Which One Works Best?

That's what Tim Carey and his colleagues wanted to know. In a study published in the New England Journal of Medicine in October, 1995, Carey and his colleagues compared the average time to recovery, patient satisfaction and cost effectiveness of back pain treatment provided by primary care practitioners, chiropractors and orthopedic surgeons.

	Primary care physicians, orthopedic surgeons and chiropractors all had about the same success rate at treating back pain.

"Given that most back pain has a reasonably benign prognosis, will you have better outcomes and lower cost starting with a generalist physician?" says Carey. "Or, conversely, should you go to someone who sees a lot of back pain and views themselves as being clinically specialized in that area?"

So Carey and his colleagues randomly selected more than two hundred practitioners in North Carolina. The practitioners fell into six categories: urban and rural primary care providers, urban and rural chiropractors, orthopedic surgeons and primary care providers at a group-model health maintenance organization.

Many study participants learned how to stretch properly to ease back pain.

The selected practitioners then enrolled 1,633 patients with back pain. Over the next six months, the researchers contacted patients each week to assess how long it took to achieve functional recovery - the ability to carry out everyday tasks - and return to work and consider themselves "completely better." The researchers also noted how often the patients saw their health care provider and how satisfied they were with their treatment.

When Carey and his colleagues analyzed their data, primary care physicians, orthopedic surgeons and chiropractors all had about the same success rate at treating back pain. In all six categories of care, the majority of patients felt better in less than two weeks. At 4, 8, 12 and 24 weeks out, no category of care provider had significantly more success easing their patient's back pain than any other. "In terms of overall effectiveness," reports Carey, "spinal manipulation for mechanical back pain is better than doing nothing and probably about the same as going to see your primary care doctor."

	Why see a chiropractor? Carey's study posed the same question.

Similarly, in a 1998 study also published in the New England Journal of Medicine, researchers measured the relative therapeutic values of chiropractic, physical therapy, and providing patients with an informational pamphlet about back care. The team led by Dr. Daniel C. Cherkin at the Center for Health Studies in Seattle, WA recruited more than three hundred back pain sufferers, then randomly assigned them to one of the three treatment groups.

Patients in the chiropractic group received treatment that included manipulation, stretching, and strengthening. The physical therapy patients received physiotherapy, learned back exercises, and were given the book, "Treat Your Own Back" by Robin A. McKenzie. The final group of patients was just given an educational booklet about back pain.

Four weeks into the study, patients who saw a chiropractor reported less severe pain. But after twelve weeks had passed, no group had improved significantly more than any other. So since the educational booklet was the cheapest and least time-consuming course of therapy, why see a chiropractor? Carey's study posed the same question.

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