Health News
Our clinic practices evidence-based healthcare. This means that we use the
best available scientific evidence to guide us in our treatments. The
following research reviews provide information about current topics
related to chiropractic care:
Chiropractic Manipulation in Acute Discogenic Sciatica
Synopsis. One hundred two patients with acute back pain and sciatica
with disc protrusion were randomized to active and simulated manipulation.
Interventions were done 5 days per week by experienced chiropractors, using
a rapid thrust technique. The number of sessions depended on pain relief,
up to a maximum of 20 sessions.
Results. Manipulation compared with placebo 6 months after therapy was much better for low back pain (effect size 1.68) and leg pain (effect size 1.08).
Study Quality.Overall, this was a high quality study.
Conclusion. Chiropractic care delivered a very large clinically important pain reduction benefit at six months, and no patient experienced an adverse event.
Clinical Comment. This high quality study was designed and implemented by medical doctors. Practitioners managing patients with acute back pain and sciatica with protruding discs should consider chiropractic care as a first option. The magnitude of these findings is impressive.
Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J 2006;6:131-7.
Glucocorticoids in Acute Discogenic Sciatica
Synopsis. Double-blinded randomized controlled trial. The
use of glucocorticoids in the treatment of acute discogenic sciatica (prolapsed
disc) is controversial. Sixty patients with acute sciatica (<6-week
duration) of radiologically confirmed discogenic origin were randomized to
receive placebo or a single IV bolus of 500 mg of methylprednisolone.
Results. Glucocorticoids compared with placebo was a little better at day one (effect size .26 for pain) but worse at day ten (effect size -.09 for pain).
Study Quality.Overall, this was a high quality study.
Conclusion. IV glucocorticoids had a clinically tiny benefit at one day that quickly faded. Additionally, there was no improvement in functional disability or clinical signs of radicular irritation.
Clinical Implications. The failure of glucocorticoids directly contrasts with the success of chiropractic in an equivalent patient population. Practitioners managing patients with acute back pain and sciatica with protruding discs should avoid IV glucocorticoids.
Finckh A, Zufferey P, Schurch MA, Balague F, Waldburger M, So AK. Short-term efficacy of intravenous pulse glucocorticoids in acute discogenic sciatica. A randomized controlled trial. Spine 2006;31:377-81.
Yoga for Chronic Low Back Pain
Synopsis. One hundred one adults with chronic low back pain
were randomized into 12-week sessions of yoga (75-minute viniyoga yoga classes),
or 12 weeks of conventional therapeutic exercise classes (75-minute sessions)
or a self-care book.
Results. Yoga was better (effect size .78 for pain, .36 for function) than conventional exercise. Yoga was also much better than the self care book.
Study Quality.Overall, this was a high quality study.
Clinical Implications. Yoga delivered a clinically important reduction of pain and an improvement of function at 3 1/2 months. Yoga should be considered for patients with chronic low back pain.
Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann Intern Med 2005;143:849-56.
Chiropractic Reduces Surgery Rates
Synopsis. This study is an analysis of claims data from a managed-care health
plan over a 4-year period. The use rates of advanced imaging, surgery, inpatient care, and radiographs were
compared between employer groups with and without a chiropractic benefit.
Results. On a per-episode basis, the rates in the group with coverage were reduced by the following: surgery (32.1%); computed tomography (CT)/magnetic resonance imaging (MRI) (37.2%); plain-film radiography (23.1%); and inpatient care (40.1%). For patients with neck pain, the use rates were reduced per episode in the group with chiropractic coverage as follows: surgery (49.4%); CT/MRI (45.6%); plain-film radiography (36.0%); and inpatient care (49.5%).
Research Quality. Reasonable quality with the conclusions following the data.
Conclusion. For the treatment of low back and neck pain, the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs.
Nelson CF, Metz RD, LaBrot T. Effects of a Managed Chiropractic Benefit on the Use of Specific Diagnostic and Therapeutic Procedures in the Treatment of Low Back and Neck Pain. JMPT 2005;28:564-569.
