Health
problems Back Pain research
Osteopathy
& Back Pain
Osteopathy is an established, recognised system of diagnosis and treatment
that lays its main emphasis on the structural integrity of the body. It is
distinctive in the fact that it recognises much of the pain and disability
we suffer stems from abnormalities in the function of the body structure
as well as damage caused to it by disease.
Osteopathy uses many of the diagnostic procedures used
in conventional medical assessment and diagnosis. Its main strength,
however, lies in the unique way the patient is assessed from a mechanical,
functional and postural standpoint and the manual methods of treatment
applied to suit the needs of the individual patient.
Why see an Osteopath?: - It is the osteopath’s comprehensive approach
to healthcare that makes treatment unique. Osteopaths do not look on
patients simply as back sufferers but as individuals with their own unique
requirements for health. Treatment is designed to correct each
individual’s mechanical problems in order to stimulate their own natural
healing processes. Osteopaths do not simply treat back problems but look
at all the factors contributing to a disturbed state of natural health.
Visiting an Osteopath: - When you visit an osteopath for the first time
a full case history will be taken and you will be given an examination.
You will normally be asked to remove some of your clothing and to perform
a simple series of movements. The osteopath will then use a highly
developed sense of touch, called palpation, to identify any points of
weakness or excessive strain throughout the body.
The osteopath may need additional investigations such
as x-ray or blood tests. This will allow a full diagnosis and suitable
treatment plan to be developed with you. Osteopathy is patient centred,
which means the treatment is geared to you as an individual.
Osteopathy and patient protection: - Osteopaths are
trained to recognise and treat many causes of pain. Osteopathy is an
established system of diagnosis and manual treatment, which is recognised
by the British Medical Association as a discrete clinical discipline.
For the last sixty years, osteopaths have worked within a system of
voluntary regulation that set standards of training and practice.
In
1993, osteopathy became the first major complementary health care
profession to be accorded statutory recognition under the 1993 Osteopaths
Act. This has culminated in the opening of the statutory register of
osteopaths by the General Osteopathic Council in May 1998. Only those
practitioners able to show that they have been in safe and competent
practice of osteopathy will be allowed onto the register and in the future
all osteopaths will be trained to the same high rigorous standards. All
osteopaths will need to have medical malpractice insurance and to follow a
strict code of conduct.
Patients will have the same safeguards as when currently they consult a
doctor or dentist.
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Reflexology
& Back Pain
A study conducted at the Hospital
of Beijing College of Languages investigated the effect of reflexology
treatment on acute lower back pain. Twenty patients between the ages of 35
and 55, all of whom were teachers or office workers, and suffering from
lower back strain participated in the study.
The reflex points on the patients’ feet were treated for a maximum of
ten treatments and the results analysed. All of the patients reported that
the treatment had effectively eliminated their pain; 5 of the patients
obtained complete relief after only one treatment, 10 after 3 to 4
treatments and a further 5 after 5 to 7 treatments. No analgesics or other
medications were used throughout the course of treatments.
Although a small scale study, it adds to the growing body of evidence
confirming that reflexology has extensive therapeutic value beyond the
realms of mere relaxation and stress management.
Xiao Zhenge, Hospital of Beijing College of Languages Reflexology
Research Reports 2nd Edn. Compiled by K Walker. Association of
Reflexologists.
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Acupuncture
& Hypnosis & Back Pain
Whilst it is now generally accepted that both hypnotherapy and
acupuncture can alleviate pain, the precise mechanism that triggers the
analgesic response remains unclear for both treatments. It was for this
reason that researchers at the Department of Anaesthesiology, Hospital
Cantonal Universitaire of Geneva, Switzerland recently investigated and
compared the analgesic effect of hypnotherapy with acupuncture.
Experimental pain was induced by a cold pressor test in eight male
volunteers. The analgesic effects of hypnosis and acupuncture were
assessed before and after double-blind administration of a placebo or
naloxone, in a prospective, crossover study.
The results showed that pain intensity was significantly lower with
hypnotherapy as compared with acupuncture, and the pain scores did not
differ significantly when naloxone or placebo was administered.
The researchers concluded that:-
-
Both hypnosis and acupuncture can
significantly reduce pain induced by cold pressor tests.
-
Hypnotherapy is more effective than
acupuncture,
-
The effects of hypnotherapy and
acupuncture are not primarily induced by the opiate endorphin system,
and plasmatic levels of
beta-endorphins are not significantly affected by either hypnotherapy
or acupuncture, nor by naloxone or placebo administration.
