Chiropractic and chronic pain

What chiropractic used to be might be quite different from what it has become and these changes may not necessarily be in the best interest of patients.

Spanning over a century, chiropractic history was originally rooted in the observation that the spine and the related nervous system were somewhat involved in the health and well-being of the individual. It is said that this science was discovered when a deaf man recovered his hearing following the reduction (adjustment) of a bump on his spine.

While trying to explain this outcome with the knowledge of the time, an understanding would emerge where the nervous system was recognized as the mediator between the mind, the body and the environment. Interferences within this mediation could result in a less than optimal expression of health: a “dis-eased” state.

According to the 19th century perspective, the nerves were thought to carry nerve impulses, from the brain to the body. They were largely responsible for the cellular and organic expression of life. This notion was related to vitalism. Therefore, the chiropractor was to analyse the spine so as to localise spinal misalignments that could significantly interfere with nerve transmission. The primary goal was to correct these interferences in order to restore or improve health.

This basic understanding, as well as the outcomes associated with this new application would, in the next century, elevate the chiropractic profession to one of the top three primary health-care professions in the world. This exponential growth came essentially via word-of-mouth. The profession was never bankrolled by outside industries. It stood on its own merit. Its success has been self-evident throughout its history. The effectiveness of spinal manipulation could no longer be questioned. At the same time, the rationale as to its mechanism of action did and will evolve as we gain a better understanding of the physiological processes behind its associated and diversified outcomes.

The principle was simple, if your condition were anywhere related to spinal misalignment (vertebral subluxation), we could likely make you better. This “better” was not only related to the reduction of pain but, above all, to the improvement of nerve transmission and the ensuing enhancement in tissue, organ or cellular functions. Hence, the chiropractor was not treating pain but correcting spinal misalignment.

Chiropractic patients are often afflicted with conditions that have evolved through time. Most present themselves with chronic conditions, which have been lasting or recurring for over three months. An essential distinction has to be made here. Pain from a chronic condition is distinct from, what is defined today as “chronic pain.”

“Chronic pain can be a disease in itself. Chronic pain has a distinct pathology, causing changes throughout the nervous system that often worsen over time. It has significant psychological and cognitive correlates and can constitute a serious, separate disease entity,” according to the U.S. National Academy of Medicine.

One definitive characteristic of chronic pain is the persistence of pain despite healing of the injury and in some cases, without an initial injury. Chronic pain is a diagnosis as opposed to pain, the symptom. People afflicted with chronic pain do not represent the typical profile of those seeking chiropractic care.

This distinction is fundamental and seems to escape some chiropractic institutions. Some of our fellow students are being taught an insidious paradigm where patients suffering from a chronic condition and those afflicted by chronic pain are presented as one of the same. Conveniently, this perspective uses chronic pain’s scientific literature in an attempt to dismiss the consistent and considerable benefit of conventional chiropractic care.

This behaviour is utterly irresponsible and is driving a potentially lethal blow to the profession. The pain symptom has become the main motive for intervention as opposed to a motive for consultation. We have moved from a wellness professional to pain neutralizer therapist. This new goal is being promoted by the application of a 1 to 10 scale to objectify pain as the foremost measure of therapeutic efficiency. Pain is no longer a purely virtual signal. It is like marketing a new smoke detector with a volume control, as if the noise, not the fire, is the problem or nuisance.

In this pain scenario, we are invited to co-manage the patient with all those who share, in this new age of enlightenment, the new paradigm: “pain as nuisance”.

‘Therapeutic teams” shall do their mutual best to disrupt the pain signal, blinded to its cause and to the lasting and disturbing consequences of their actions on the patient’s future health and wellness.

We would be remiss not to remind the reader of some facts, such as:

• Annually, 18.6 per cent of the population suffers from back pain
• Less than 22 per cent of the victims suffer from back pain for the first time
• More than 20 per cent of back pain recurs in less than six months
• Over 75 per cent of back pain victims have similar symptoms 12 month later.

It would seem that treating pain, in itself, is likely a failure. The chiropractic objective is to precisely correct spinal dysfunction and the associated neural interferences when indicated. As far as evidence based data are concerned, chiropractic manipulative therapy is improperly compared with the pain-disabling effect of medical or alternative care.

 The reduction of pain following traditional chiropractic care is mainly the by-product of a corrective procedure. Indeed, pain originating from ongoing tissue or cellular damage is an appropriate and vital warning signal. Therefore, the therapeutic goal should be to identify and understand the underlying mechanism and to figure out how to respond in order to stop, control and/or prevent such damage. The ensuing reduction of pain, in this case, is of a secondary benefit, demonstrating the probable effectiveness of the method. Pain naturally subsides as we recover from tissue injury. The signal becomes gradually useless as the regenerative process takes over. Otherwise, pain will likely re-occur as an ongoing degenerative process may further disrupt tissue integrity. This is a fundamental distinction that has defined chiropractic care throughout history. Many ignore this fact but we shouldn’t any longer.

Gone are the days where a chiropractor, as a primary health-care provider, could respond and care for the genuine needs of the community. It is a fact that most new chiropractic patients have previously consulted another health-care professional and, according to one large survey, three in four patients describe chiropractic care as
“very effective.”

Not so long ago, most successful chiropractors would have never demeaned themselves in such a subservient position as to lose our professional autonomy and independence that past generations helped establish and preserve. Are we being coerced into becoming second-tier team members whose first intent is to assault the pain signal, despite the patient’s genuine and ultimate needs?

Have we betrayed those who have entrusted us with chiropractic’s future? Most importantly, have we betrayed those who have entrusted us with their health? (For a list of references cited by the authors for this article, email the editor at mdeguzman@annexweb.com)

LE GROUPE AXIS is a think-tank focused on the future and practice of the chiropractic profession. The council brings together six chiropractic practitioners combining more than 200 years of clinical experience: Dr. Charles Allyson (PCC); Dr. Daniel Charland (PCC); Dr. André Lajoie (PCC); Dr. Richard Morency (CMCC); Dr. Louis-Philippe Morin (PCC); Dr. Pierre Paillé (PCC). Email them at comment@GroupeAxis.ca.