Abstract
Objective
To document the potential role of maintenance chiropractic spinal manipulation to
reduce overall pain and disability levels associated with chronic low-back conditions
after an initial phase of intensive chiropractic treatments.
Methods
Thirty patients with chronic nonspecific low-back pain were separated into 2 groups.
The first group received 12 treatments in an intensive 1-month period but received
no treatment in a subsequent 9-month period. For this group, a 4-week period preceding
the initial phase of treatment was used as a control period to examine the sole effect
of time on pain and disability levels. The second group received 12 treatments in
an intensive 1-month period and also received maintenance spinal manipulation every
3 weeks for a 9-month follow-up period. Pain and disability levels were evaluated
with a visual analog scale and a modified Oswestry questionnaire, respectively.
Results
The 1-month control period did not modify the pain and disability levels. For both
groups, the pain and disability levels decreased after the intensive phase of treatments.
Both groups maintained their pain scores at levels similar to the postintensive treatments
throughout the follow-up period. For the disability scores, however, only the group
that was given spinal manipulations during the follow-up period maintained their postintensive
treatment scores. The disability scores of the other group went back to their pretreatment
levels.
Conclusions
Intensive spinal manipulation is effective for the treatment of chronic low back pain.
This experiment suggests that maintenance spinal manipulations after intensive manipulative
care may be beneficial to patients to maintain subjective postintensive treatment
disability levels. Future studies, however, are needed to confirm the finding in a
larger group of patients with chronic low-back pain.
Key Indexing Terms
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References
- 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain.Spine. 1987; 12: 632-644
FrymoyerJW, Ducker TB. The adult spine: principles and practice. 2nd ed. Philadelphia: Lippincott-Raven; 1997. p. xxviii, 2443, 42.
- Occupational low back disorder causation and control.Ergonomics. 2000; 43: 880-902
- Outcome of low back pain in general practice: a prospective study.BMJ. 1998; 316: 1356-1359
- Risk factors associated with the transition from acute to chronic occupational back pain.Spine. 2002; 27: 92-98
- Back injury and work loss. Biomechanical and psychosocial influences.Spine. 1997; 22: 2575-2580
- Spinal manipulative therapy.in: Frymoyer JW The adult spine. 2nd ed. Lippincott-Raven, Philadelphia1997: 1837-1861
- Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions.Spine. 1997; 22: 2128-2156
- Manipulative therapy versus education programs in chronic low back pain.Spine. 1995; 20: 948-955
- Spinal manipulation for low-back pain.Ann Intern Med. 1992; 117: 590-598
- Cost and effectiveness analysis of chiropractic and physiotherapy treatment for low back and neck pain Six-month follow-up.Spine. 1997; 22: 2167-2177
- A survey of practice patterns and the health promotion and prevention attitudes of US chiropractors. Maintenance care: part I.J Manipulative Physiol Ther. 2000; 23: 1-9
- Holistic health care in primary practice: chiropractic contributing to a sustainable health care system.J Manipulative Physiol Ther. 1992; 15: 604-608
- The Oswestry Disability Index.Spine. 2000; 25: 2940-2952
- Low back pain: what is the long-term course? A review of studies of general patient populations.Eur Spine J. 2003; 12: 149-165
- Outcome measures for low back pain research. A proposal for standardized use.Spine. 1998; 23: 2003-2013
- Recovery pattern of patients treated with chiropractic spinal manipulative therapy for long-lasting or recurrent low back pain.J Manipulative Physiol Ther. 2001; 24: 288-291
- Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment.BMJ. 1990; 300: 1431-1437
- A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale.Phys Ther. 2001; 81: 776-788
- Perception of disability in chronic back pain patients: a long-term follow-up.Pain. 1989; 37: 67-75
- Effect of an early intervention program on the relationship between subjective pain and disability measures in nurses with low back injury.Spine. 1996; 21: 2329-2336
- The relation between pain intensity, disability, and the episodic nature of chronic and recurrent low back pain.Spine. 2000; 25: 834-841
- The role of anticipation and fear of pain in the persistence of avoidance behavior in patients with chronic low back pain.Spine. 2000; 25: 1126-1131
- Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up.Spine. 2003; 28: 525-531
- Mechanisms and effects of spinal high-velocity, low-amplitude thrust manipulation: previous theories.J Manipulative Physiol Ther. 2002; 25: 251-262
Article info
Publication history
Received in revised form:
June 5,
2003
Received:
May 1,
2003
Footnotes
This study was funded by the Fonds pour la Formation de Chercheurs et l'Aide a la Recherche-Quebec and Foundation Chiropractique du Quebec.
Identification
Copyright
© 2004 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
