of chronic pain.  One hundred fifteen patients having had chronic spinal pain for at least 13 weeks in duration (although a couple reported pain greater than 31 years) were randomly assigned to groups of either medicine, acupuncture, or spinal manipulation and were treated a total of 9 weeks.  The treating clinicians were allowed to practice as they normally would but were limited to utilizing only their specified treatment modality.   Participants were given assessment questionnaires and measurements at various intervals during the treatments.

The medication group was given either Celebrex, Vioxx, or paracentamol with the aim of choosing a medication that had yet not been tried by the participant.  The dose was left to the medical doctor’s discretion.

Acupuncture patients were treated twice weekly with 8 to 10 needles placed locally in the area of maximum pain, as well as about 5 needles in more distant acupuncture meridian points (eg. upper limb, lower limb, or scalp) depending on the spinal pain that was being treated.  Needle agitation was also performed to increase the effectiveness.

Spinal manipulation was delivered twice weekly by a chiropractor using high-velocity, low amplitude thrusts to the spinal levels of involvement.

After the 9 weeks were up, the results were tabulated and the data was crunched.

Forty patients comprised the medication group.  Eleven (27.5%) gave up and dropped out before the 9 weeks were up because it wasn’t helping them.  Seven (17.5%) others dropped out due to side-effects such as indigestion, abdominal pain, or skin rash.  In the end, 2 (5%) patients reported full relief of their symptoms.

Thirty-two patients were in the acupuncture group.  Ten (31.25%) gave up before the 9 weeks because it wasn’t working.  None dropped out due to side effects.  In the end, 3 (9.4%) found full relief of their symptoms.

Finally, thirty-three patients were in the spinal manipulation group.  Eight (24.2%) dropped out before the 9 weeks because it wasn’t working for them.  None dropped out due to side effects.  In the end, 9 (27.3%) found full relief of their symptoms.

Now I would love to report that everyone in the spinal manipulation group got better, but they didn’t.  But what these results tell us is that better than one in four spinal manipulation patients with chronic pain will get full relief of their symptoms.   Not the best odds, but not too shabby when you are talking about chronic pain, and even better when you compare it to the other options.  Remember, according to this study, medicine can only claim fully helping one in twenty and acupuncture, one in ten.  As an aside, the drugs used to help the medication group (Celebrex and Vioxx) have experienced more notable press than this study as of late:  both were pulled from the shelves due to their high side-effect of death.  This decision has since been reversed, however, due to high political pressure within the FDA.

What made the spinal manipulation results even more remarkable was that this group happened to have, on average, the longest duration of spinal pain prior to the study:  8.3 years (compared to 4.5 years for medicine and 6.4 years for acupuncture).

Also very interesting in the study was that even though not everyone achieved full relief of their symptoms, 42.4% of the patients in the spinal manipulation group chose to continue with their chiropractic treatments, as they did find that it provided them with some pain relief and better range of motion.  And, patients in the manipulation group reported a full 47% improvement in the questionnaire used to measure one’s perceived level of overall health — medicine scored 18% and acupuncture scored 15%.

The authors pointed out that unlike some studies, these results can be generalized because the sample had such a broad socioeconomic background and a wide age range.

One of the main weakness of the study, however, was that it did not provide any long-term implications.  Well that weakness is no loner, as it was taken care of in the January 2005 edition of the Journal of Manipulative and Physiological Therapeutics.  The same authors returned conducting a 12-month follow-up questionnaire on the same patients.  Their results:  “Comparisons of initial and extended follow-up questionnaires to assess absolute efficacy showed that only the application of spinal manipulation revealed broad-based long-term benefit:  5 of the 7 main outcome measurements showed significant improvements compared with only 1 item in each of the acupuncture and the medication groups.”

The researchers concluded, “In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit.”  Considering that chiropractors perform 94% of the spinal manipulations in our society, I couldn’t have said it better myself.

__________

Sources used for this article:
Chiropractic best for chronic spine pain.  Dynamic Chiropractic.  21(18). 2003
Giles and Muller.  Chronic spinal pain:  a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine 28(14):1490-1503. 2003
Muller and Giles.  Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes.  JMPT. 28(1): 3-11. 2005
Petersen.  No business treating chronic spinal pain.  Dynamic Chiropractic.  21(18). 2003
Silber.  Letter to the editor. Re:  Chronic spinal pain by Giles and Muller.  Spine. 29(5). 2004.
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