Author: Richard H. Adler

Practitioners treating patients with acute and chronic neck and back injuries from personal injury trauma know the importance of keeping abreast of new research studies. Studies published in respected journals assist providers in educating patients, responding to ill-informed insurers, drafting reports to insurers and attorneys, rebutting IMEs and paper peer review reports, and handling deposition and trial testimony with greater confidence and ease.

A new study published in Spine provides another example of the importance of keeping current on research developments. The study, "Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation"¹ by Giles and Muller, compared the relative effectiveness of medication, needle acupuncture and spinal manipulation for managing "chronic" spinal pain (defined as pain greater than 13 weeks in duration).

This study gathered 115 subjects without contraindications for medication, needle acupuncture, or spinal manipulation regimens between February 1999 to October 2001. They were then enrolled at an Australian Public Hospital in the Multi-Disciplinary Spinal Pain Unit. One of three separate intervention protocols were used: medication, needle acupuncture or chiropractic spinal manipulation. Patients were assessed before treatment by a sports medicine physician and a research assist for exclusion criteria using the Oswestry Back Pain Disability Index, the Neck Disability Index, the Short-Form-36 Health Survey Questionnaire, Visual Analogy Scale of pain intensity and ranges of movement. These instruments were administered at the beginning of the clinical trial and again at two weeks, five weeks, and nine weeks after the beginning of treatment.

The results of this randomized controlled clinical trial revealed:

1. The highest portion of patients able to return to asymptomatic status did so through manipulation 27.3%, followed by acupuncture 9.4%, and medication 5%.
2. Spinal manipulation achieved the best overall results, with improvement of 50% on the Oswertry Scale, 38% on the Neck Disability Index Questionnaire, 47% on the Short-Form-36 Health Survey Questionnaire, and 50% on the Visual Analogy Scale for back pain, 38% for lumbar standing flexion, 20% for lumbar sitting flexion, 25% cervical sitting flexion, and 18% for cervical sitting extension.
3. Acupuncture showed a slightly better result than spinal manipulation on the Visual Analogue rating for neck pain at 50% vs. 42%.
4. All forms of treatment resulted in some positive response according to the Short-Form-36 health survey questionnaire.
5. The authors concluded: "The consistency of the results provides... evidence that patients with chronic spinal pain, [greater than 13 weeks duration], spinal manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication. However, the data does not strongly support the use of only manipulation, only acupuncture or only steroidal anti-inflammatory drugs for the treatment of chronic spinal pain."
6. The authors also added another caveat: "It should be strongly emphasized that this study was exclusively with chronic spinal pain, and that consequently, no statement what-so-ever can be made about that potential role of medication in treatment acute spinal pain syndromes."

Staying abreast of recent developments in the medical literature advances ones own continuing knowledge base. The cutting edge information can also be used as a sword and shield in responding to misguided opinions and denials of treatment bills in the medical-legal traumatic personal injury context.

The link between medical and legal consequences of traumatic injury requires doctors and attorneys, like the personal injury recovery professionals at the law firm of Adler Giersch, to form the first lines of defense between the patient/client and the insurance companies. This medical-legal connection is natural, and serves the interests of the patient-turned-client best when the health care and legal communities work together. Reading and sharing research literature is one way of integrating the health care provider's knowledge with the personal injury attorney's advocacy skills to achieve better treatment results and fairness for the patient.

1. Lynton G. F. Giles, DC, PhD, and Reinhold Muller, PhD, Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation. Spine. Volume 28, Number 14, 1490-1501 (2003)