DOs Equal MDs At Relieving Chronic Back Pain

Manual therapy by an osteopath appears to be as effective at relieving chronic lower back pain as traditional medical care. Results of a study from Chicago researchers (including my alma matter medical school, CCOM) showed patients who received osteopathic therapy for subacute low back pain received fewer drugs and needed less physical therapy than those treated with standard care.

Osteopathic medicine focuses on the need to optimize blood circulation to maintain or restore health, sometimes using manipulation to accomplish this goal, the researchers note. In contrast, traditional medicine treats chronic low back pain mainly with drug therapy, including pain-relieving drugs or muscle relaxants.

Standard medical treatment consisted of pain-killers and anti-inflammatory drugs plus active physical therapy. Other therapies such as ultrasound, hot and cold packs, and electrical nerve stimulation were also used. For patients in the alternative-treatment group, osteopathic physicians used manipulation techniques on areas that they considered related to the patient's back pain.  Both groups were treated for 12 weeks, and then were assessed for pain, functional ability, and satisfaction with their treatment.

Improvement occurred in both groups on every measure of outcome used, the authors report, adding that there were no statistically significant differences between treatment groups in terms of improvement. The researchers also found that about 90% of the patients in each group were satisfied with their care. The only difference between the two groups was in their use of medication, where nonsteroidal anti-inflammatory drugs were prescribed on almost 55% of visits to usual care physicians compared with approximately 25% of visits to osteopathic physicians. Patients receiving usual medical care were also more likely to receive muscle relaxants at approximately 25% of visits compared with those who received osteopathic care at approximately 6% of visits.

The authors indicate that since most patients with low back pain recover without specific treatment during the first 2 to 4 weeks after injury, it is difficult to assess how much additional benefit manual therapy offers. But because patients treated by osteopathic practitioners took fewer medications and received less physical therapy than those who received standard care, osteopathic care was cheaper.

Given the known and potentially serious adverse effects and costs of nonsteroidal anti-inflammatory drug therapy, the achievement of equal outcomes in regard to pain relief, function, and satisfaction, with less use of medication and physical therapy, suggests an important benefit of osteopathic manipulative treatment.

The New England Journal of Medicine  November 4, 1999;341:1426-1431, 1465-1467

Dr. Mercola's Comment:

Good to see my old medical school making NEJM. The article is not earth shattering though as many others prior to it show that manipulation works better than traditional care. I certainly believe that optimized structure is an important part of health but I tend to avoid treating pain, as there are so many excellent chiropractors in my area whose passion is treating pain. My passion is using nutrition to treat chronic illness so I restrict my efforts to this area and everyone seems to benefit.

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