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1. Canadian government's findings on the effectiveness and cost effectiveness of chiropractic care in the treatment of low back pain (The Manga Report)
2. Guidelines for the Treatment of Acute Low Back Pain - released by the Agency of Health Care Policy and Research, US Department of Health and Human Services
3. Randomized comparison of chiropractic and hospital outpatient management for low back pain
4. 90% of individuals with low back pain still suffer 1 year later under regular medical care
5. Heavy lifting damages spinal discs
6. Back exercises help back injuries
1. The Manga Report
As the largest existing analysis of scientific literature on low back pain, the 1993 Ontario Ministry of Health commissioned study drew international attention when it recommended the management of low back pain be moved from medical doctors to chiropractic doctors.
Due to serious financial problems with the Canadian governments, the different types of treatments for low back conditions were evaluated in an effort to reduce and contain health care costs. Their findings showed chiropractic manipulation was the most cost effective and efficacious care for low back pain.
The researchers also stated that studies on the prevalence and incidence of low back pain suggest that it is the leading cause of disability and morbidity in middle-aged persons, and is by far the most expensive source of workers' compensation costs North America.
This Canadian Government report concluded with the following findings:
The following recommendations were also included in the report:
1. The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) - University of Ottawa, Canada.
2. The Agency of Health Care Policy and Research Study
On December 8, 1994, the Agency for Health Care Policy and Research (AHCPR) of the US Department of Health and Human Services released Clinical Practice Guidelines for the management of acute low back pain. Their guidelines were developed after extensive study of diagnostic and treatment methods for acute low back pain.
The guidelines were created by the AHCPR panel to provide primary care clinicians with information and recommended strategies for the assessment and treatment of acute low back problems. The AHCPR panel was made up of 23 members consisting of medical doctors, chiropractic doctors, nurses, experts in spinal research, physical therapists, an occupational therapist, a psychologist, and a consumer representative.
The following conclusions were made in this landmark study:
1. Acute Low Back Problems in Adults. Clinical Practice Guidelines. Bigos S, et al. Agency for Health Care Policy and Research Publication No. 950642 (1994) - U.S. Department of Health and Human Services.
3. Chiropractic vs. Hospital Outpatient Management for Low Back Pain Study Abstract
Objective - To compare the effectiveness over three years of chiropractic and hospital outpatient management for low back pain.
Design - Randomised allocation of patients to chiropractic or hospital outpatient management.
Setting - Chiropractic clinics and hospital outpatient departments within reasonable traveling distance of each other in 11 centres.
Subjects - 741 men and women aged 18-64 years with low back pain in whom manipulation was not contraindicated.
Outcome Measures - Change in total Oswestry questionnaire score and in score for pain and patient satisfaction with allocated treatment.
Results - According to total Oswestry scores improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals. The beneficial effect of chiropractic on pain was particularly clear. Those treated by chiropractors had more further treatments for back pain after the completion of trial treatment. Among both those initially referred from chiropractors and from hospitals more rated chiropractic helpful at three years than hospital management.
Conclusions - At three years the results confirm the findings of an earlier report that when chiropractic or hospital therapists treat patients with low back pain as they would in day to day practice those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals.
1. British Medical Journal. August 05, 1995.
4. 90% Receiving Regular Medical Care Still Suffer Low Back Pain 1 Year Later
Objectives - To investigate the claim that 90% of episodes of low back pain that present to general practice have resolved within one month.
Design - Prospective study of all adults consulting in general practice because of low back pain over 12 months with follow up at 1 week, 3 months, and 12 months after consultation.
Setting - Two general practices in south Manchester.
Subjects - 490 subjects (203 men, 287 women) aged 18-75 years.
Main Outcome Measures - Proportion of patients who have ceased to consult with low back pain after 3 months; proportion of patients who are free of pain and back related disability at 3 and 12 months.
Results - Annual cumulative consultation rate among adults in the practices was 6.4%. Of the 463 patients who consulted with a new episode of low back pain, 275 (59%) had only a single consultation, and 150 (32%) had repeat consultations confined to the 3 months after initial consultation. However, of those interviewed at 3 and 12 months follow up, only 39/188 (21%) and 42/170 (25%) respectively had completely recovered in terms of pain and disability.
Conclusions - The results are consistent with the interpretation that 90% of patients with low back pain in primary care will have stopped consulting with symptoms within three months. However most will still be experiencing low back pain and related disability one year after consultation.
1. British Medical Journal. 1998;316:1356-9
5. Heavy Lifting Dries Out Vertebral Discs
Heavy lifting may trigger a range of physiological changes that can hasten damage to the discs that cushion the bones of the spine, eventually leading to back pain and disability, according to a study presented by California researchers at a meeting in Belgium on Friday. The study findings may lead to better treatments for back pain and new ways to prevent back injuries.
The report helps shed light on the changes that lead to disc degeneration, a condition in which the spongy cushions separating the vertebral bones in the back become dehydrated and damaged. A common condition, disc degeneration can be painful and debilitating.
"The findings should lead to improved treatments for one cause of low back pain, disc degeneration," noted lead author, Dr. Jeffrey Lotz, of the University of California at San Francisco. The findings should also help researchers determine how much weight people can lift safely.
Lotz and colleagues examined the way compression affects the discs in the tails of mice. A mouse's tail is an extension of its spine, and includes discs similar to those in the human back.
The researchers attached a device that exerted varying degrees of pressure on the discs in each mouse's tail. They found that chronic compression triggered an array of changes in both the structure and biological activity of the discs.
Among other things, chronic compression killed cells in the discs. The greater the pressure, the greater the number of cells killed. Widespread cell death eventually limited the surviving cells' ability to maintain and repair the discs, the authors found. Over time, this caused water loss inside the discs, leaving them dehydrated. Once dehydrated, the discs were less able to withstand pressure, and bulged outward.
Dehydration of the discs triggered other changes, including the release of chemicals that appeared to irritate surrounding nerves, the researchers found. The release of these chemicals, and the pressure that bulging discs might exert on nearby nerves, may cause the pain associated with disc degeneration, the researchers report.
In light of these findings, it may be possible to treat degeneration by injecting damaged discs with growth factors that stimulate cell repair, note the researchers, who are now testing this procedure. If the technique is successful, it could be an alternative to back surgery, the current treatment for disc degeneration.
1. Reuters. June 12, 1998.
6. Back Exercises Help Back Injuries
According to a new study, specific back stabilizing exercises are essential for preventing the recurrence of back injuries.
Following back injuries, the smaller stabilizing muscles of the back, such as the multifidus muscles, undergo atrophy. Because these smaller muscles play an important "stabilizing" role in the back, failing to rehabilitate them back to normal almost always results in reinjury.
In this study, researchers found that in patients who sustained back injuries, 29% experienced reinjury within one year if they had received treatment which included back stabilizing exercises. In the group of individuals who did not receive these exercises, an astonishing 80% experienced reinjury within 1 year.
This not only marks the importance of fully rehabilitating the spine following a back injury, but also shows the recurrent nature of back injuries in general. Therefore, individuals suffering from back injuries should seek treatment which addresses the health of their spine and involves the full rehabilitation of the spinal components. Treatments dealing with symptomatic relief only are highly ineffective and short-lived.
1. Reuters. June 03, 1998.
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I have been a patient of Dr. Pisarek for a few years now. Every morning I have to say "thank you Dr. P.!". Your care and your treatment renew my energy... no more pains in my lower back, knee and foot. With your help I lost 20 pounds and I am keeping it off. I am really grateful to you and your wife Hilda for taking care of me. My retirement got a new meaning, thanks to you.