Podcast episode (host Dr. Jeff Langmaid) reviewing a JMPT randomized clinical trial (JMPT, Vol.27 No.6, ~July–August 2004) that compared chiropractic adjustments to muscle relaxants for subacute low back pain (defined in the episode as 2–12 weeks). The host summarizes key findings: chiropractic was statistically more beneficial than placebo in reducing pain and more beneficial than placebo or muscle relaxants in improving global impression of severity; VAS and Oswestry scores showed greater improvement in the chiropractic group over 2–4 weeks. The episode includes sponsor mentions (RockTape) and practical advice on communicating research to patients and other providers.
Welcome to the Evidence Based Chiropractor. Providing you with elegant and efficient research based content to help your practice prosper and succeed. Now get ready for a variety of dynamic communication tools designed for immediate growth. Courtesy of your host, Dr. Jeff Langmaid.
Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Today we're going to look at a study from JMPT which took a close look at chiropractic adjustments versus muscle relaxants for subacute low back pain. So this is a, this is a great study for multiple reasons and we're going to dive into why during our episode this week. Before we get started, I'd like to say a few words about Rock Tape. Rocktape is proud to be a sponsor of the evidence based Chiropractor. Rocktape offers the world's best kinesiology tape pain relief topicals, mobility tools and functional fitness accessories. New from Rocktape is Rocksauce Chill, a powerfully cool pain relief topical in a convenient roll on with 6% menthol, it's stronger than the freeze competition. They are more than just a tape company. They are a movement company. Learn more and get access to your medical discount by visiting rocktape.com A couple weeks back we had Dr. Steve, Medical Director from Rocktape on and he talked a bunch about functional movement and taping and the research behind it. So if you haven't checked out that episode, I would encourage you to do so. But today we're going to look at a study from JMPT, Volume 27, Number 6. I believe it was in June, July, or excuse me, July, August 2004. And this study titled A randomized clinical trial Comparing Chiropractic adjustments to Muscle Relaxants for Subacute Low Back Pain is a great study that we're going to dive into for a couple different reasons. One is that it is a randomized clinical trial. It's an rct. That's the top tier of research. So that is a great starting point. Second to that, they look at chiropractic adjustments versus muscle relaxants for subacute low back pain. So let's take a look at that. First is that they're looking at specifically chiropractic adjustments. So that's great. It's extremely focused. Additionally, they're looking at chiropractic adjustments versus muscle relaxants. So muscle relaxants, as we all know, very commonly prescribed medication. And specifically in this study, they're looking at it in a subacute low back pain format. So I also Love that. When a patient goes into their primary care, right off the bat, they are typically assigned NSAIDs. When the NSAIDs either don't work when the patient's not making progress or they plateaued, that's when muscle relaxants are then prescribed. And that is usually during the subacute phase. So this is a really accurate portrayal of what a patient goes through and their subacute pain. They may be getting muscle relaxants or they may be seeking chiropractic care. So to be able to take a randomized clinical trial and compare those two modalities or treatment options is extremely powerful. What the researchers found was, quote, unquote, chiropractic was more beneficial than placebo in reducing pain and more beneficial than either placebo or or muscle relaxants in reducing global impression of severity. So the researchers found chiropractic beat out placebo. That should be easy. Happy to hear that, that's great. But more importantly perhaps is that chiropractic beat out not only the placebo but also the muscle relaxants in the global impression of severity. So patients undergoing chiropractic care in the subacute phase reported that this symptomatology was less severe. And that's even compared to those who were taking muscle relaxants. So I really like that aspect of it. Subacute back pain in this study was defined as pain of 2 to 12 weeks in duration. The researchers also found statistically the chiropractic group responded significantly better. So when they looked at chiropractic care, when they looked at medical care, AKA muscle relaxants, they found that statistically the chiropractic group responded significantly better. Now, before I dive into the application of those statements, I would like to, as I do, it seems as though every week at this point, really thank everybody that's gone and picked up Marketing Chiropractic to Medical Doctors. It's my book, it's available on Amazon and it's consistently been the number one new release in the chiropractic genre on Amazon.com worldwide for the last, I don't know, month or two now. So for everybody that's picked up Marketing Chiropractic to medical doctors, I greatly appreciate it. If you haven't, I'd encourage you to check it out. Probably less than the price that you'll pay for lunch this afternoon. And it really gives you a step by step guide and a lot of supplemental knowledge in the application of a lot of what we talk about every week on this podcast. So please check it out and pick it up if you haven't had the opportunity yet because again, it's gonna take some of the knowledge. Let's really segue into what we're talking about today when we're discussing with our patients or other care providers, hey, there's research out there. However it comes up in conversation. But there's randomized clinical trials that support chiropractic care and as a matter of fact, they actually beat out muscle relaxants for subacute low back pain. Framing that conversation is important for multiple reasons. Number one is that if it's with another provider, it's important to emphasize the fact that you understand where they're coming from. But there may be something that you can provide of value that they are not doing or are unaware of. From a patient perspective, I think it's important to emphasize that decision. If they're already a patient, then emphasizing the fact of chiropractic care and emphasizing the results of care in a research based study is effective patient communication. You don't need to bog them down with the specifics of every research trial ever performed. But when you can emphasize the point of, hey, we're going through a care plan because as time progresses on chiropractic has been shown to be very valuable. Now we're going to reassess at XYZ interval and make sure we're making the best clinical decisions for you. But if they're not getting well after visit one or visit two, they might start to get ants in their pants. And being able to explain that in a subacute phase, while it might take some time, chiropractic has outperformed muscle relaxants. I think can give and provide a lot of peace of mind with that. So I think that's important. Now this study equated the benefit achieved by placebo to be in accordance with really the natural history. At the two week intervention phase, chiropractic adjustments were shown to be statistically more beneficial than placebo in reducing pain and more beneficial than placebo or or muscle relaxants in reducing that GIS or global impression of severity. So really with these patients it didn't take too long. What we see is that they also looked at the VAS scores and the oswestry scores for outcome assessments with this and they found again very similar things. When I look at the VIS scores from initial to 2 week to 4 week, the chiropractic in this study actually started out near 5 on a VAS score. It was the highest out of all three between the medical or muscle relaxants, chiropractic and the control Group chiropractic patients in this study started with the highest VAS scores and by the end of two weeks and by the end of four weeks they found themselves to being the most reduced in terms of VAS scores. So the least amount of pain when we look at oswestry, very similar chiropractic started out near the top on those oswestry scores and by the time we got to two weeks and of course by the time we got to four weeks, chiropractic was well below the medical or muscle relaxants and control group with that outcome assessment. Now if I had to kind of guess or if I looked, if we had any way to look at the statistics on this, I'm willing to bet almost no primary care internal medicine docs have seen this study. One probably because of jmpt. JMPT is a very high quality research publication, but it's probably not as widely read as Spine or British Medical Journal. So with that I think it's a little bit less popularized. Second to that is that many of the docs or primary care doctors that we've seen or talked to or with the research shows that they just don't know very much about chiropractic care. So being able to showcase I think a new journal, being able to show them that it's an RCT in that journal, a randomized clinical trial and being able to bring value to them on some educational points which they may be unaware all can really help provide the benefits basis of some relationship building. Now you don't want to go in and blast them with chiropractic care is better than what they're doing. That can be challenging from a relationship building standpoint. But taking the research, applying it not only to the practitioners in your area but the patients already in your office can go a long way. Hope you got a great amount of value out of this one doc this week and we will talk to you next week. Have a great week and practice and we will talk to you soon.
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