Chiropractic Eases Low Back Pain in Military Members
Evidence-based study outcomes show care by a chiropractor improves low back pain in soldiers with cross-over to civilians.
As opioids continue to raise concerns, more people are seeking safer therapies for spine care. A study published May 2018 in JAMA Network Open validates a common non-drug therapy—chiropractic care. Researchers found that military members who underwent both care by a chiropractor and “usual medical care” had better low back pain relief and function than those who only had usual medical care. While the study focused on the military, civilians can also benefit from its outcomes.
The study followed 750 military personnel with low back pain, making it the largest trial to compare usual medical care coupled with chiropractic care to usual medical care alone.
Outcomes of the largest study comparing chiropractic care to usual medical care alone.
“The current study provides the strongest evidence to date that chiropractic care is safe, effective, and results in high levels of patient satisfaction and perceived treatment benefit, thus strengthening our knowledge regarding this conservative non-drug option for low back pain,” said the study’s lead author Christine Goertz, DC, PhD, Chief Executive Officer for The Spine Institute for Quality.
Low Back Pain: Understanding the Problem to Find the Solution
Low back pain is a common disorder—approximately 20% of American adults struggle with low back pain. In the U.S. military, the condition can stand between soldiers and their ability to perform combat duty.
Its prevalence means it’s a costly problem: Back pain’s direct costs in 2010 hit $34 billion, according to the study authors. When you factor in the indirect costs (like lost productivity), low back pain’s cost skyrockets to $200 billion.
Combating low back pain is challenging, given the complication rate of many of the most commonly prescribed therapies. Non-steroidal anti-inflammatory drugs (NSAIDs), epidural steroid injections, spine surgery, and most notably, opioids bear significant risks and aren’t always effective at sustainably managing low back pain.
Given the gravity of low back pain as a public health issue and safety concerns surrounding drug therapies, the research team sought to understand whether adding chiropractic to usual medical care would provide safer, lasting low back pain relief.
A Snapshot of the Low Back Pain Study
The clinical trial was conducted between September 2012 and February 2016 at 3 military treatment centers (2 large centers and 1 smaller hospital). Eligible participants were active-duty U.S. military members between 18 and 50 years of age who had low back pain.
The trial enrolled 750 participates (250 per facility). The average participant age was 31 years, and 23% were female.
Trial participants underwent 6 weeks of care with either chiropractic and usual medical care or only usual medical care. Forms of usual medical care included self-care, medications, physical therapy, and pain management referral. Chiropractic care included spinal manipulation, rehabilitative exercise, and hot and cold therapies.
When the research team followed up at the 6- and 12-week points, they found participants receiving chiropractic care with usual medical care had significantly lower low back pain intensity within the past 24 hours compared with those who had only usual medical care. The patients receiving chiropractic care also had significantly higher satisfaction with their care and reported using less pain medication than those receiving only usual medical care.
The study highlights chiropractic’s ability to provide short-term low back pain relief and supports its inclusion in a multidisciplinary back pain treatment program. It also underscores the safety of chiropractic, which should be weighed heavily in light of growing opioid concerns, said N. Ray Tuck, Jr., DC, President of the American Chiropractic Association.
“The findings of the clinical trial comparing medical care and chiropractic care for the treatment of low back pain conducted in the Department of Defense health care system add to an ever-expanding body of evidence supporting the use of chiropractic as part of a multidisciplinary, evidence-based, and patient-centered approach to the treatment of acute and chronic pain,” Dr. Tuck said. “With the opioid epidemic still taking its toll on public health, it is especially important for patients in pain to have access to effective, non-drug options for treatment.”
Closing the Chiropractic Care Knowledge Gap
Care by a chiropractor is available at more than half of U.S. military treatment centers, but many service members have knowledge gaps about the treatment. Most of the participants in this study had never been to a chiropractor, which begs the question why?
Dr. Goertz pointed to a 2017 Gallup-Palmer College of Chiropractic Annual Report, which said more than two-thirds of adults (68%) who have never seen a chiropractor or went more than a year ago said they would be more likely to go to a chiropractor if they knew the chiropractor would work closely with their other doctors. Additionally, nearly half of people (47%) who don’t use chiropractic said they would be more likely to go to a chiropractor if they knew more about what chiropractors do.1
Another barrier, Dr. Goertz said, is the disconnect between chiropractic and personal physicians.
“Almost 75% of patients say that they have never discussed chiropractic with their [personal care physician] PCP, and an additional 7% say that their PCP has a negative opinion of chiropractic,” she said. “This data was collected before the American College of Physicians (ACP) published its guideline on low back pain in 2017.”
The ACP’s 2017 non-surgical back pain treatment guideline supports non-drug therapies, including several used in chiropractic (such as spinal manipulation, massage, and acupuncture).
However, Dr. Goertz said there is little indication that the use of these recommended therapies, including chiropractic care, has risen since these guidelines were issued.
“The ACP, the U.S. Food and Drug Administration, and The Joint Commission now all recommend non-drug therapies as a first-line treatment for low back pain,” Dr. Goertz said. “Hopefully studies such as this will begin to raise awareness among physicians and open minds regarding the potential benefits of adding chiropractic care to usual medical care for patients with low back pain,” Dr. Goertz said.
What the Study Means for All Back Pain Sufferers
Whether you’re a service member or civilian, chances are that you’ll experience low back pain at some point in your life. As opioids draw increasing criticism, more people are seeking safer therapies for spine care. A Gallup study showed that 78% of American adults with back and neck pain prefer to use non-drug therapies before trying prescription medications.1
Three strategies can help connect you with the right back pain treatment:
- Make your treatment preferences known to your doctor (“If possible, I’d like to try a non-drug treatment before moving on to a prescription drug”).
- Always ask about the benefits and risks of a treatment.
- Don’t be afraid to ask what therapies are backed by research, and what treatments medical advocacy groups support.
“Given the global burden of low back pain and current opioid crisis, this study’s findings have never been more important for patients,” Dr. Goertz said. “It is my hope that patients, healthcare providers, payors, and policymakers will be more likely to consider chiropractic as part of a multi-disciplinary care approach given this new evidence.”