|
July 2005, Vol. 15, Iss. 3
Table of Contents
A Great Opportunity • Age of Confusion •
APMR Accepts CBP® Research • CBP® has 13 Published Clinical Trials • Chronic Back Pain, Your Brain, & Chiropractic •
Creating a Great First Impression • Evidence Based Exams •
Had Enough? • Lateral Head Flexion from Vestibular Dysfunction •
Letters to the Editor • Life's Rise from the Ashes •
PosturePrint™ is now a Validated Posture Analysis •
The Disease of Unrealistic Expectation • Thousands of Heroes •
When You Can't Critique CBP® in the Peer-reviewed Literature
back to front page
Chronic Back Pain, Your Brain, and Chiropractic
by Daniel J. Murphy, DC, FACO
Vice President of ICA
Dan Murphy graduated magna cum laude from Western States Chiropractic
College in 1978, and has more than 26 years of practice experience. He received his Diplomat in Chiropractic Orthopedics in 1986. Since 1982, Dr. Murphy has served as part-time undergraduate faculty at Life Chiropractic College West, where he is
currently teaching classes to seniors in the Management of Spinal Disorders.
Dr. Murphy is on the post-graduate faculty of several chiropractic colleges. His
post-graduate continuing education classes include “Whiplash and Spinal Trauma,”
“Neuroimmunology,” “Pediatrics,” “Phospholipid Neurobiology,” “The Neurophysiology of Therapeutic Lasers,” and “Nutrition.” Dr. Murphy is the coordinator of a year-long certification program (through the International Chiropractic Association) in “Chiropractic Spinal Trauma,” now (2005) in its eighteenth year of being offered. He has taught more than 1,000 post-graduate continuing education seminars, including classes in the United States, Canada, Australia, France, England, Portugal, Ireland, Italy, Greece, New Zealand, and South Korea.
Dr. Murphy is a contributing author to the books Motor Vehicle Collision Injuries, published by Aspen, 1996, Pediatric Chiropractic, published by Williams & Wilkins, 1998, and Motor Vehicle Collision Injuries, 2nd edition, Jones and Bartlett, 2005. Since 1991, Dr. Murphy has written a quarterly column in The American Journal of Clinical Chiropractic, with more than 55 columns appearing to date.
In 1987, 1991 and 1995 Dr. Murphy received the “Post-Graduate Educator of
the Year” award, given by the International Chiropractic Association.
In 1997 he received “The Carl S. Cleveland, Jr., Educator of the Year” award,
given by the International Chiropractic Association of California.
In 2001, Dr. Murphy was honored by the readers of Dynamic Chiropractic as the
top vote receiver for the “Our Virtual Chiropractic Association”. He was also awarded
“Chiropractor of the Year” by the International Chiropractic Association of California, and “Pediatric Chiropractor of the Year” given by Chiropractic Pediatric University.
In 2003, Dr. Murphy was awarded “Chiropractor of the Year” by Chiropractic
Biophysics. This award is most prestigious because Chiropractic Biophysics has more
chiropractic research studies published in the scientific literature than any other
chiropractic group.
Since 2003 Dr. Murphy is the Vice President of the International Chiropractic
Association.
Dr. Murphy reviews articles regarding alternative health issues, which can be
accessed through Dr. Murphy’s website at www.danmurphydc.com.
Last year, an article published in the Journal of Neuroscience1 compared brain morphology of 26 chronic back pain patients to matched control subjects, using magnetic resonance brain imaging. Chronic back pain was defined as back pain in excess of 6 months. Neocortical gray matter volume was compared in both groups. Patients with chronic back pain showed 5-11% less neocortical gray matter volume than control subjects. The magnitude of this decrease in neocortical grey matter is equivalent to the gray matter volume lost in 10-20 years of normal aging. The authors showed that the longer the pain, the greater the brain grey matter loss. The chronic back pain patients lost an average of 1.3 cm3 loss of gray matter for every year of chronic pain. The authors referred to this loss of grey matter from chronic back pain as “brain atrophy.”
These authors further quantify that “normal whole-brain gray matter atrophy is 0.5% per year of aging” and that atrophy caused by chronic back pain is 5-11% per year, which means that the “brain gray matter atrophy caused by chronic back pain is equivalent to 10-20 years of aging” per year of chronic back pain.
These authors also note that 10% of adults suffer from severe chronic pain, back problems constitute 25% of all disabling occupational injuries, and that in 85% of those with back pain, “no definitive diagnosis can be made.” They note that chronic pain greatly diminishes quality of life and increases anxiety and depression.
Apparently, these authors claim that if the chronic back pain is treated successfully and quickly, that the gray matter shrinkage is reversible, but with more prolonged pain the atrophy may not be reversible because it is attributable to neurodegeneration.
The authors note that the cause of chronic back pain is excitotoxicity [i.e. exposure to glutamate and aspartate, which are commonly added to foods as taste enhancers] and inflammatory agents [such as the omega-6 arachidonic acid cascade to the pro-inflammatory eicosanoid prostaglandin E2].
The most important question, I believe, is:
What is the most effective treatment for chronic back pain, which would minimize the brain atrophy, neocortical dysfunction, anxiety and depression documented in this article?
In 1985, Canadian Family Physician2 published a study that looked at 283 chronic, disabled, and prior treatment failed (including surgical failures) low back pain patients. These patients were given a 2-3 week regime of daily spinal adjustments by a chiropractor. The results show an essential resolution (either symptom-free with no work or activity restrictions, or mild intermittent pain with no work or activity restrictions) in 81% of the patients diagnosed with referred pain syndromes, and in 48% of the patients diagnosed with nerve root compression syndromes.
