McKinney Chiropractor Best Practices
Research Commentary;
Frequency & Duration of Chiropractic Care for Headaches, Neck and Upper Back Pain
Treat Pain with Chiropractic!
A review of
K. Maltby, DC, Donald D. Harrison, PhD, DC, MSE, Deed E. Harrison, DC, Joseph W. Betz, BS, DC, Joseph R. Ferrantelli, BS, DC, Gerard W. Clum, DC
Frequency & Duration of Chiropractic Care for Headaches, Neck and Upper Back Pain
Vertebral Subluxation Res. August 21, 2008
Research review by Dr. Bryan Stephens
Summarized Review Conclusions
This article studied forty seven randomized controlled trials on chiropractic care for headaches, neck and upper back pain in order to evaluate the treatment theory of 6-12 visits of Spinal Manipulation Therapy (Chiropractic Adjustment) being enough to resolve chronic pain issues. The conclusion they determined by evaluating the plethora of research was that it takes an “average” of 24 (SMT) visits to document, stabilize, and resolve these chronic conditions. The significant finding of this review was in recognizing the necessity of a stabilization or corrective phase to accomplish a complete healing process. In their evaluation of the RCT research they documented 46.5% improvement in an average of 7.7 visits. This meant that the patients felt better, but still experienced some pain and dysfunction after the 7.7 visits. This study recognizes the need of acute care but in addition went on to outline a need for continued stabilization care. I will summarize the key sections of the study for you below so that you may understand why consistent care at the beginning of a treatment program is key to not only alleviating initial pain but also in stabilizing the patient which prevents the pain from returning. Remember, Treat Pain with Chiropractic!
“Even though there are no reports of percentage of improvements in headaches, neck pain and upper back pain RCTs, there are several reports which claim that these conditions should resolve in 6 to 12 chiropratic spinal manipulation treatments”
J.K. Maltby et. Al, “Frequency & Duration of Chiropractic Care for Headaches, Neck and Upper Back Pain”, J. Vertebral Subluxation Res. August 21, 2008
In reference to the 7.7 average of visits resulting in 46.5% resolution
“…the average incoming pain was NRS = 5.2, and the average post-treatment pain score was NRS = 2.8, nearly 3.0…defined as “consistent slight pain, starting to interfere with daily living tasks.””
J.K. Maltby et. Al, “Frequency & Duration of Chiropractic Care for Headaches, Neck and Upper Back Pain”, J. Vertebral Subluxation Res. August 21, 2008
“We yield 17 average visits to resolve symptoms of headache, neck pain, cervico-brachial pain, or upper back pain…Using the initial examination visit, 4 once per week stabilization visits, and two follow-up visits, there are found to be 24 visits needed to examine, treat, stabilize, document, and follow-up on patients..”
J.K. Maltby et. Al, “Frequency & Duration of Chiropractic Care for Headaches, Neck and Upper Back Pain”, J. Vertebral Subluxation Res. August 21, 2008
Introduction to the Research
Neck pain has been rising and is second only to low back pain in terms of health care costs in the United States. Since 1978, there have been numerous controlled trials documenting the treatment of neck and upper back pain with spinal manipulative therapy (SMT). Despite many people seeing results in their initial pain indexes, the percentages of complete relief were never addressed. The authors of this research examined the theory that pain should be gone in 6-12 visits with SMT adjustments, after reviewing the actual data of the combined RCTs they established that further care was needed to completely resolve the patients chronic pain issues.
Many times throughout the research, the authors noted that there wasn’t a full resolution of pain without a continued care program on average of 24 visits. This finding is important because it deconstructs the mistaken treatment theory that once your pain, or your symptom, is gone, then the problem has been resolved. You should continue to treat pain with chiropractic.
Research Methodology
The authors performed searches on multiple medical research databases and found 47 RCTs in English that evaluated headaches, neck and upper back pain that also included pain scales with their trials. They put these into a table and formed two equations to also determine reasonable theoretical average number of treatments needed to completely resolve the pain. They formed the equation of
Estimated Care = (Average visits x 100%)(% average improvement)
While they see the amount of treatments needed to resolve pain, they also state the obligation of health care workers to “examine, diagnose and document treatment and clinical response to care, to stabilize and bring suffering subjects to maximum medical improvement.” To find the Total Visits needed, they included the initial exam, the minimum number of 2 follow up exams, and 4 once per week stabilization visits following acute treatment.
Research Findings
From the 47 RCTs, there were 2,069 subjects with an average of 7.7 visits provided in the research design. Only 41 of those trials included pain scales and showed only a 46.5% improvement. They used the linear extrapolation equation mentioned above to yield 17 visits actually needed to resolve the symptoms to 100%. From this number of treatments needed, they ran the second equation of total visits needed and found a total of 24 visits on average.
Research References
As always with these reviews, these are my takeaways from the article and I encourage you to read the article in its entirety. The references used in this article by the authors of this article are listed here.
Our Message
We love digging into the research to find the best ways to treat pain with Chiropractic. Our Doctors at our McKinney location, located near the corner of Eldorado Pkwy. and Ridge Rd., know that choosing a Chiropractor is a big decision. That’s why we take the time to not only review the research ourselves, but share what we find with our patients to give the the best care and the best education o their pain and their health. When you are dealing with Low Back Pain, Neck Pain or Headaches, choose a Chiropractor you can trust. Choose a Chiropractor who knows how to get you out of pain and can help you become healthier so that you stay out of pain!