Chiropractors and Exercise Are Better than Drugs Says New Study
Chronic pain is an exceedingly common condition impacting an estimated 76.5 million Americans, one-third of whom describe their pain as severe and "disabling".i
Among them, many suffer from neck pain, which is the third most common type of pain according to the American Pain Foundation.
It is estimated that 70 percent of people will experience neck pain at some point in their lives but research into effective treatments is surprisingly limited.ii
If you visit a conventional physician for pain, there's a very good chance you'll leave with a prescription for a medication,as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen (Tylenol) and even opioids (OxyContin, Vicodin, etc.) are the go-to treatment for pain in the modern medical world.
However, there are better options than drugs for neck pain, not only in terms of pain relief, but also in helping to treat the underlying cause of the pain so that healing can truly occur.
New Study Shows Exercises and Chiropractic Care Beat Drugs for Neck Pain
According to a new study published in the Annals of Internal Medicine and funded by the National Institutes of Health, medication is not the best option for treating neck pain.
After following 272 neck-pain patients for 12 weeks, those who used a chiropractor or exercise were more than twice as likely to be pain free compared to those who took medication.
- 32 percent who received chiropractic care became pain free
- 30 percent of those who exercised became pain free
- 13 percent of those treated with medication became pain free
"For participants with acute and subacute neck pain, SMT [spinal manipulation therapy] was more effective than medication in both the short and long term. However, a few instructional sessions of HEA [home exercise with advice] resulted in similar outcomes at most time points."
Why Exercise is Essential if You Have Neck Pain
Because exercise often leads to improved posture, range of motion and functionality of your body, it can help treat the underlying source of your pain as well as help prevent chronic neck pain from developing in the first place. Exercise helps prevent and relieve pain through a number of mechanisms including strengthening key supportive muscles and restoring flexibility.
Not surprisingly, repetitive strain injuries have become increasingly common as so many people spend most of their work days sitting in front of computers. Computer work is associated with neck pain specifically originating from the trapezius muscle, also referred to as trapezius myalgia, and many types of neck pain can be traced back to poor posture at work or during your commute.
It's a vicious cycle as poor sitting posture leads to neck pain and once neck pain develops, it can make your posture even worse. For instance, one study showed people with chronic neck pain demonstrate a reduced ability to maintain an upright posture when distracted.iii
The same study further revealed, however, that after following a specific exercise program, people with neck pain had an improved ability to maintain a neutral cervical posture during prolonged sitting, which suggests it may help break the poor posture/neck pain cycle. Other research has similarly shown that exercise is incredibly beneficial for treating neck pain including:
- Research in the Journal of Applied Physiology found that repetitive strain injury caused by office work can be reduced using certain strength training exercises.iv
- A study published in the journal Arthritis & Rheumatism showed that strength training targeting the neck and shoulder muscles is the most beneficial treatment for women with chronic neck muscle pain as opposed to a general fitness routine.v
Five Specific Exercises to Target Chronic Neck Pain
Five specific strength exercises target the neck and shoulder muscles involved in causing chronic neck pain. Both studies mentioned above involved the same five exercises using hand weights, and detailed explanations of how to perform each exercise are provided by the National Research Centre for the Working Environment:vi
- Dumbbell shrug
Stand upright with the hand weights at the side of your body. In one even motion, lift your shoulders up towards your ears and lower them again slowly. At the same time, try to relax your jaw and neck.
- One-arm row
Stand with one knee on the bench and lean on the same-side hand on the front of the bench. With the free arm you pull the weight up towards your lower chest. When the weight touches your chest, lower it in a controlled motion.
- Upright row
Stand upright with your arms stretched and the hand weights in front of your body. Lift the weights in a straight line as close to your body as possible, until they reach the middle of your chest and your elbows point up and out. During the whole exercise, the hand weights should be placed lower than the elbows.
- Reverse fly
Lie down on a bench in a 45° forward bent angle with the hand weights hanging towards the floor. Lift the weights outward and upward until they are horizontal, and then lower the weights in one controlled motion. During the exercise, the elbows should be slightly bent.
