New England Journal of Medicine study is not the most in-depth or valid study on low back pain conducted in recent years

Pennsylvania Chiropractic Association's Response

This section is compiled by Frank M. Painter, D.C.
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Pennsylvania Chiropractic Association




October 8, 1998

Contact: Gene Veno, Executive Vice President

(717) 232-5762

The Pennsylvania Chiropractic Association today issued the following statement in response to a study published in the October 8, 1998 issue of The New England Journal of Medicine. The study, which questions the effectiveness of chiropractic treatment in two asthma and low back pain cases, is not the most in-depth or valid study on low back pain or asthma conducted in recent years.

According to Gene G. Veno, Executive Vice President of the Pennsylvania Chiropractic Association, "We welcome continuing research on the expert level of care our Doctors of Chiropractic provide to their many patients daily. One study does not make a profession nor does one survey alter the perception of the excellent delivery of health care the profession of Chiropractic offers to million of individuals daily."

"The Chiropractic profession provides an exceptional level of quality health care," Veno continued, "and continues to gain wide acceptance in today s medical fraternity of care givers. As the public seeks alternative health care medicine for themselves and their families, the Chiropractic Profession should be approached as one answer to some of the deficiencies within today s medical system."

Behind dentistry and medicine, Chiropractic is the nation s third - largest primary health profession, reference Journal of Manipulative and Physiological Therapeutics. When it comes to the care of a patients neuromusculosketal disorders and related conditions including but not limited to back pain, headaches, neck pain, Doctors of Chiropractic are highly educated to assess and manage these patient disorders.

Clinical studies in the U.S. continue to show that there would be highly significant cost savings if more management of low-back pain was transferred to chiropractors.

The training of today s Doctor of Chiropractic exceeds 5,000 hours of professional resident study, more than 2,000 hours in biological and clinical sciences, more than 1,000 hours in specific chiropractic techniques and over 900 hours of clinical practice prior to graduation.

While The Pennsylvania Chiropractic Association welcomes new continuing research on the types of treatment doctors of chiropractic provide, the New England study in particular, has several areas that must be addressed:

  • It is not accurate to say this study compares physical therapy and chiropractic. The study actually compares a type of stretching treatment (McKenzie) used in physical therapy, against chiropractic manipulation. And, since McKenzie method is not physical therapy per se and is often incorporated into some forms of chiropractic treatment, it is not an ideal comparison.
  • All three of these methods: manipulation, stretching and patient education are all important aspects of chiropractic treatment, and it would be reasonable to expect less favorable outcomes by using only one of these important treatments.
  • Chiropractic treatment is not restricted to the short lever, high velocity manipulation used in this study. No other physical treatments (complementary and preparatory) that would typically be incorporated into chiropractic treatment of low back pain were included in the study.
  • There were limitations on the patient pool used in the study. For instance, no patients with sciatica, no patients who had prior back surgery, no patients involved in workers comp claims and no patients who had previous chiropractic or physical therapy care were included in the study.

Other recent studies have found that doctors of chiropractic are experts in the treatment of low back pain -- the most common health complaint experienced by working Americans today, and a condition which costs the economy at least $50 billion a year in lost wages and productivity. A plethora of research exists demonstrating chiropractic s efficacy and cost effectiveness for this condition:

  • In 1994, an expert panel convened by the U.S. Agency for Health Care Policy and Research (AHCPR) concluded that spinal manipulation is a recommended and effective form of initial treatment for acute low back problems in adults.
  • The [prestigious RAND Corporation also determined that spinal manipulation is an appropriate treatment for acute back pain, and reported from its analysis that 94 percent of all manipulations are performed by doctors of chiropractic.
  • A 1993 study funded by the Ontario Ministry of health found that chiropractic manipulation was the most cost effective and efficacious care for low back pain.
  • A 1995 study published in the British Medical Journal supported chiropractic s long-term effectiveness in treating low back pain. The study found that "improvement in all patients at three years was about 29 percent more in those treated by chiropractors that in those treated by the hospitals. The beneficial effect of chiropractic on pain was particularly clear."
  • A study published in the March 1996 issues of The American Journal of Managed Care, concluded "managed chiropractic is an extremely promising method of treating acute back and neck discomfort: and recommended "its wider application by the managed care industry and the physician community."

As many as 80 percent of Americans will suffer from low back pain at some point in their lives. Furthermore, low back pain and symptoms are the most common causes of disability for Americans under age 45. It is the best interest of consumers to know the facts when it comes to combating one of the nation s most pervasive health care problems.


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