What’s the best way to treat low-back pain?

Our Bristol chiropractor, Rupert Clements, writes about this low-back pain clinical trial:

A 2006 report estimated that the direct and indirect costs of low-back pain in the United States are more than $100 billion annually.  Additionally, patients with back pain incur 73% higher health care costs than those without back pain–related complaints.  Much of this cost is related to improper management of low-back pain.  This is especially with respect to unnecessary diagnostic imaging, medications and spinal injections.

The low-back pain study:

Recently, there was an epic study carried out by some really enlightened doctors (thanks Ian Paskowski, Schneider M, Stevans J, Ventura JM and Justice BD.) in America that was reported in the JMPT in Feb 2011.  They work at the Jordan Hospital in Plymouth Mass where the low-back pain programme is run chiefly by chiropractors!  They created a ‘multidimensional spine care pathway’ – oh yes indeed! This used evidence-based and standardised care.  Their goal was to improve clinical outcomes and reduce costs, particularly in diagnostic testing.  

They used a large number of patients in this trial, starting with over 500 and then settling on 432.  The patients were then treated by chiropractors and physical therapists.  95% of patients reported that their care was ‘excellent’ and low-cost at about $302 per case.  Self-reported pain and disability scores were reduced by about 70% over the course of just a few weeks.  All of this is really good – the sort of figures a drug company would die for!

The authors of the trial add:

“…interprofessional collaboration between doctors of chiropractic, physical therapists, and medical doctors within teams improved spine care; that promotion of care coordination reduced unnecessary testing and procedures; and the standardization of LBP management reduced practice variations and significantly reduced the costs of care.”

Our attempt at this at C1 is with the mix of chiropractors and sports injury therapists but one day, all hospitals will be like this.  Why? well, we’d like to think it would be because it works but I suspect it’ll be because it saves money.

Here is the abstract so you can have a look if you want.

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