When a patient goes to the ER, urgent care or a PCP before they see a chiropractor for low back pain and sciatica, you can almost always guess the drugs they were given.
Muscle relaxers, some version of opioids and either a steroid (such as a Medrol dosepak) or a strong anti-inflammatory (such as ibuprofen or naproxen) are pretty much the mainstays of treatments. While some medical providers will refer to a chiropractor Mesa, AZ relies on at the slightest hint of low back pain, this still seems to be a rarity across medicine.
The approach taken is to use drugs first to see if this will help. If the drugs don’t help, maybe some X-rays or MRIs will be ordered. Or, if you’ve got a strong desire to develop some radiation-induced cancer, a couple of CT scans with some contrast thrown in is always good. Then some pain management with injections which might include epidural steroid injections for localized back pain without any leg pain associated with it (this is almost always a bad scenario for epidurals).
Maybe. Just maybe, at this point there will be a referral to a chiropractor. Or surgeon. Just depends on the treating physician.
Here’s the deal. It is has been well established by one of the largest insurance companies in the US (if not the planet) that if a chiropractor is the first point of entry for any non-surgical spinal complaint there will be a cost savings and a better outcome (about 30% off the top of expenses). But if a patient does NOT see a chiropractor first, chiropractic care is pretty rarely used and when it is it is brought in late in the game.
But this article isn’t strictly about chiropractic care. It is more about WHY chiropractic care should be the first answer.
And this is mainly because all the other options mentioned above just don’t seem to work well. Even worse, they come with a long list of side effects that are likely to destroy the very tissues you are trying to protect. Anti-inflammatories absolutely interfere with the healing process and damage a long list of other.
While muscle relaxers can certainly be addictive, so few patients really have bona fide muscle spasms. What that means is that these drugs won’t fix anything, but they will make you not care in the meantime.
Epidurals increase the degeneration in your discs and will increase your likelihood of getting invasive spine surgery.
Which brings us to the steroids. The side effects of steroids are generally well known to patients. Bone destruction, weight gain, diabetes, adrenal gland shutdown and destruction of tendons. But these are all with short term use, right? Not so. Even a single dose of steroids will change the very DNA of the cells of your soft tissues, increasing the risk of a later rupture.
But side effects can be worth it if the benefit outweighs the risks. And this particular article (https://jama.jamanetwork.com/article.aspx?articleid=2293294) nicely outlines the strong LACK of a benefit in oral steroid use for back-related leg pain. 269 Adults with radicular pain (pain down the leg that is consistent with leg pain caused by a disc bulge) for less than 3 months and a herniated disk confirmed by MRI were given a tapering 15-day course of oral prednisone (5 days @ 60 mg, then 40 mg, and then 20 mg; total dose = 600 mg) or a placebo. Here’s what happened:
- Oswestry scores (a questionnaire gauging how much your back pain interferes with your life) dropped 19 points and placebo 13.6 in 3-weeks.
- As far as leg pain, the steroid group improved 0.3 (out of 10) points after 3 weeks compared with the placebo group (0.6 more improvement at one year).
- The prednisone group improved by 3.3-points (out of 100) in the SF-36 PCS (a survey relating to how much pain is affecting your life) at 3 weeks with no difference at the one-year mark.
- There were no differences in surgery rates at the one-year mark.
- As expected, side effects were more 51% common with the steroids (49.2% vs 23.9%).
In other words, the steroids provided very little benefit for either short term (3 weeks) or long term (one year) pain or function. If we then consider the fact that these steroids are damaging the tissues surrounding the spinal, increasing the risk of long term, more severe damage, the use of steroids for back-related leg pain just doesn’t make any sense.
Thank you to our friends at contributors at LifeCare Chiropractic for their insight into pain relief and chiropractic care.