Abstract
M.Tech.
OBJECTIVE: The aim of this study was to determine the extent of the benefit of combining psychological intervention, in the form of guided imagery, with spinal manipulative therapy, in the treatment of mechanical chronic lower back pain. The guided imagery functioned to address the psychosocial factors playing a role in the experience, maintenance and exacerbation of chronic pain (Turk, Swanson & Tunks, 2008), while the chiropractic spinal manipulative therapy functioned to address the dysfunctional biomechanics which cause the biological and neurological aspects of the chronic pain.
DESIGN AND METHODOLOGY: 30 subjects between the ages of 18 and 40, presenting to the University of Johannesburg Chiropractic day clinic with chronic lower back pain, participated in the trail. They were randomly divided into 2 groups, which both underwent 6 treatments. During the initial consultation, both groups had their lumbar range of motion measured with the digital inclinometer, and were asked to complete the Oswestry Pain and Disability Index (Appendix G), Numerical Pain Rating Scale (Appendix H), and Perceived Stress Scale (Appendix I). This was followed for group A by spinal manipulative therapy to the restricted segments. Group B was treated with spinal manipulative therapy and a guided imagery session, performed by a registered psychologist. The participants were instructed on how to perform the guided imagery on their own, and were asked to perform it at home 3 times per week for the duration of the treatment.
During the 2nd consultation, both groups received spinal manipulative therapy, and their progress was noted throughout on a SOAP note. During the 3rd consultation, both groups again had their lumbar range of motion measured, and were asked to complete the Oswestry Pain and Disability Index, Numerical Pain Rating Scale, and Perceived Stress Scale. Treatment followed as per the initial consultation for both groups. During the 4th and 5th consultations, both groups received spinal manipulative therapy.
During the final consultation, both groups were again treated with spinal manipulative therapy, followed by lumbar range of motion measurements, and final completion of the Oswestry Pain and Disability Index, Numerical Pain Rating Scale, and Perceived Stress Scale.
RESULTS: There was a statistically significant improvement in overall lumbar range of motion for both groups throughout all degrees of freedom respectively. It is interesting to note that both in extension as well as rotation the inter-group measurements were statistically significantly different at treatment outset, but due to greater improvement in group B over group A, became statistically comparable on completion of the trials.
There was also a significant overall improvement and decrease in subjective symptoms of perceived pain, disability and stress for both groups, and the Numerical Pain Rating Scale also demonstrated a statistically significant improvement in results, due to greater improvement of group B over group A.
CONCLUSION: The subjective and objective results between participants of the same group, demonstrated that both spinal manipulative therapy alone, as well as spinal manipulative therapy in conjunction with guided imagery was effective in treating chronic mechanical lower back pain.
When comparing results between the two groups, the combined protocol group showed statistically significant improvement above the purely chiropractic group in 3 out of 6 objective measures, and 1 out of 3 subjective measures.
There is thus limited evidence as to the advantage of combining guided imagery with the chiropractic treatment protocol of chronic mechanical lower back pain, however unfortunately not sufficient evidence to draw a definitive conclusion.