Comox Valley Chiropractor – Tips for your Health

Health tips from your Comox Valley Chiropractor

Management of Chronic Low Back Pain September 10, 2008


Chronic low back pain has been the subject of much research and funding, with very little relevant information coming from the effort. It is a very difficult condition to manage, and its effect on society can be valued into the billions of dollars. However, it is also a condition that is seen with much frequency at the office of this Comox Valley Chiropractor.


A recent study in the prestigious journal Spine set out to analyze the evidence-based management of chronic low back pain with electrical stimulation, interferential current, ultrasound and hot/cold packs. These modalities are used often in the offices of manual medicine practitioners, usually with the goal of relieving pain and inflammation.


What was surprising about this study was the blatant lack of evidence to support the use of these modalities, especially given that they are so prevalent.  No eligible studies of good quality were even found for interferential current, ultrasound and hot/cold pack therapy, leading to the suggestion that these modalities should be avoided. Of the 6 studies that were found for electrical stimulation, 4 were of very poor quality and the remaining 2 found benefit only in the short term. These results suggest that electrical stimulation should be used as only one component of a short term treatment plan (and not on its own).


This article was part of a special edition of Spine in which many different treatments were analyzed for their effectiveness. The general consensus is that not enough research exists to choose one specific treatment over another, however “when viewed optimistically, the articles in this special focus issue do suggest that a reasonable approach to CLBP (chronic low back pain) would include education strategies, exercise, simple analgesics, a brief course of manual therapy in the form of spinal manipulation, mobilization, or massage, and possibly acupuncture.”  Haldeman S, Dagenais S. What have we learned about the evidence-informed management of chronic low back pain? Spine J. 2008 Jan-Feb;8(1):266-77.


If you have any questions about chronic low back pain, feel free to contact your Comox Valley Chiropractor.


2 Responses to “Management of Chronic Low Back Pain”

  1. We stopped using all modalities in our practice for about six months and then slowly phased them in one at a time in trials with specific stubborn patient populations.

    We now use electric stimulation occasionally in cases of true spasm or soft tissue problems that don’t respond to manual therapies or cold laser. The ultrasound machines have been collecting dust.

  2. drdebbie Says:

    I seem to be on the opposite track – when I started practice I only trusted my hands. Then over time with new research and developments I’ve started adding new modalities in. Currently I am using only cold laser, but would be open to more in the future once I have more space and if the evidence shows it works.

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