FOCUS: Don't turn your back on chiropractic 2009/10/18 More Malaysians are suffering from lower back pain

, not only causing discomfort but losing productivity at work as well. MICHAEL HANELINE describes the chiropractic options available for a patient to seek relief. LOWER back pain is a very common problem that affects about 80 per cent of all people at some point in their lives. In developed countries, back pain is the second most common reason people visit their doctors, the fifth most common reason people are hospitalised and the third most common reason for surgery. Malaysia is no exception. A recent survey found that about 12 per cent of respondents had existing lower back pain. Many people think that lower back pain will usually get better on its own in a few weeks. However, recent research has shown that about half of lower back pain sufferers continue to have pain for up to one year following its onset and that some people never recover. Lower back pain that has been present for more than a few months is considered c h r o n i c. The pain can sometimes be quite severe and disabling; thus, lower back pain is one of the most common reasons people have to miss work caused by illness. In Britain for instance, 175 million working days were lost in 2006 because of lower back pain, at a cost of more than £100 billion (RM550 billion). Treating the condition is also very costly, with US$85.9 billion (RM290 billion) being spent by Americans seeking relief from back and neck pain in 2005. One study reported that the average annual medical costs to treat people with back problems wa s US$6,096 per person in 2005, about 76 per cent more than people without back problems. Lower back pain can be caused by falls, sports injuries, and heavy lifting, although sometimes the pain appears for no apparent reason. It also commonly occurs during pregnancy. The origin of a person’s lower back pain is often, difficult to determine because there are several possible sources of pain, including muscles, ligaments, facets, sacroiliac joints and intervertebral d i s c s. When any of these areas are irritated, they typically cause pain in the same area of the body — the lower back. There are subtle differences, however, that a trained expert can usually diagnose for optimal treatment. COMMON TREATMENTS FOR LOWER BACK PAIN A healthcare professional will first examine a patient before making a diagnosis. Based on the diagnosis and various factors about the patient, a suitable treatment can be recommended. There are numerous treatment choices available to lower back pain suffers,

including medication, acupuncture, massage, chiropractic and many others. There are pros and cons to each type of care and a particular type of treatment may be appropriate for one person but not another person who appears to have a similar problem. Over-the-counter pain relievers may be viable as a short-term solution for lower back pain, but prolonged use may cause problems. For instance, non-steroidal antiinflammatory drugs, which include ibuprofen and aspirin, are commonly used for lower back pain. These medications increase the risk of serious adverse reactions involving the stomach lining, kidneys and cardiovascular system. Another commonly used pain reliever is acetaminophen (the active ingredient in Panadol) which, according to the US Food and Drug Administration, is the leading cause of liver failure in the West. Surgery is generally not recommended for people with lower back pain unless they have pain or numbness extending from the back into the leg and/or foot that does not respond to other forms of treatment. There are other indications for surgery in lower back pain patients, but only a small percentage of cases ever require it. Massage, acupuncture and physical therapy are other treatments that are sometimes beneficial. These types of care are considered to be noninvasive because no surgery is involved. One positive feature of these types of care is that they are unlikely to cause severe adverse reactions. Chiropractic is another noninvasive type of care that increasing numbers of Malaysians are choosing and one that a great deal of research has shown to be helpful for people with lower back pain. While still a developing profession in Malaysia, chiropractic is one of the most popular treatment options among Americans. In fact, it has been estimated that 22 million Americans visit chiropractors every year and the major complaint of about 35 per cent of them is lower back pain. Severe adverse reactions to chiropractic care for lower back pain are extremely unlikely. CHIROPRACTIC CARE FOR LOWER BACK PAIN The main focus of chiropractic is the diagnosis and treatment of disorders of the bones and muscles of the body, especially involving the back and neck. Doctors of chiropractic (also referred to as chiropractors) commonly treat a variety of conditions, including back and neck pain, headaches, pain in the arms or legs, and many others. Chiropractors are trained to locate back disorders that involve restricted movement and/or abnormal position between adjoining vertebrae (back bones). This condition is known as a “subluxation,” which chiropractors correct using

“chiropractic adjustments”. During this procedure, the chiropractor applies specific forces to the restricted and/or misaligned areas using their hands or an adjusting instrument. Chiropractic adjustments restore the movement and/or position of the affected joints, which reduces the strain on the surrounding tissues and relieves pain. In addition to providing adjustments, chiropractors also use ancillary procedures to assist the healing process, such as rehabilitative exercise, dietary advice, physical therapy modalities, and others. If the chiropractor determines that a patient’s condition will not likely respond to chiropractic care, the patient will be referred to an appropriate healthcare provider. Other types of doctors and therapists use manipulation in their practices too, but chiropractors provide the t majority of this service. For example, in the US, 94 per cent of all manipulation is provided by chiropractors. No other healthcare provider is better equipped to provide this type of service than a chiropractor because manipulation (adjustment) of the back and neck is the central focus of a chiropractor’s four years of education and the basis of their daily practice. RESEARCH SUPPORTS CHIROPRACTIC CARE The use of manipulation (adjustment) in the treatment of low back pain has been extensively studied by researchers throughout the world, probably more than any other treatment option. The findings of this research have been used to produce guidelines for healthcare providers about the best way they should treat their lower back pain patients. Some examples of the recommendations in these guidelines are: • The Agency for Health Care Policy and Research, a US research organisation, carried out an extensive study of all research until 1993 on the care for lower back probl e m s. The agency recommended spinal manipulation as the only safe and effective form of initial professional treatment for adults with acute lower back problems. • Another lower back pain treatment guideline was developed by the American College of Physicians and the American Pain Society in 2007. After reviewing all of the research that had been carried out on treatments for lower back pain in general, their recommendations were reported in an article that appeared in the Annals of Internal Medicine. Spinal manipulation was the only recommended active treatment for patients with sub-acute or chronic lower back pain. Another option that the authors of the article recommended was rehabilitative exercise to help stabilise the back, which is something that chiropractors routinely recommend to their patients. • Earlier this year, the National Institute for Health and Clinical Excellence in Britain released guidelines that were prepared for doctors who treat patients with lower back pain. Spinal manipulation (adjustment), mainly done by chiropractors, was one of only a

handful of recommended treatment methods. Research has also shown that patients with lower back pain are usually more satisfied with chiropractic care than with other types of healthcare. For instance, a survey of 14,000 subscribers of Consumer Reports magazine asked questions about lower back pain and the results were reported in their May issue. The article indicated that chiropractic care was the top-rated treatment by back pain sufferers and that chiropractors received the highest “satisfaction with care” rat - ings; higher than those given to medical doctors, physical therapists and acupuncturists. * Prof Michael Haneline is head of Chiropractic, International Medical University

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