In 1990, the British Medical Journal3 published a randomized controlled study that evaluated 741 back pain patients who where allocated hospital or chiropractic treatment for back pain. The study concludes “chiropractic almost certainly confers worthwhile, long-term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain.”
The following month (July 28, 1990), The Lancet4 published an editorial comment to the 1990 British Medical Journal study that noted:
“This highly significant difference occurred not only at 6 weeks, but also for 1, 2, and even (in 113 patients followed so far) 3 years after treatment. Surprisingly, the difference was seen most strongly in patients with chronic symptoms.”
As an interesting note, this Lancet editorial notes that 84% of the patients from the British Medical Journal study3 treated in the hospital actually received manipulation from staff physiotherapists as a part of the management. The implication is that the benefit achieved in these chronic back pain patients should not be credited to manipulation, but rather to chiropractic manipulation [adjustments]. This fact led to the following editorial comment:
“Physiotherapists need to shake off years of prejudice and take on the skills that the chiropractors have developed so successfully.”
In 1995, The British Medical Journal5 published a 3-year follow-up to the 19903 study comparing hospital and chiropractic managements of back pain. After 3 years, the chiropractic patients maintained a 29% improvement over hospital management as measured with standard measurement outcomes. The conclusions of the article is:
“At 3 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 chiropractors derive more benefit and long-term satisfaction than those treated by hospitals.”
In 2003, Spine published6 a randomized clinic trial comparing chiropractic spinal adjusting to needle acupuncture and to the drugs Celebrex and Vioxx for the treatment of chronic spinal pain. Chiropractic spinal adjusting was greater than 5 times more effective than the drugs, and nearly three times more effective than needle acupuncture in that study (see chart below).
Importantly, in 2005, Journal of Manipulative and Physiological Therapeutics7 published a one-year follow-up to the 2003 Spine study6 that showed the reduction in pain from chiropractic adjustments remained stable, while the few who benefited from drugs and acupuncture had quickly regained their pain after cessation of treatment. These authors conclude: “In patients with chronic spinal pain syndromes, spinal manipulation, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit.” They further note that drugs did not achieve an improvement in chronic spinal pain.
In 2004, the British Medical Journal8 published a study to assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise (combined treatment) to “best care” in general practice for patients consulting with low back pain. Importantly, approximately one-third of the “manipulations” performed in this study were adjustments performed by practicing chiropractors. This study had the following findings:
Spinal manipulation is a cost effective addition to “best care” for back pain ingeneral practice.
Spinal manipulation alone gives better value for money than manipulation followed by exercise.
Manipulation alone yielded the highest improvement in quality of life for these back pain patients, and did so for the lowest cost.
“Manipulation achieves extended dominance over both exercise and combined treatment” of manipulation plus exercise.
“The improvements in health status reported here [with spinal manipulation] reflect statistically significant improvements in function, pain, disability, physical and mental aspects of quality of life.”
Patients continued to show benefits from treatment at 12 months, so the cost effectiveness of manipulation “may be better than we have reported.”
“As back pain is a common problem, making manipulation generally available will require many therapists.”
“Whereas physiotherapists can rapidly train to deliver the exercise package, insufficient trained manipulators are available in the United Kingdom to meet potential demand, and it will take several years to produce additional manipulators.”
CONCLUSION:
Chronic back pain significantly ages the brain, causing brain atrophy. These studies clearly show that the most effective treatment for chronic back pain is chiropractic spinal adjusting, especially as compared to drugs (Celebrex and Vioxx), needle acupuncture, physiotherapy, and exercise. Successful treatment of chronic back pain can prevent brain atrophy and even potentially reverse it. This argues that chiropractic spinal adjusting is the best treatment for chronic spine pain and for preventing related brain shrinkage and atrophy.
REFERENCES:
1) Vania Apkarian, Yamaya Sosa, Sreepadma Sonty, Robert M. Levy, R. Norman Harden, Todd B. Parrish, and Darren R. Gitelman; Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic Gray Matter Density; The Journal of Neuroscience, November 17, 2004, 24(46):10410-10415.
2) WH Kirkaldy-Willis and JD Cassidy, Spinal manipulation in the treatment of low back pain, Canadian Family Physician, Vol. 31, March 1985, pp536-40.
3) TW Meade, S Dyer, W Browne, J Townsend, AO Frank. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. British Medical Journal, June 2, 1990;300: 1431-7.
4) The Lancet, Chiropractors and low back pain, July 28, 1990, p. 220.
5) TW Meade, S Dyer, W Browne, AO Frank. Randomised comparison of chiropractic for low back pain: results from extended follow up. British Medical Journal, August 5, 1995;311: 349-51.
6) Lynton GF Giles and Reinhold Muller, Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation, Spine, July 15, 2003; 28(14): 1490-1502
7) Reinhold Muller, PhD, Lynton G.F. Giles, DC, PhD, Long-Term Follow-up of a Randomized Clinical Trial Assessing the Efficacy of Medication, Acupuncture, and Spinal Manipulation for Chronic Mechanical Spinal Pain Syndromes, Journal of Manipulative and Physiological Therapeutics, January 2005, Volume 28, Number 1, pp. ••
8) Andrea Manca, the UK BEAM Trial Team, United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care, British Medical Journal;329:1381 December11, 2004.
| 
