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Another Chiropractic Triumph

© Dr. David L. Phillips

Two years ago, the Worker's Safety and Insurance Board in Ontario (WSIB) began a novel and unique approach to the assessment and treatment of acute lower back pain. This program is known simply as "The Acute Low Back Pain Program of Care" and is based solely on current scientific evidence. "Current scientific evidence" means, "Let's do what is proven to work".

One would have thought that doctors and therapists only and always do what works, right? Wrong! In fact, there's mounting evidence that much of what passes for treatment for lower back pain is a sham. The WSIB, in their Acute Program of Care listed what therapies they recommended, and therefore would pay for, and which they didn't, and therefore no longer reimbursed. Such common physical therapies as spinal traction, ultrasound, various electrical stimulating devices, biofeedback and acupuncture where not recommended, much to the frustration and angst of the most of our physiotherapists.

The search for what works and what doesn't is not restricted to physical therapies alone. Recently drug therapies have also been examined and studied to see whether, or not, they are effective. Nikolai Bogduk of Australia is a world-famous researcher in the field of lower back pain who recently has been vocal about drug treatments for back pain. He says, "On the basis of the evidence, no drug regimen can be legitimately recommended for back pain" and then he "cautions practitioners not to rely on drugs for the treatment of low back pain". From his studies of evidence-based medicine, he has found that most of the common drugs used for pain control are mostly no better, or just slightly better, than placebos. And while powerful drugs do dull pain, their side-effects and dangers negate any real benefit.

Dr. Bogduk goes on to explain that even with chronic lower back pain, drug therapies "do not provide a solution". The recent fiasco with the hugely popular drug, Vioxx should illustrate this adequately.

So what is the solution for back pain? The WSIB Program of Care gives us some interesting insights. In September the results of its first year stats were released. The report is based on 4000 cases, of which about half went to a chiropractor and half went to other therapies, mostly physiotherapy. The report cites the following findings:

• Patients were able to access chiropractic care much quicker than other types of care - 3 days as opposed to 13 days.
• The average number of work days lost among those workers treated by chiropractors was 9 days compared to 20 days for other therapies.

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