Veterans

A decade after being asked to study how chiropractic care may increase fitness among troops with lower back pain, the Defense Department has submitted its report to Congress.

But service members still shouldn’t expect the treatment to be available at every military health facility.

And as for military family members, retirees and their families, the benefit, along with other alternative therapies, remains uncovered by Tricare.

Earlier this month, Acting Assistant Secretary of Defense for Manpower and Reserve Affairs James Stewart sent a final report to Congress (PDF) on three clinical trials conducted in the last 10 years at military health facilities by Rand Corp., Palmer College of Chiropractic and the Samueli Institute to determine whether chiropractic care can ease lower back pain in troops, help service members stop smoking and increase readiness.

Related:   Does Tricare Cover Chiropractic Care?

The $7.5 million study was ordered under the fiscal 2010 National Defense Authorization Act, signed into law on Oct. 28, 2009. According to the report released Sept. 6, the trials showed some positive results.

The first clinical trial, to determine whether chiropractic care reduced pain and helped troops stop smoking, showed statistically significant improvement for service members with back pain who received chiropractic care alongside regular medical care.

The second trial, to test whether chiropractic care had any effect on the reaction and response times of special operations troops, showed that a single session had an immediate effect on motor response.

But the trials also found that chiropractic care had no real influence on smoking cessation, nor did the acceleration of response time among special operators last after the initial effect.

The third trial — on whether chiropractic care improves fitness among troops with back pain — showed that those who received such care saw a 5% increase in isometric strength, as opposed to a 6% decrease in strength among the control group, made up of service members who also had lower back pain but didn’t receive chiropractic care.

Endurance also increased 14% in the chiropractic group, compared with a 10% decrease in the control group, according to the third trial.

“Based on the results, the investigators concluded that chiropractic care improves key fitness characteristics among active-duty service members with lower back pain and could lead to improved military readiness in such individuals,” the report notes.

While Congress passed a law in 2000 requiring the Defense Department to offer chiropractic care for active-duty personnel and activated Reserve and National Guard members, it is available in only 65 of the DoD’s 54 military hospitals and 377 clinics.

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OBJECTIVES:   To characterize the nature of pain complaints among younger and older veterans receiving primary care, and to determine whether characteristics of pain vary as a function of age.

METHODS:   Primary care patients at a Veterans Affairs medical center were screened for pain prior to a routine office visit, and those who endorsed a concern about pain were given a self-administered questionnaire that inquired about specific characteristics of their pain including site, duration, frequency, and average intensity of the pain.

RESULTS:   Over a 7–month period, 1,290 patients were screened; 641 (50%) reported a concern about pain, and of these, 516 (82%) completed the pain survey. Among younger (age <65 years, N = 191) and older (age > or =65 years, N = 325) respondents, the mean number of sites causing pain was similar (3.6 vs 3.3). Back pain was the most frequently reported site of pain causing the most discomfort among younger (vs older) respondents (31.9% vs 17.8%), whereas older (vs younger) respondents most often endorsed leg pain (32.3% vs 19.9%). The mean duration of pain was not significantly different between older and younger (10.7 vs 10.1 years) respondents; but older (vs younger) respondents were more likely to report constant pain (63.7% vs 46.9%). Using a 0 to 10 numeric rating scale, pain intensity scores were higher among younger (vs older) respondents (5.3 vs 4.3). Rates of prescription pain medication use were not significantly different (52.4% vs 48.0%). Compensation for pain-related disability was more common among younger (vs older) respondents (40.4% vs 19.4%).

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Chiropractic services have been delivered on station at select Veterans Health Administration (VHA) medical facilities since late 2004. No published data describing the characteristics of VHA chiropractic physicians (chiropractors) and chiropractic clinics exist at a national level. This study was designed to examine elements of the structures of chiropractic services in VHA settings. Web-based survey methods were used to question all chiropractors in VHA facilities (N = 36). Data were obtained from 33 providers, yielding a 91.6% response rate. Most respondents were full-time VHA employees, while others were part-time employees or contractors. Differences were found in prior training, integrated practice, and academic or research experience. Of the respondents, 88% ranked low back pain as the most common patient complaint seen in practice and 79% ranked cervical pain the second most common complaint. Of the new patient consultations, 67.6% originated from primary care, 9.4% from pain management, and 6.2% from physiatry. Most respondents were similar in their reported use of diagnostic and therapeutic procedures, but their reported rates of participation in various facility activities were different. Further work is needed for researchers and policy makers to more fully understand the integration and delivery of chiropractic services in VHA settings.

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BACKGROUND CONTEXT:   non-battle illnesses and injuries are the major causes of unit attrition in modern warfare. Spine-area pain is a common disabling injury in service members associated with a very low return-to-duty (RTD) rate.

PURPOSE:   To provide an overview of the current understanding of epidemiology, possible causes, and relative prognosis of spine-area pain syndromes in military personnel, including a discussion of various treatment options available in theaters of operation.

STUDY DESIGN:   Literature review.

METHODS:   Search focusing on epidemiology, etiology and associative factors, and treatment of spinal pain using electronic databases, textbooks, bibliographic references, and personal accounts.

RESULTS:   Spine-area pain is the most common injury or complaint “in garrison” and appears to increase during training and combat deployments. Approximately three-quarters involve low back pain, followed by cervical and midback pain syndromes. Some predictive factors associated with spine-area pain are similar to those observed in civilian cohorts, such as psychosocial distress, heavy physical activity, and more sedentary lifestyle. Risk factors specific to military personnel include concomitant psychological trauma, g-force exposure in pilots and airmen, extreme shock and vibration exposure, heavy combat load requirements, and falls incurred during airborne, air assault, and urban dismounted ground operations. Effective forward-deployed treatment has been difficult to implement, but newer strategies may improve RTD rates.

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