- Lateral raise / shoulder abduction
Stand upright with the hand weights at the side of your body. Lift the weights outward and upward until they are horizontal, and then lower the weights in one controlled motion. During the exercise, the elbows should be slightly bent.
The researchers recommended performing the exercises three times per week (Mondays, Wednesdays, and Fridays) and alternating between exercises 1, 2, and 5 on one day, and exercises 1, 3, and 4 the next. When starting out, perform 2 sets of each exercise with 8-12 repetitions for each set. Increase at your own pace to 3 sets for each. Depending on the exercise and your current muscle strength, the recommended beginner's weight is between 6-12 lbs.
As a general rule of thumb, increase the weight as soon as you can comfortably execute all three sets. As a guideline, the participants in the study roughly doubled the weight used in 10 weeks. After approximately four weeks, you can reduce the number of repetitions of the last sets in order to increase the weight.
The Benefits of Chiropractic Care and Other Alternative Treatments for Neck Pain
Seeing a qualified chiropractor is another wise option if you suffer from chronic pain. I am an avid believer in the chiropractic philosophy, which places a strong emphasis on your body's innate healing wisdom and far less reliance on Band-Aids like drugs and surgery. Chiropractic, osteopathic, and naturopathic physicians receive extensive training in the management of musculoskeletal disorders during their course of graduate healthcare training, which typically lasts from 4-6 years.
Due to their comprehensive training in musculoskeletal management, numerous sources of evidence have shown that chiropractic management is much safer and often more effective than allopathic medical treatments, particularly for back and neck pain. In addition, researchers have also found that chiropractic adjustments affect our bodies on a deep cellular level.
What that means is that chiropractic care may affect the basic physiological processes that influence oxidative stress and DNA repair, so in addition to addressing any immediate spinal misalignment that might cause pain, it can also address deeper dysfunction in your body.
As many of you know I am an osteopathic physician. DOs, like chiropractors, also receive extensive additional training in spinal adjustments and may also be a good option for you. However, in my experience, only a small percentage of DOs are skilled in this area as they have chosen a more conventional allopathic model. So if you see a DO for this make sure they provide this service.
Overall, the important point to remember is that there are many other options for treating chronic pain than drugs. For instance, therapeutic massage has been found to offer clinically significant improvement in function and symptoms for those with neck pain,vii while a variety of complementary and alternative medicine (CAM) treatments (including acupuncture, massage, spinal manipulation, and mobilization) were deemed to be significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment for those with neck or low-back pain.viii
So you have options when it comes to dealing with your pain, and there is good reason to explore them before you opt for medicated relief. Additionally, many massage and physical therapists can provide effective alternatives.
Pain Medications are Risky at Best
Millions of Americans depend on anti-inflammatory drugs to relieve pain, but the drugs are among the most dangerous on the market. Aside from significantly increasing your heart risks (such as a two to fourfold increase in the risk of heart attacks, stroke or cardiovascular death), NSAIDs are linked to serious gastrointestinal risks like bleeding of the digestive tract, increased blood pressure and kidney problems. Remember, this applies not only to prescription medications like Celebrex but also to over-the-counter drugs like aspirin, Advil and Motrin.
It's very difficult to find a drug-based method of pain relief that is not saddled with severe side effects. The FDA has even recently limited the amount of acetaminophen allowed in prescription products and added a boxed warning due to liver toxicity concerns. Acetaminophen is actually the leading cause of acute liver failure in the United States.
As for the opioid painkillers like OxyContin, they are among the most commonly abused prescription drugs and are a leading contributor to the rising rates of fatal prescription drug overdoses. Many become addicted after using them to treat conditions like back or neck pain.
But no matter what type of painkiller you choose, the bottom line to remember is that they do not come without risks! Unfortunately, if you visit your conventional physician with chronic pain, a long-term treatment plan will typically include a drug-combination approach, using anti-inflammatory drugs, anti-seizure medications, muscle relaxants and possibly other types of pain medication as well. In other words, the answer for pain relief is drugs, drugs and more drugs -- each one raising your risk of suffering potentially lethal side effects. Is there a better way?