Moret V; Forster A; Laverriere MC; Lambert H; Gaillard RC; Bourgeois P;
Haynal A; Gemperle M; Buchser E . Mechanism of analgesia induced by
hypnosis and acupuncture: is there a difference? Pain (NETHERLANDS) May
1991,45 (2) p135-40
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Music therapy
& Back Pain
Japanese researchers have
assessed the potential role of music therapy in the field of pain
management. The researchers decided to analyse the effects of music on
pain associated with having to keep a compulsory posture. Classical musics
were chosen in this study. Five healthy adult females kept a supine
position for two hours without music. Complaints, and variations of heart
beat and respiration were observed in each subject during the two hour
experiment. After five days or more, these subjects had the same
experience, but this time with music. Frequency and intensity of
complaints were found to be significantly diminished by music. Although
heart rate was not changed by music, frequency of irregular respiration
was found to be significantly decreased by the music. There was therefore
a positive correlation between frequency of irregular respiration and
number of complaints in subjects kept without music. The researchers
claimed that their study demonstrated that music is effective to relieve a
pain associated with a compulsory posture and that music may play a
significant role on pain management in palliative therapy.
Ishii C; Hagihara S; Minamisawa R. [Effects of music on relieving pain
associated with a compulsory posture] Nihon Kango Kagakkaishi (JAPAN) Jul
1993, 13 (1) p20-7
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Chiropractic
manipulation & Back Pain
Chiropractic manipulation has been recognised as highly effective in
treating back pain, and the Royal College of General Practitioners issued
guidelines for GPs in 1996 which recommended manipulation within six weeks
of onset for the relief of acute low back palm.
Chiropractors are trained to identify and treat the specific cause of
your back pain, and once you have been treated, they may also advise you
on an appropriate rehabilitation and maintenance care plan to prevent a
recurrence.
The bones of your spine protect the spinal cord; if they lose their
normal motion or position, this can irritate the nerve roots that branch
from the spinal cord to the organs and tissues of your body. is a general
term describing pain in the sciatic region, which extends from the base of
the spine down the back and side of the leg. Unless there is a specific
injury to this region, pain here is ‘referred’ from other areas. (The
irritation of the nerve in one area can sometimes lead to pain, known as
‘referred’ pain, in other parts of the body). The nerves that supply
the sciatic region come from the lower back.
In order for the spine to be flexible, the vertebrae are joined
together by soft tissue structures known as discs and ligaments. Each disc
is made up of two parts — a central soft core and outer rings of tough
cartilage. The discs allow movement and also help to absorb shock. A
is the rather inaccurate term used to describe the condition, often in
the lower back, where trauma or ‘wear and tear’ have caused damage to
the outer rings of cartilage, so that the core is squeezed outwards. This
can eventually result in a bulge which can press on the spinal cord, the
nerve root or the nerve itself. It can cause excruciating pain, either in
the back or referred elsewhere — for example in the lower leg or foot.
Chiropractic treatment can mobilise the spine to reduce any inflammation
around the spinal cord or nerves.
(sometimes referred to as ‘fibrositis’) are very common and related
to back pain. They occur in the neck or shoulders (often caused by bad
posture or stress) or sometimes in the buttock area at the base of the
spine. Painful ‘knots’ form within muscles which have gone into spasm
— a reaction which the body triggers in order to tighten muscles round a
problem area to prevent further injury. This is why the condition so often
occurs in patients who have had a back pain problem for some time.
Your chiropractor will therefore use manipulation to adjust the
relevant joint, and also deep massage and soft tissue work to relieve the
condition. Since the ‘knots’ of muscle are often very tender, the soft
tissue treatment may be painful at first.
References:
1 Report of the CSAG Committee on Back Pain, May 1994
2 Clinical Guidelines for the Management of Acute Low Back Pain, Royal
College of General Practitioners, September 1996
Source: - British Chiropractic Association.
Chiropractic treatment is
more effective in the treatment of back pain than conventional treatments
according to a study funded by the Medical Research Council and published
in the British Medical Journal (1). 741 men and women between the ages of
18-64 with low back pain were randomly assigned to one of two groups –
one to receive chiropractic care and the other to receive physiotherapy in
hospital out-patient clinics.
Progress was monitored by
patients completing the ‘Oswestry’ questionnaire on back pain which
allocates scores in ten sections including intensity of pain, difficulty in
lifting, walking, travelling etc. At the end of the year the patients were
also asked whether they thought their treatment had help their back pain. At
the end of the 3 year period, the results showed that improvement was
approximately 29% greater in the chiropractic group than in the conventional
physiotherapy treatment group, and the researchers concluded that ‘the
results confirm the findings of an earlier report that when chiropractic or
hospital therapists treat patients with low back pain as they would in
day-to-day practice, those treated by chiropractic derive more benefit and
long-term satisfaction than those treated by hospitals.
