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Back to basics.


Some surprising results have emerged from a study published in the June 2 BMJ (formerly the British Medical Journal) that may provide some new clues to low back pain, a problem that affects 75 percent of us at some time in our lives and costs this country billions of dollars annually in medical care and lost productivity.

The British research involved looking at day-to-day experience (known as "pragmatic" investigation) instead of using placebos and other procedures not part of "real" life ("fastidious" investigation). From March 1986 to March 1989, the prestigious Epidemiology and Medical Care Unit of the British Medical Research Council in Harrow, Middlesex, England, studied more than 700 patients in 11 different towns or cities in England. In order to compare traditional medical care with chiropractic manipulation, patients were randomly assigned to either type of treatment, after researchers first determined by physical examination and x-ray that patients had no infections, nerve root injuries, bone abnormalities, etc., that would make chiropractic care potentially dangerous. The type of treatment given at either clinic was not decided in advance, but whatever the treatment, it was carefuly recorded. The response to treatment was evaluated in terms of level of pain, weight of objects that could be lifted, and length of time the patient could remain comfortably in the sitting positions.

Previous studies have usually shown that chiropractic treatment produced results for only a matter of hours after each session. This study showed that the 378 patients receiving chiropractic care tended to have better results after the first six months of treatment than the 339 treated in medical clinics. these better results continued during the next two years of follow-up. Because the study was "pragmatic," the researchers were not able to determine why the chiropractic treatment produced better results. It may have been chiropractic manipulation, or it may have been something else. It is interesting, however, that the chiropractic care lasted much longer (up to 30 weeks) than the medical care (up to 12 weeks) and involved 44 percent more sessions. It could thus be hypothesized that increased contact between patient and chiropractor (as compared with the lesser contact in the medical clinics) may have had something to do with the better results in the former.

The all-too-common complaint of medical patients is the brief time they are able to spend with the therapist. Given the uncertain causes of most low back pain, it may be less the actual treatment procedures, and more the manner that treatment is given, that affects the outcome.
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Title Annotation:British Medical Research Council research on low back pain
Publication:Medical Update
Date:Dec 1, 1990
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