Back pain affects most of us at some point in our lives.
Back Pain is (almost) inevitable. It is a fact that 80% of us will experience some form of it at some stage in our life, and almost half the UK population (49%) report low back pain lasting for at least 24 hours at some time in the year.
Here at Riviera Wellbeing we spend much of our time helping people who are struggling with back pain of one sort or another. There are many causes of this condition and therefore, no single ‘wonder-cure’.
Our Approach to treating back pain
Our approach (generally) starts with a full consultation with one of our Chiropractors, who will ask about your symptoms, your medical history, perform physiological and neurological tests and make a diagnosis based upon their findings.
In certain circumstances, they may refer you for X-Ray, MRI imaging or refer you back to your GP for blood tests to give further insight into the cause of your back pain.
Once all the necessary information has been gathered, they will discuss your proposed treatment plan with you.
Our clinicians understand the underlying causes for back pain, as well as the varying ways it can affect patients. Treatment is tailored specifically for each individual, and you are free to ask as many questions as you need
In most cases, treatment will be offered in our Paignton clinic, but if we feel that we cannot help, we will be honest with you, and will refer you to someone that can.
The Evidence
There is a growing body of evidence that proves both chiropractic and acupuncture are effective in the treatment of specific types of back pain. We have known this for years, but now, the scientific community are producing more and more clinical evidence to back this up.
The NHS now advocates the use of chiropractic for persistent lower back pain. In many areas of the UK both acupuncture and chiropractic are made available on the NHS.
Some of the evidence for chiropractic
There is a range of evidence to indicate that chiropractic care is safe and effective. This evidence includes:
This MRC-funded study estimated the effect of adding exercise classes,spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to “best care” in general practice for patients consulting with back pain. All groups improved over time. Exercise improved disability more than “best care” at three months. For manipulation there was an additional improvement at three month sand at 12 months.
For manipulation followed by exercise there was an additional improvement at three months and at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred.
Spinal manipulation is a cost effective addition to “best care” for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.
Summary of recommendations for treatment of acute non-specific low back pain:
- Give adequate information and reassure the patient
- Do not prescribe bed rest as a treatment
- Advise patients to stay active and continue normal daily activities including work if possible
- Prescribe medication, if necessary for pain relief; preferably to be taken at regular intervals; first choice paracetamol, second choice NSAIDs
- Consider adding a short course of muscle relaxants on its own or added to NSAIDs, if paracetamol or NSAIDs have failed to reduce pain
- Consider (referral for) spinal manipulation for patients who are failing to return to normal activities
- Multidisciplinary treatment programmes in occupational settings may be an option for workers with sub-acute low back pain and sick leave for more than 4 – 8 weeks
Manipulation/mobilisation – Summary of the evidence:
- There is moderate evidence that manipulation is superior to sham manipulation for improving short-term pain and function in chronic low back pain (CLBP)
- There is strong evidence that manipulation and GP care/analgesics are similarly effective in the treatment of CLBP
- There is moderate evidence that spinal manipulation in addition to GP care is more effective than GP care alone in the treatment of CLBP
- There is moderate evidence that spinal manipulation is no less and no more effective than physiotherapy/exercise therapy in the treatment of CLBP
- There is moderate evidence that spinal manipulation is no less and no more effective than back-schools in the treatment of CLBP
Recommendation: Consider a short course of spinal manipulation/mobilisation as a treatment option for CLBP.
5. Low back pain: early management of persistent non-specific low back pain
NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. Its guideline on the acute management of patients with chronic low back pain was published in May 2009.
The evidence-based recommendations include the following:
- Provide people with advice and information to promote self-management of their low back pain.
- Consider offering a course of manual therapy including spinal manipulation of up to 9 sessions over up to 12 weeks
- Consider offering a course of acupuncture needling comprising up to 10 sessions over a period of up to 12 weeks
- Consider offering a structured exercise programme tailored to the individual.
6. Effectiveness of Manual Therapies – The UK Evidence Report
This review, by Bronfort et al, was published in the journal Chiropractic & Osteopathy in 2010. Commentaries by Professor Scott Haldeman and Professor Martin Underwood accompany the report.
In summary, the report demonstrates robust randomised controlled trial (RCT) evidence that the care offered by chiropractors is effective for a wide range of conditions including back pain, neck pain, pain associated with hip and knee osteoarthritis and some types of headache.
