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Chronic Low Back Pain: What Should I Do?Chiropractic? Or Surgery?

Written by Benjamin Evans


Globally, low back pain is one if the leading causes of years of disability and absenteeism from work. In a study in 2017, an estimated 577 million people around the globe suffered from low back pain. The lifetime prevalence of low back is as high 80% with 10-40% turning into a state of chronicity (meaning long standing or persistent). People with chronic low back pain are also more likely to experience psychological factors including anxiety, depression, being unable to cope, catastrophising, and low self-efficacy, which can have a significant impact on a persons mental and social well-being. The studies clearly show that back is extremely common, but it certainly is not normal and should not be ignored.

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What is Chiropractic?

Chiropractic is a healthcare profession which aims to address the root cause of a persons pain without invasive surgery or medications. Chiropractors are hands on experts in the diagnosis and treatment of musculoskeletal pain, which means anything coming from the muscles, joints and nerves. They have many forms of treatment, the most utilised being specific spinal manipulation , a form of therapy used to improve function of the spine. Spinal manipulation is an evidence-based therapy and is recommended by several practice guidelines.

What is surgery?

Surgery is a highly invasive intervention in which surgeons will use advanced technologies with the aim of treating certain conditions, often by cutting into the body with or without anaesthesia. Surgery is generally used for acute conditions and emergency situations such as heart attacks but may also be considered for chronic issues such as chronic low back pain.

Which route should I take?

The evidence shows us that often low back pain will resolve by itself. However, in those circumstances in which back pain persists, some people may want to try to help themselves by trying some form of therapy. Typically, conservative treatments are recommended in non-emergency situations with surgery being used as a last resort if nothing else works. Surgery can prove to be an expensive modality for back pain and may only result in a 30% reduction in pain. The research also suggests that 20% of people, after receiving back surgery will require further surgery to help ongoing symptoms. One study showed 94% of patients experienced low back pain following surgery whilst 71% reported a dull ache and 70% reported numbness. To put this in other terms, most people who underwent back surgery had the same symptoms as people with chronic low back pain who had not undergone surgery.

In a report by Web MD, 1.7 million cases were studied in which 700,00 received chiropractic care and the remaining 1 million did not. After thorough comparison, they found that people who underwent Chiropractic care reduced the cost of treating their back pain by 28% compared to those who did not. They also found hospitalisations were reduced to 41% and back surgeries were reduced by 32%.

The Manga Report, from the university of Otttowa, reviewed all international evidence on the management of back pain care. Dr Manga, PhD. Concluded that significant cost savings would incur if the management of low back pain were transferred from physicians to chiropractors. He stated that Chiropractic is safer than medical management of low-back pain. He then went on to explain “many medical therapies are of questionable validity or are dearly inadequate. Chiropractic care is greatly superior to medical treatment in terms of scientific validity, safety, cost effectiveness and patient satisfaction”

There are rare circumstances in which surgery is unavoidable and Chiropractic care may be used in conjunction post-surgically for better patient outcomes. However, there is an abundance of evidence supporting the use of Chiropractic rather than surgery for chronic low back pain.

This means we are in the ideal position to triage and help you or any friends or family who may be experiencing low back pain. If you or anybody you know have long term low back pain, research states you are better off avoiding surgery and having Chiropractic.

References

Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med2020; 8:299–299. doi: 10.21037/atm.2020.02.175, 32355743

James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet2018; 392:1789–858. doi: 10.1016/S0140-6736(18)32279-7, 30496104

Zaina F, Balagué F, Battié M, Karppinen J, Negrini S. Low back pain rehabilitation in 2020: new frontiers and old limits of our understanding. Eur J Phys Rehabil Med2020; 56:212–21. doi: 10.23736/S1973-9087.20.06257-7, 32214063

"Doctor's surgery". Collins English Dictionary. Archived from the original on 10 February 2018. Retrieved 10 February 2018.

Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: An updated overview. Eur Spine J. 2018;27:2791-803

Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166:514-30

Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. National clinical guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2018;27(1):60-75

Inoue S, Kamiya M, Nishihara M, Arai YP, Ikemoto T, Ushida T. Prevalence, characteristics, and burden of failed back surgery syndrome: the influence of various residual symptoms on patient satisfaction and quality of life as assessed by a nationwide Internet survey in Japan. J Pain Res. 2017 Apr 6;10:811-823. doi: 10.2147/JPR.S129295. PMID: 28435318; PMCID: PMC5388346.

Legorreta, A.P. Archives of Internal Medicine, Oct. 11, 2004; vol 164: pp 1985-1992. Douglas Metz, DC, chief health services officer, American Specialty Health Plans, San Diego. George DeVries, president and CEO, American Specialty Health Plans, San Diego. Scott Boden, MD, professor of orthopaedics, Emory University School of Medicine; director, Emory Orthopaedic and Spine Center, Atlanta

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