Letter to the Editor: Benefits of chiropractic care not always certain

Lynne Haggerman usually provides useful information to me and, I'm sure, to much of your readership. In the case of her article in the May 20-26 issue (Chiropractic care reduces workers' compensation costs), I don't believe that it is particularly valuable for the readership to be presented such a biased view regarding chiropractic treatment of work injuries.

She could have limited her discussion to chiropractic management of back pain since well-done studies that show a hint of benefit from chiropractic treatment for cumulative trauma conditions and carpal tunnel syndrome are sparse. She could have discussed the proven lack of therapeutic benefit from modalities such as hot packs, ultrasound or electrical stimulation, often administered at considerable cost over time by chiropractors as well as physical therapists.

She could have discussed the differences in outcomes of workers compensation claims by state, proving that contingencies affect human behavior. She could have discussed the personality types who demand surgery for their pain problems. Obviously, costs are increased when surgery is performed. People who do not demand surgery and are free of anxiety, somatoform disorders and hypochondriasis are less expensive to treat. The surgeon should not bear the brunt of the blame for this and other reasons.

I understand that this journal is not the proper venue for detailed scientific discussion of all of these topics. If we limit our concern to the treatment of back pain, I would like to point out that there are studies that indicate that most episodes of back pain resolve without treatment. The treatments by any health care provider must therefore be compared to the spontaneous rate of healing, so as to know whether or not any specific benefit from treatment exists. (Nonspecific benefit is termed the placebo response.) I would also make certain that your readers know that there are numerous options for employers and patients in Springfield for nonsurgical treatment of back pain. Most medical and osteopathic doctors who treat back pain will be considering a broader array of treatment options than would chiropractors or physical therapists, if they were to be allowed to practice independently. Many of us have the experience of patients rarely needing to miss work for back pain. This is in sharp contrast to the 18 percent of patients who needed to miss work for a full week when treated by chiropractors in Oregon, as mentioned by Ms. Haggerman.

Treatment of work injuries is a complex topic due to the multitude of factors that come to bear on the complaint. Doctors of any sort can only really deal with the physical complaint. They have little if any impact on the propensity to complain, job satisfaction, general state of health, economic stressors, general psychological health of the worker and his or her family or the workers compensation system in the state of Missouri. I refer back pain patients occasionally to chiropractors or osteopaths and have had some excellent results from these forms of physical therapy. My interest is in helping your readers understand that there is no magic bullet for the nonsurgical treatment of the determined workers' compensation claimant. I believe that skillful multi-modal management ("treatment" if you like) is most apt to bring about the best outcome for all parties involved though it is the most difficult to quantitate. There must be a reason that many employers and claims representatives of workers' compensation insurance carriers are reluctant to allow referral to a chiropractor.

Charles Mauldin, MD

Springfield