Welcome back to Spine IQ’s Back Blog! Today we are going to talk about a study that provides some insight into why chiropractic care may have an impact that goes beyond low back pain itself. In 2018, Dr. Goertz and her co-authors published a large, pragmatic study that reported the beneficial effects of chiropractic care on pain and pain-related disability.1 However, there are anecdotal reports from both patients and clinicians that chiropractic care can have additional beneficial effects on quality of life. To address this issue, Goertz et al included secondary measures in the study mentioned to evaluate the impact of chiropractic treatment on conditions such as anxiety, depression and fatigue using the PROMIS 29 questionnaire. In this week’s blog, we are going to discuss these findings, which were recently published in Pain Medicine.2
Low back pain continues to be the leading cause of disability and costliest condition in the United States.3,4 In an attempt to intervene on the health concerns and cost burden of low back pain, clinical practice guidelines consistently recommend interventions commonly delivered by chiropractors such as spinal manipulation, exercise, advice, and education.5,6 Most studies evaluating chiropractic care assess the effect on pain and pain-related disability. While these are important measures, there is a growing need to understand the effect of chiropractic care on measures that impact health related quality of life including sleep, anxiety, depression, satisfaction, physical function, and pain interference. The recently published study collected data from a large (n=750) population of patient with low back pain in order to compare usual medical to usual medical care plus chiropractic care. As this was a pragmatic study, all clinicians (medical and chiropractic) were able to treat patients as they would normally, without additional study requirements or restrictions.
In this study, chiropractors delivered spinal manipulation to all participants followed by exercise (49%), electrical muscle stimulation (47%), hot or cold packs (47%), mechanical traction (23%), and other manual therapy (23%). Adding chiropractic care to the usual medical care pathway led to significant benefit for patients in terms of physical function, pain interference, sleep disturbance, anxiety, depression, and satisfaction. While chiropractic care was still beneficial, the smallest effects were seen for sleep and depression. Consistent with other studies, the largest benefits were found for pain interference.7 The study authors hypothesize that conditions such as sleep, anxiety, and depression may improve due to a decrease in pain. Future studies are needed to identify additional rationale for these findings.
This study provides additional evidence that chiropractic care may lead to beneficial effects for patients with low back pain when added to usual care.
- Goertz CM, Long CR, Vining RD, Pohlman KA, Walter J, Coulter I. Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial. JAMA Netw Open. 2018;1(1):e180105. doi:10.1001/jamanetworkopen.2018.0105
- Hays RD, Shannon ZK, Long CR, et al. Health-related quality of life among United States service members with low back pain receiving usual care plus chiropractic care plus usual care vs usual care alone: Secondary outcomes of a pragmatic clinical trial. Pain Med Malden Mass. Published online January 21, 2022:pnac009. doi:10.1093/pm/pnac009
- Dieleman JL, Cao J, Chapin A, et al. US Health Care Spending by Payer and Health Condition, 1996-2016. JAMA. 2020;323(9):863-884. doi:10.1001/jama.2020.0734
- GBD 2016 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Lond Engl. 2017;390(10100):1260-1344. doi:10.1016/S0140-6736(17)32130-X
- Qaseem A, Wilt TJ, McLean RM, Forciea MA, Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. doi:10.7326/M16-2367
- Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54(2):79-86. doi:10.1136/bjsports-2018-099878
- Saragiotto BT, Maher CG, Traeger AC, Li Q, McAuley JH. Dispelling the myth that chronic pain is unresponsive to treatment. Br J Sports Med. 2017;51(13):986-988. doi:10.1136/bjsports-2016-096821