More Natural Solutions for Neck (and Other Types of) Pain
In the case of neck pain, the underlying cause is often related to body mechanics, meaning your posture or muscle balance is off kilter. Addressing your posture (or other factors that may be contributing to the strain, such as sleeping in an awkward position) and treating the condition with exercises is often effective at relieving the pain and addressing the underlying cause. If you have chronic pain of any kind, please understand that there are many safe and effective alternatives to prescription and over-the-counter painkillers, though they may require some patience.
Among the best are:
- Start taking a high-quality, animal-based omega-3 fat like krill oil. Omega-3 fats are precursors to mediators of inflammation called prostaglandins. (In fact, that is how anti-inflammatory painkillers work, they positively influence prostaglandins.) The omega-3 fats EPA and DHA contained in krill oil have also been found in many animal and clinical studies to have anti-inflammatory properties.
- Eliminate or radically reduce most grains and sugars (including fructose) from your diet. Avoiding grains and sugars will lower your insulin and leptin levels. Elevated insulin and leptin levels are one of the most profound stimulators of inflammatory prostaglandin production. That is why eliminating sugar and grains is so important to controlling your pain.
- Optimize your production of vitamin D by getting regular, appropriate sun exposure, which will work through a variety of different mechanisms to reduce your pain.
In the meantime, you don't need to suffer unnecessarily. Following are options that provide excellent pain relief without any of the health hazards that pain medications often carry.
- Astaxanthin: One of the most effective oil-soluble antioxidants known. It has very potent anti-inflammatory properties and in many cases works far more effectively than NSAIDs. Higher doses are typically required and one may need 8 mg or more per day to achieve this benefit.
- Ginger: This herb is anti-inflammatory and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.
- Curcumin: Curcumin is the primary therapeutic compound identified in the spice turmeric. In a study of osteoarthritis patients, those who added 200 mg of curcumin a day to their treatment plan had reduced pain and increased mobility. In fact, curcumin has been shown in over 50 clinical studies to have potent anti-inflammatory activity, as well as demonstrating the ability in four studies to reduce Tylenol-associated adverse health effects.
- Boswellia: Also known as boswellin or "Indian frankincense," this herb contains powerful anti-inflammatory properties, which have been prized for thousands of years. This is one of my personal favorites as I have seen it work well with many rheumatoid arthritis patients.
- Bromelain: This protein-digesting enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form, but eating fresh pineapple may also be helpful. Keep in mind that most of the bromelain is found within the core of the pineapple, so consider leaving a little of the pulpy core intact when you consume the fruit.
- Cetyl Myristoleate (CMO): This oil, found in fish and dairy butter, acts as a "joint lubricant" and an anti-inflammatory. I have used a topical preparation for myself to relieve ganglion cysts and a mild annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards.
- Evening Primrose, Black Currant and Borage Oils: These contain the fatty acid gamma linolenic acid (GLA), which is useful for treating arthritic pain.
- Cayenne Cream: Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body's supply of substance P, a chemical component of nerve cells that transmits pain signals to your brain.
- Therapeutic modalities such as yoga, acupuncture, meditation, hot and cold packs, and even holding hands can also result in astonishing pain relief without any drugs.
- i American Pain Foundation, Pain Facts & Stats (PDF)
- ii Annals of Internal Medicine January 3, 2012 vol. 156 no. 1 Part 1 1-10
- iii Physical Therapy April 2007 vol. 87 no. 4 408-417
- iv J Appl Physiol. 2009 Nov;107(5):1413-9.
- v Arthritis & Rheumatism Vol. 59, No. 1, January 15, 2008, pp 84–91
- vi National Research Centre for the Working Environment, Rehabilitation of Neck/Shoulder Muscle Pain
- vii Clinical Journal of Pain. 2009;25(3):233–238.
- viii Evid Based Complement Alternat Med. 2012;2012:953139.