A treatment approach analysis was conducted in the management of chronic low back pain and with no surprise, chiropractic treatments were related with reduced likelihood of surgery. The analysis was funded by Eli Lily and Company.

This analysis is very important for people living with chronic low back pain. If you are living with chronic low back pain, it is worth a treatment trial to see if you can benefit from a series of adjustments from a chiropractor. Surgery should always be the last resort with back pain, especially with such evidence.

As a Denver chiropractor, I utilize chiropractic adjustments to the spine and extremities as well as various forms of electrical stimulation, ultrasound, graston technique, musle energy techniques, myofascial release, core stabilization, kinesiotaping, evidence based nutrition counseling, and trigger point therapy.

Below is a copy of the abstract from the American Pain Society.

Real-world use of duloxetine for low back pain: a propensity score analysis of surgery risk
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Year: 2009

Poster #: 240

Title: Real-world use of duloxetine for low back pain: a propensity score analysis of surgery risk

Authors: R Swindle, H Birnbaum, J Ivanova, B Johnstone, M Hsieh, M Schiller, E Kantor;Eli Lilly and Company, Indianapolis, IN

Classification: Treatment Approaches (Medical/Interventional)

Themes: D04 – Antidepressants


Low back pain (LBP) treatment often entails step-therapy additions of medications (including antidepressants) and noninvasive therapies to remediate pain, improve functioning, and avoid surgery. We examine the role of duloxetine and other treatments in the likelihood of LBP surgery, adjusting for potential selection bias and confounding. The 211,551 patients, ages 18-64 years, with >1 LBP diagnosis, as specified by HEDIS, were identified from a large administrative insured claims database. Patients had continuous eligibility at least 12 months after their index LBP diagnosis (study period) and >6 months before their index diagnosis (baseline period) and no other LBP diagnosis during the baseline period. 4,331 patients (2.05%) had back surgery, and 3,756 (1.78%) patients received duloxetine, after their index LBP diagnosis. Logistic regression was used to develop a propensity score predicting study period duloxetine use using: demographics; baseline comorbidities; resource use; medication use; and direct costs. Patients receiving duloxetine were matched to LBP patients untreated with duloxetine based on propensity score and key confounders (e.g., baseline depression, baseline opioid use). Logistic regressions were conducted to assess the impact of study period treatments on back surgery risk for the full matched sample and the non-depressed subsample. We propensity matched 2,521 duloxetine patients to controls. In general, duloxetine was the last of all treatments (including opiates) initiated prior to surgery. Likelihood of surgery was significantly increased for patients with chronic LBP (<3 months) and severe LBP diagnoses. Three treatments significantly reduced the likelihood of surgery: NSAIDs, chiropractic therapy, and duloxetine. No other antidepressants, anxiolytics, narcotics, relaxants, anti-epileptics, or corticosteroids predicted surgery. Results for treatments were the same in the non-depressed subsample. Duloxetine, NSAIDs, and chiropractic treatments were associated with reduced likelihood of LBP surgery. (Research funding provided by Eli Lilly and Company.)

To Your Health,

Dr. Trent Artichoker MS, DC

Denver Chiropractic, LLC
3890 Federal Blvd Unit 1
Denver, CO 80211