Acute & Chronic Pain Care

acute chronic pain careMost people don’t initially visit a Chiropractor until they are already in pain and are seeking relief. As discussed in the “Wellness Care” section, there are many substantial benefits to regular chiropractic care aside from relief from existing pain. In addition to the other many health benefits, regular Wellness Care is recommended to proactively prevent injury and pain from occurring and/or, after healing and pain relief is reached, to prevent re-injury. Nevertheless, chiropractic care is quite often effective in promoting healing and achieving relief from pain when such injury does occur.

When chiropractic care is sought for injury and pain, treatment can generally be divided into three distinct and separate stages. These stages generally describe the reaction to a musculoskeletal injury and are the “Acute Stage”, the “Sub-Acute Stage” and the “Chronic Stage”.

Acute Stage

The acute stage is defined as the period immediately following the injury and normally lasts 48-72 hours (although some patients remain in this stage for a week or more). During this stage, the primary characteristic is inflammation. A clinical characteristic is the presence of pain in the early part of the range of motion. Even the slightest movement may cause pain. Treatment during this stage is largely directed at pain relief, controlling swelling, and supporting or protecting injured tissue. Recovery is usually quicker and more complete for the patient when he or she seeks chiropractic intervention during this stage.

Inflammation, pain, and spasms are reduced in the office and home care advice is given. The treatment during this stage usually involves multiple visits to move the patient from pain relief to the second stage, the Sub-Acute stage. Physiotherapeutic modalities, such as ice, electrical muscle stimulation, and ultrasound, are quite often used in this stage.

Sub-Acute Stage

After passing fairly quickly through the Acute stage, the body begins to change directions from a physiologic point of view. The body turns its attention from controlling the impact of the injury to the task of healing and repair. This stage may last several weeks with a variable time frame depending on the patient and the type and extent of injury. During this stage, there is a gradual reduction of inflammation and pain. There is also a gradually increasing degree of pain-free motion, with pain present near the end of the range of motion. Many patients remain in pain during this stage; therefore, the increase in function may be used as a reasonable guideline to monitor the patient’s progress. The primary characteristic of this stage is the presence of fragile, re-injured tissue. Unfortunately, as the symptoms and pain subside during this period, some patients exceed their functional limitations and exacerbate his or her condition, causing the patient to re-enter the Acute stage. Some patients will vacillate several times between these stages. Additionally, compliance with care tends to fall off as the patient begins to feel better. It is, however, important to follow through with a treatment plan to avoid returning to the Acute stage.

In addition to spinal adjustments, a variety of other techniques, including soft tissue techniques, rehabilitative exercises, and stretching ergonomics, are often used to restore proper function so the patient is not limited in his or her daily living activities.

Chronic Stage

For some patients, recovery is delayed or incomplete and the chronic stage is entered. These conditions, by their very nature, are long-lasting and may last for several months or even years. Professional opinion varies as to when a particular problem enters the chronic stage. It is, however, usually agreed that a condition that is not showing continued signs of improvement at 6-7 weeks should be considered chronic.

During this stage, shortened connective tissue in the form of fibrosis and adhesions are the primary characteristic. Pain is present at the end of range of motion, although the total range of motion may be reduced.

Chiropractic Research

An ever growing list of research studies and reviews demonstrate that the services provided by Chiropractic Physicians are both safe and effective. The following are excerpts and summaries from a few of such recent studies. The evidence strongly supports the natural, whole-body and cost-effective approach of chiropractic care for a variety of conditions

For Acute and Chronic Pain

“Many treatments are available for low back pain. Often exercises and physical therapy can help. Some people benefit from chiropractic therapy or acupuncture.”
–Goodman et al. (2013), Journal of the American Medical Association

“[Chiropractic Manipulative Therapy] in conjunction with [standard medical care] offers a significant advantage for decreasing pain and improving physical functioning when compared with only standard care, for men and women between 18 and 35 years of age with acute low back pain.”
–Goertz et al. (2013), Spine

“In a Randomized controlled trial, 183 patients with neck pain were randomly allocated to manual therapy (spinal mobilization), physiotherapy (mainly exercise) or general practitioner care (counseling, education and drugs) in a 52-week study. The clinical outcomes measures showed that manual therapy resulted in faster recovery than physiotherapy and general practitioner care. Moreover, total costs of the manual therapy-treated patients were about one-third of the costs of physiotherapy or general practitioner care.”
— Korthals-de Bos et al (2003), British Medical Journal

“Patients with chronic low-back pain treated by chiropractors showed greater improvement and satisfaction at one month than patients treated by family physicians. Satisfaction scores were higher for chiropractic patients. A higher proportion of chiropractic patients (56 percent vs. 13 percent) reported that their low-back pain was better or much better, whereas nearly one-third of medical patients reported their low-
back pain was worse or much worse.”
— Nyiendo et al (2000), Journal of Manipulative and Physiological Therapeutics

In Comparison to Other Treatment Alternatives

“Reduced odds of surgery were observed for…those whose first provider was a chiropractor. 42.7% of workers [with back injuries] who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor.”
— Keeney et al (2012), Spine

“Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction; clinically important differences in pain and disability improvement were found for chronic patients.”
— Haas et al (2005), Journal of Manipulative and Physiological Therapeutics

“In our randomized, controlled trial, we compared the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner in patients with nonspecific neck pain. The success rate at seven weeks was twice as high for the manual therapy group (68.3 percent) as for the continued care group (general practitioner). Manual therapy scored better than physical therapy on all outcome measures. Patients receiving manual therapy had fewer absences from work than patients receiving physical therapy or continued care, and manual therapy and physical therapy each resulted in statistically significant less analgesic use than continued care.”
— Hoving et al (2002), Annals of Internal Medicine

For Headaches

“Cervical spine manipulation was associated with significant improvement in headache outcomes in trials involving patients with neck pain and/or neck dysfunction and headache.”
— McCrory, Penzlen, Hasselblad, Gray (2001), Duke Evidence Report

“The results of this study show that spinal manipulative therapy is an effective treatment for tension headaches. . . Four weeks after cessation of treatment . . . the patients who received spinal manipulative therapy experienced a sustained therapeutic benefit in all major outcomes in contrast to the patients that received amitriptyline therapy, who reverted to baseline values.” ‘
— Boline et al. (1995), Journal of Manipulative and Physiological Therapeutics

For Neck Pain

“In a study funded by NIH’s National Center for Complementary and Alternative Medicine to test the effectiveness of different approaches for treating mechanical neck pain, 272 participants were divided into three groups that received either spinal manipulative therapy (SMT) from a doctor of chiropractic (DC), pain medication (over-the-counter pain relievers, narcotics and muscle relaxants) or exercise recommendations.

After 12 weeks, about 57 percent of those who met with DCs and 48 percent who exercised reported at least a 75 percent reduction in pain, compared to 33 percent of the people in the medication group. After one year, approximately 53 percent of the drug-free groups continued to report at least a 75 percent reduction in pain; compared to just 38 percent pain reduction among those who took medication.”
— Bronfort et al. (2012), Annals of Internal Medicine

Cost Effectiveness

Low back pain initiated with a doctor of chiropractic (DC) saves 40 percent on health care costs when compared with care initiated through a medical doctor (MD), according to a study that analyzed data from 85,000 Blue Cross Blue Shield (BCBS) beneficiaries in Tennessee over a two-year span. The study population had open access to MDs and DCs through self-referral, and there were no limits applied to the number of MD/DC visits allowed and no differences in co-pays. Researchers estimated that allowing DC-initiated episodes of care would have led to an annual cost savings of $2.3 million for BCBS of Tennessee. They also concluded that insurance companies that restrict access to chiropractic care for low back pain treatment may inadvertently pay more for care than they would if they removed such restrictions.
— Liliedahl et al (2010), Journal of Manipulative and Physiological Therapeutics

“Chiropractic care appeared relatively cost-effective for the treatment of chronic low-back pain. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulative efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis.”
— Haas et al (2005), Journal of Manipulative and Physiological Therapeutics

Patient Satisfaction

“Chiropractic patients were found to be more satisfied with their back care providers after four weeks of treatment than were medical patients. Results from observational studies suggested that back pain patients are more satisfied with chiropractic care than with medical care. Additionally, studies conclude that patients are more satisfied with chiropractic care than they were with physical therapy after six weeks.”
— Hertzman-Miller et al (2002), American Journal of Public Health

Popularity of Chiropractic

“Chiropractic is the largest, most regulated, and best recognized of the complementary and alternative medicine (CAM) professions. CAM patient surveys show that chiropractors are used more often than any other alternative provider group and patient satisfaction with chiropractic care is very high. There is steadily increasing patient use of chiropractic in the United States, which has tripled in the past two decades.”
— Meeker, Haldeman (2002), Annals of Internal Medicine