T.W.Meade, Sandra Dyer, Wendy
Browne, AO Frank. Randomised comparison of chiropractic and hospital
out-patient management for low back pain: Results from extended follow up.
BMJ 1995:311: 349,51.
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Alternative
therapies
& Back Pain
Researchers at the Department of
Rheumatology, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Tel Aviv
University, Sackler Faculty of Medicine, Israel recently evaluated the benefits
of alternative treatments for patients suffering from chronic back pain.
Acupuncture, Chiropractic and Alexander technique
were evaluated by patients and a pain specialist.
At admission to the study, the patients were asked to complete a questionnaire
concerning their socio-demographic background and disease history.
They also underwent a psychological evaluation based on a questionnaire
and an interview. The patients were evaluated at the end of the four week
program and after 6 months of follow up.
The results showed that the patients in the
treatment group experienced significant improvement in the pain rating, pain
frequency and analgesic drug consumption, and this was maintained for a period
of 6 months. The best outcomes were seen in
those patients who had the lowest predominance of psychological factors, a high
level of motivation and family support. Poor results were
found to be associated with a divorced marital status and unemployment, diffuse
complaints, post surgery status, a high predominance
of psychological factors,and personality disorders.
The report concluded that patients with chronic
back pain seem to benefit from this proposed multidisciplinary approach. The
improvement was maintained for a period of 6 months.
And, most significantly, the outcome of the therapies was clearly related to
psychosocial factors.
Elkayam O; Ben Itzhak S; Avrahami E; Meidan
Y; Doron N; Eldar I; Keidar I; Liram N; Yaron M
Multidisciplinary approach to chronic back pain: prognostic elements of the
outcome. Clin Exp Rheumatol (ITALY) May-Jun 1996, 14 (3) p281-8
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Massage,
Chiropractic & Back Pain
A randomized
controlled trial of chiropractic manipulation, stroking massage, corset and
transcutaneous muscular stimulation (TMS) were evaluated for the treatment
of low back pain. This trial employed specific inclusion and exclusion
criteria, including nonspecific low back pain for a duration of 3 wk to 6
months and ages between 18 and 55.
The data revealed that chiropractic manipulation
had a better but nonsignificant result than corset, possibly due to
insufficient sample size and/or duration of treatment. The researchers
concluded that both instruments are reliable for measuring low back pain
disability, and chiropractic manipulation has a superior short-term benefit
when compared to stroking massage and TMS in subacute low back pain
patients.
J Manipulative Physiol
Ther 1992 Jan;15(1):4-9, Hsieh CY,
Phillips RB, Adams AH, Pope MH, Research
Division, Los Angeles College of Chiropractic, Whittier, CA 90609.
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Chronic
back pain & Acupuncture Vs Electrical nerve stimulation
Sixty patients aged 60 or over with back pain for at least 6 months were
recruited from General Practitioner referrals and randomized to 4 weeks
of treatment with acupuncture or transcutaneous electrical nerve
stimulation (TENS). All treatments were administered by the same
physiotherapist and both groups had the same contact with him. The
following were measured at baseline, completion and at a 3-month
follow-up by an independent observer blinded to treatment received: (1)
pain severity on visual analogue scale (VAS); (2) pain subscale of
Nottingham Health Profile (NHP); (3) number of analgesic tablets
consumed in previous week; (4) spinal flexion from C7 to S1. Thirty-two
patients were randomized to acupuncture and 28 to TENS; only three
withdrew (two from acupuncture, one from TENS). Significant improvements
were shown on VAS (P < 0.001), NHP (P < 0.001) and tablet count (P
< 0.05) between baseline and completion in both groups, these
improvements remaining significant comparing baseline with follow-up
with a further non-significant improvement in VAS and NHP in the
acupuncture group. The acupuncture but not the TENS patients showed a
small but statistically significant improvement (P < 0.05) in mean
spinal flexion between baseline and completion which was not maintained
at follow-up. Thus in these elderly patients with chronic back pain both
acupuncture and TENS had demonstrable benefits which outlasted the
treatment period. Acupuncture may improve spinal flexion. This trial
cannot exclude the possibility that both treatments are 'placebos'.
Pain 1999 Jul;82(1):9-13 Grant DJ,
Bishop-Miller J, Winchester DM, Anderson M, Faulkner S Liberton
Hospital, Edinburgh, UK. d.j.grant @ btinternet . com
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