Integrative Care for Low Back Pain: A Research Report Worth Reading
Does the name David Eisenberg sound familiar? David Eisenberg’s landmark 1993 study, published in The New England Journal of Medicine in 1993, put complementary and alternative medicine on the radar screen for most health professionals. Eisenberg of Beth Israel Deaconess Medical Center/Harvard Medical School and colleagues conducted a national telephone survey of 1539 homes, and surveyed the use of alternative therapies and alternative practitioners. The Eisenberg et al. (1993) study showed that 34 % of respondents used at least one unconventional therapy in 1990, and one third of these persons saw a provider of unconventional therapy. They saw the providers for an average of 19 visits, and paid an average of $27.60 per visit. A majority used unconventional therapy for chronic conditions, and the most frequent disorders involved were back problems (36 percent), anxiety (28 percent), headaches (27 percent), chronic pain (26 percent), and cancer or tumors (24 percent). Another important finding by Eisenberg was that 72 % of those using unconventional therapy did not disclose this information to their medical doctor.
Eisenberg’s name has appeared on a steady stream of research reports since 1993, ranging from the use of herbal medications in the US, to the value of NCCAM supported research, to the use of mind-body therapies in pain disorders.
Eisenberg is back with another article worthy of the practitioner’s time. Eisenberg and nine colleagues published an article in April 2012 in the Journal of Alternative and Complementary Medicine on “A Model of Integrative Care for Low Back Pain.” The group recruited 20 individuals with acute low back pain (of 3-12 weeks duration), and randomly assigned them to either a “usual care” treatment regimen or a “usual care plus integrative care” regiment. The usual care group received the standard regimen typically used in primary care, including non-steroidal anti-inflammatory drugs, muscle relaxants, referrals to physical therapy, bed rest, education, and prescribed modifications in their activity. The integrative care group received these “usual care” interventions, but also received a range of alternative interventions including acupuncture, chiropractic, massage therapy, occupational therapy, physical therapy, mind–body techniques, nutritional counseling, and medical specialty referrals. The integrative care practitioners functioned as a team.
The patients assigned to the integrative care condition showed significantly better outcomes, on the following primary outcomes: pain, “bothersomeness,” and functional status at 12 weeks. Some other variables were also more favorable for the integrative care group, but not statistically significant. The authors acknowledge the limitations of their small study, and call for more research measuring the effectiveness and cost effectiveness of “integrative models” of care delivery, which combine mainstream and alternative therapies in one coordinated treatment protocol.
The authors also acknowledge that the integrative care patients received “enhanced patient contact,” education, and encouragement by members of the integrative care team, and that the enhanced contact could have made the difference in outcomes, rather than the specific alternative therapy components in the package. One might ask why “usual care” in the US does not include enough enhanced patient contact, education, and encouragement to produce better outcomes.
I encourage blog readers to review the article and judge its persuasiveness yourselves. Readers can get free access to this Eisenberg et al. (2012) study at the following URL: