Chiropractic management of mechanical neck and low-back pain: A retrospective, outcome-based analysis

Background: Evidence suggests that spinal manipulation is an effective trea tment for mechanical neck and low-back pain (LBP). Treatment efficacy is im portant to establish for these symptoms because combined they account for a considerable amount of disability and substantial, associated direct and i ndirect costs to society. Objective: The purpose of this study was to examine the outcome of patients undergoing chiropractic treatment for mechanical neck or LBP. Design and Setting: A retrospective, outcome-based analysis was done for pa tients seeking care at a private chiropractic practice over a 1-year period . A total of 512 files were reviewed, with 119 patients selected for inclus ion. Patients were included if their chief symptom was uncomplicated mechan ical neck or LBP. Diagnoses included cervical, lumbar, or sacroiliac joint sprain/ strain (International Code of Diagnostics version 9 [ICD-9] code: 8 47.1, 847.3, 846.1, respectively), discogenic LBP (ICD-9: 722.1), and heada ches (ICD-9: 784.0) because many patients with neck pain presented with con comitant headaches. Disability and pain were measured with the modified Osw estry scale (for the patients with LBP), Neck Disability Index, and an 11-b ox visual analogue pain scale before and after treatment. Treatment consist ed of spinal manipulation, various soft-tissue techniques, home-care instru ctions, and ergonomic and return-to-activity advice, including rehabilitati ve exercises. Patients received an average of 12 treatments over a 4-week p eriod. Statistical analysis was performed on pretreatment and posttreatment values for both disability and pain. Stratification was based on duration (acute/ subacute, chronic, acute exacerbation of a chronic condition) and severity (mild, moderate, or severe) of symptoms. Results: Statistically significant reductions in disability and pain scores were achieved in all groups. An average 52.5% and 52.9% reduction in pain and disability, respectively, was achieved in the low-back group. The chron ic LBP group realized a less statistically significant reduction of pain an d disability (19.7% and 19.8%, respectively) than the acute/subacute (66.8% and 62.5%) or the chronic/recurrent group (56.5% and 63.4%). The differenc es were statistically significant. Patients with neck pain had an average 5 3.8% and 48.4% reduction in their pain and disability, respectively. Patien ts with concomitant neck pain and headaches had statistically significant h igher pretreatment and posttreatment disability and pain scores than those with only neck pain. There was no statistically significant difference in o utcomes between groups stratified according to pain intensity. Conclusions: Patients attending a private chiropractic clinic for treatment of mechanical neck pain or LBP had statistically significant reductions in their pain-related disability after treatment. These results indicate that chiropractic manipulation is beneficial for the treatment of mechanical ne ck pain and LBP. However, care must be taken when drawing conclusions from these outcomes. The study design does not account for the natural history o f low back- or neck pain-related disability and therefore does not allow fo r claims of treatment efficacy. rn addition, it has been suggested that pat ients presenting to medical doctors with these symptoms have significant ov erlying comorbidity when compared with patients presenting to a chiropracto r.