In this article you will find the evidence to pass to friends, your GP and anyone you may feel would benefit from chiropractic treatment.
When GPs became Fundholders in the 1990s and were in charge of their own budgets, a study by the Wiltshire Health Authority showed that 83% of patients were better 6 months after treatment and had high satisfaction with reduced costs to the NHS. Primary Care Trusts were introduced in 2000, which slowed down the involvement of chiropractors working with the NHS.
In 2009 the National Institute for Health and Clinical Excellence (NICE) Back Pain Guidelines, once again recommended spinal manipulation as practiced by Chiropractors. In 2012 the Coalition Government set up local Clinical Commissioning Groups. The idea was to use the independent sector more to give patients greater choice and to introduce competition to improve efficiency and reduce costs. GPs can now commission what are termed “Any Qualified Providers” or AQPs to provide some services, such as the treatment of neck and back pain. Chiropractors can apply to become an AQP but need the help of their patients to put pressure on GPs to get this going. The Chiropractic Associations can assist chiropractors with the application procedure for AQP status.
GPs, AQPs and chiropractors on the NHS
A good example of GPs using AQPs for back pain and paying for patients to see chiropractors on the NHS, is the North East Essex project. Chiropractor Mark Gurden has worked tirelessly with osteopaths and physiotherapists to establish such a back pain service. The results of this pilot scheme, published in 2012, showed that more than 99% of patients referred were satisfied with their care. Interestingly chiropractors worked alongside osteopaths and physiotherapists to get these favourable results.
When a patient went to their GP with back or neck pain they were assessed and could be referred into the manual therapy program. They were sent to their choice of chiropractor, osteopath or physiotherapist and were seen within 2 weeks. Gone were the long waiting lists for referral to other NHS services. Gone was sole reliance on a fistful of drugs and a photocopied leaflet of exercises. Patients had a series of about six sessions of manual therapy, guided exercises and advice.
Two out of three of these patients showed good improvements in their pain levels and daily activities. Importantly, nearly half had pain for a year or more with very little relief. Finally they found something to help them. Of the 696 people who went along to these therapists, most reduced their medication as well.
Even if your chiropractor does not want to get involved with the NHS, it will benefit all current and future patients if the medical profession has a greater understanding of what chiropractors can do. Please therefore help to spread the word. More resource materials are available from the Chiropractic Patients’ Association (Tel: 01980 610218 E-mail: firstname.lastname@example.org)
Evidence for the benefit of chiropractic treatment for low back pain
Low back pain: early management of persistent non-specific low back pain NICE guidelines May 2009.
The evidence-based recommendations include the following:
- Provide people with advice and information to promote self-management of their low back pain.
- Consider offering a course of manual therapy including spinal manipulation of up to 9 sessions over up to 12 weeks
- Consider offering a course of acupuncture needling comprising up to 10 sessions over a period of up to 12 weeks
- Consider offering a structured exercise programme tailored to the individual.
Meade et al (1995) Randomised comparison of chiropractic and hospital outpatient treatment for low back pain: results from extended follow up. BMJ 311; 349-351
Funded by the MRC, confirmed the findings of the earlier report.
RCGP (1999) Clinical Guidelines for the Management of Acute Low Back Pain.
Funded by the Royal College of General Practitioners proved that the risks of manipulation are very low in skilled hands and it can provide short-term improvement in pain and activity levels and higher patient satisfaction.
UK BEAM Trial Team (2004) United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ 329:1377.
Funded by the MRC, showed that exercise was better than “best care” in general practice at three months. Adding manipulation there was further improvement at three months and at 12 months.
UK BEAM Trial Team (2004) United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care. BMJ 329:1381.
Spinal manipulation is a cost effective addition to “best care” for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.
European Commission Research Directorate General (2004) European Guidelines for the management of acute non-specific low back pain in primary care.
Findings were not to prescribe bed rest but advise patients to continue normal activities and take pain relief and muscle relaxants, as required. Also to consider referral for spinal manipulation.
European Commission Research Directorate General (2004) European Guidelines for the management of chronic non-specific low back pain in primary care (2004).
Recommendation: Consider a short course of spinal manipulation/mobilisation as a treatment option for chronic low back pain.
NICE (2006) IPG 183 – Non-rigid stabilisation techniques for the treatment of low back pain – guidance.
Results showed that chiropractic intervention and posture training can limit episodes of acute pain. Spinal rehabilitation can also be beneficial.
Department of Health (2006) Musculoskeletal Services Framework.
Showed that chiropractors provide evidence-based, timely and effective assessment, diagnosis and management of certain musculoskeletal disorders.
Original article from Back Chat Winter 2014, the magazine of the Chiropractic Patients’ Association Supporting Patients, promoting the awareness and benefits of chiropractic and funding essential research. www.chiropatients.org.uk || Patient Helpline: 01980 610218