Which Treatment Is Most Effective for Low Back Pain?

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For decades, there has been an ongoing battle between health care professions as to who has the most effective and/or least costly treatment for low back pain. Dr. J G Moellendorf, DC, ND, LCP provides an expert opinion on the most recent research findings.

The guidelines concluded the risk-to-benefit ratio favored spinal manipulation as less invasive than drug therapy in the treatment of acute lower back pain.

In 1994, the federal government’s Agency for Health Care Policy and Research (AHCPR) published the first guidelines for health care professionals for treating low back pain. Titled Acute Low Back Pain Problems in Adults: Assessment and Treatment, Guideline 14; publication No. 95-0642, it evaluated the current research findings as to which treatments were most effective for acute and chronic low back pain. Sturgeon Bay, Wisconsin Chiropractor Dr. J G Moellendorf, DC, ND, LCP points out that while these guidelines have been useful, after 18 years they need updating with more current research.

Dr. Moellendorf notes that the state of Oregon Health Policy Board has successfully taken on this challenge to not only “lead Oregon to a more affordable, world-class health care system” but to lead the way for the rest of the nation. A collaborative effort by the Center for Evidence-Based Practice, the Oregon Corporation for Health Care Quality, the Evidence-Based Policy of the Oregon Health and Sciences University Center, and the Oregon Health Evidence Review Commission was achieved. After several years of extensively reviewing the Medical, Osteopathic, Chiropractic, physical therapy, and pharmacologic research findings, they released their findings in December 2012. Dr. Moellendorf states that the State of Oregon Evidence-Based Clinical Guidelines for the Evaluation and Management of Low Back Pain not only provides up-to-date guidance for treating acute or recurrent low back pain by Oregon physicians, but will serve as a model for use by all health care professions nationally.

For patients with acute lower back pain (less than 4 weeks duration), Dr. Moellendorf points out that the guidelines recommended spinal manipulation (e.g. Chiropractic care) as the only nondrug treatment. The guidelines considered the risk versus benefit of spinal manipulation when compared to acetaminophen (e.g. Tylenol), non-steroidal anti-inflammatory drugs (NSAIDs) (e.g. aspirin, ibuprofen), benzodiazepines (e.g. Valium, Librium), and opiods (e.g. codeine, oxycodone). According to Dr. Moellendorf, the most significant conclusion of the guidelines agreed with the earlier AHCPR recommendations: while spinal manipulation relieves pain, it also restores spinal function. Medications only relieved pain with no functional restoration. The guidelines concluded the risk-to-benefit ratio favored spinal manipulation as less invasive than drug therapy for treating acute lower back pain.

In pointing out the shortcomings of drug therapy compared to spinal manipulaiton, the Oregon Health Policy Board considered recently published research findings. Dr. Amy Schilling and associates of the Cleveland Clinic, Cleveland, Ohio note that acetaminophen is the leading cause of acute liver failure, accounting for 140,000 poisonings, 56,000 emergency room visits (more than any other drug on the market), and over 100 deaths every year. Research published by Lanas et al (A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterol 2005; 100:1685-93.), Frech and Go (Treatment and chemoprevention of NSAID-associated gastrointestinal complications. Therapeutics and Clin Risk Manag, 2009:65-73.), and Hochman and Shah (What price pain relief? Circulation, 2006; 113:2868-70.) has pointed out that NSAIDs are the second leading cause of peptic ulcers, are associated with heart attacks and strokes in the elderly, account for 100,000 hospitalizations, cause 17,000 deaths, and add $2 billion to health care costs every year. Dr. Moellendorf concludes, “this is a very high price to pay in the attempt to relieve back pain.”

Even for more serious conditions such as lumbar radiculopathy and spinal stenosis, the Oregon Health Policy Board has recommended continued conservative management and an intensive interdisciplinary approach before resorting to surgery.

Dr. Moellendorf points out that a multitude of research studies over the last few decades has shown that Chiropractic care for lower back pain has succeeded when other methods failed. This is because Chiropractic focuses on realigning the spine while increasing movement through normal joint function. This in turn reduces tensions on the muscles and ligaments while reducing the nerve irritation that leads to pain.

With Chiropractic care, many extremely satisfied patients successfully get rid of their acute and chronic back pain. They can finally regain their quality of life by returning to their favorite sports, enjoying their hobbies, and other aspects of their lives that they had previously given up because of their back pain.

Using the latest research findings, Moellendorf Chiropractic Office, Ltd. uses a comprehensive package of Chiropractic care, decompression traction therapy, active therapeutic movement training, cold laser therapy, and nutrition for the natural treatment of acute and chronic spinal pain. Additional information about Chiropractic, Naturopathy, and other forms of natural health care has been provided by Moellendorf Chiropractic Office, Ltd. at http://www.all-about-wellness.com.

About: Dr. J G Moellendorf, DC, ND, LCP
Dr. J G Moellendorf, DC, ND, LCP attended the University of Wisconsin—Superior where he majored in Physics and Mathematics, with a minor in art photography. While attending the University of Minnesota—Minneapolis, he assisted in research on ribosomal proteins. Completing his Chiropractic studies at Palmer College of Chiropractic in Davenport, Iowa, he graduated Cum Laude (with high honors) in 1983. He started Moellendorf Chiropractic Office, Ltd. in Sturgeon Bay, Wisconsin in 1983. In 1996, Dr. Moellendorf was awarded his Doctorate in Naturopathy from Trinity School of Natural Health. In 2001, he received Chiropractic’s most prestigious award, the honorary Legion of Chiropractic Philosophers degree, for his thesis “The Workings of Innate Intelligence in Obsessive/Compulsive and Addictive Behaviors.” This paper was chosen for publishing in the book Philosophic Contemplations vol. 2 in 2002. In June of 2012, Dr. Moellendorf authored his first book titled Healthcare’s Best Kept Secret which can be ordered on Amazon. Dr. Moellendorf can be contacted by phone (920) 493-2126, fax (920) 743-1145, email jgmoellendorf(at)itol(dot)com, his website at http://www.all-about-wellness.com, or send a carrier pigeon to 44.84722N and 87.36416W.

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