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Learn how Illinois Back Institute's Natural Treatment Clinically Outperformed Other Back Treatments via Public Scientific Research

  • Studies Archived in Pubmed US National Library of Medicine National Institute of Health
  • PhD. Gianna Maddalozzo (2016, 2018, 2019) 
  • IBI's back treatment proven to significantly decrease pain, improve function outcomes, and decrease dependency on medication

Summary:

We present the finding of three research studies conducted by “The Illinois Back Institute,” Wheaton, IL.


Maddalozzo, G.F.M., Foley, J.T., Perisic, M., and Harmining, A. A Multimodal approach to treating chronic low back pain in participants with failed back surgery syndrome, bulging discs, degenerative discs, herniated discs, sciatica, spondylolisthesis, stenosis, and opioid use. In review: American Journal of Medicine.


Gianni F. Maddalozzo, PhD, FACSM, Brian Kuo, MS, Walker A. Maddalozzo, Conner D. Maddalozzo, and Johnny W. Galver, MS. Comparison of 2 Multimodal Interventions With and Without Whole Body Vibration Therapy Plus Traction on Pain and Disability in Patients With Nonspecific Chronic Low Back Pain. J Chiropr Med. 2016 Dec; 15(4): 243–251.


Maddalozzo, G.F., Akenhead, K.A., and Perisic, M., A Novel Treatment Combination for Failed Back Surgery Syndrome, with 41-Month Follow Up: A Retrospective Case Report. In Press. J Chiropr Med.


In Press:

Patients in this study saw significant decreases in their pain and Oswestry scores. At baseline, ODI scores were 47.9 + 13.1 and 44.9 + 11.7 for females and males respectively classifying them as having severe disability (Table 1). Additionally, we present outcomes for patients whose ODI scores were representative of the following ODI classifications: Moderate disability (21–40) (M=32.86); Severe disability (41–60); (47.23) crippling back pain (61–80) (65.81); and bedbound (81-100) (Table 2). The majority of therapeutic exercise intervention studies for CLBP we reviewed report mean baseline NRS scores ranging between 3.1-6.4 [26-31] with a pain classification of mild to moderate [32] or 1-2 pain classifications below participants in this retrospective study. Moreover, the majority of therapeutic exercise intervention studies for CLBP we reviewed reported mean baseline ODI scores of 19.44-39 [26-31, 33-37] classifying these participants with minimal to moderate disability. [19, 25]. MRI reports revealed that 77% of patients had bulging discs; 74% had degenerative discs; 44% had herniated discs; 76% had sciatica (determined by a positive contralateral straight leg raise test); 27% had spondylolisthesis; and 67% had stenosis (Figure 2).

Annually, more than 25 million Americans suffer from chronic low back pain (CLBP),

which is the most prevalent type of pain reported. CLBP prevalence exceeds joint pain, migraines and headaches as well as cervical, facial, or jaw pain. It is estimated that in the United States, approximately 149 million work days are lost annually due to CLBP [1, 2], with total costs estimated to be 100 to 200 billion US dollars per year. Two-thirds of this is due to lost wages and lower worker productivity [1, 2]. Among Americans reporting CLBP, roughly 36% suffered from radiculopathy resulting from disc herniation or degenerative spinal stenosis leading to root compression. Unfortunately, CLBP often exists with other conditions, such as depression, chronic fatigue syndrome, and fibromyalgia. CLBP with co-morbidities results in long-term disability and ranks CLBP sufferers among the most expensive patients. Healthcare costs for people with back pain are on average 60 percent higher than for those without back pain [3].


Commonly prescribed treatment strategies for CLBP include: 1) Physical manipulation such as chiropractic treatment; 2) Physical therapy treatments; 3) Non-steroidal anti-inflammatory drugs; 4) intensive multidisciplinary bio-psycho-social rehabilitation; 6) Pain management (epidural injections), surgeries, or comparable procedures; and 7) Opioids. Unfortunately, there is a lack of consistency among measures of recovery from CLBP, making it extremely difficult to determine if a treatment strategy has been successful [4].


Americans suffering from chronic pain such as CLBP have developed an overreliance on opioid medications to relieve pain, resulting in increased overdose and addiction. In 2016, 42,249 Americans died as a result of an opioid overdose [5]. Additionally, Opioids were present in 83 percent of deaths in 2017 in the state of Massachusetts [6]. Recently, the CDC released a Vital Signs report stating that from July 2016 to September 2017, there were more than 140,000 suspected opioid-involved overdose emergency department visits, with a 30% increase during the period [7].The average cost to treat patients for opioid-associated overdose admissions to the ICU in 2015 was $92,408, or roughly 13 billion dollars, for the 140,000 patients [7]. Thus, developing therapeutic programs that significantly decrease CLBP may help in minimizing the potential health and economic risks associated with opioid use.

The Illinois Back Institute has developed a treatment approach that has been scientifically proven to significantly decrease pain, improve function outcomes and decrease patient’s dependency on opioids to decease pain [8, 9, 10].

Findings from a research study in review [8] through data gathered from a medical health questionnaire completed by patients enrolled at the Illinois Back Institute, 496/1052 or 47% of the patients reported taking opioids for their CLBP. At discharge after successful completion of therapy, all patients reported no longer taking opioids for pain.


Figure 1. Number of patients reporting opioid use at intake and discharge (completion of treatment) based on patient recall of information from a medical health questionnaire.

Figure 2: Number of patients who were identified as having bulging discs, degenerative discs, herniated discs, sciatica, spondylolisthesis, and stenosis.

Continue Reading the Study Below...

Solberg et al., [11] recently recommended a change score of at least 20 points in the ODI and of at least 3.5 in NRS pain should be achieved to ensure a successful outcome or substantial change after surgery. The patients in this retrospective study averaged a decrease in NRS pain of 7.17- 8.8 points (Table 3) and ODI scores of 26.09-72.07 (Table 2) points resulting in very successful outcomes [11]. These results are significantly more meaningful results than reported by Fairbanks et al., [12] who compared surgical stabilization of the lumbar spine with an intensive rehabilitation program for patients with chronic low back pain. 

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In Press:

Maddalozzo, G.F., Akenhead, K.A., and Perisic, M., A Novel Treatment Combination for Failed Back Surgery Syndrome, with 41-Month Follow Up: A Retrospective Case Report. In Press. J Chiropr Med



A 45-year-old female presented 2 years post L4-L5 and L5-S1 fusion surgery with low back and sciatic pain. Prior to surgery, the patient reported having received 3 epidural injections over the period of 4 months to treat bulging discs, without lasting relief. Additionally, the patient reported starting a course of pain management treatment with opioids (hydrocodone and acetaminophen), while also receiving spinal manipulations 3 times per week for 3 months without relief.


After the surgery the patient contemplated suicide and was under the care of a psychologist prior to enrolling in the Illinois Back Institute treatment protocol. Her physical exam was significant for a positive straight leg raise indicating radiating pain in Sciatic Nerve. Her sciatic pain radiated from the low back and buttock, through the back of the patients’ thighs, and into her lower legs and feet, following the path of the sciatic nerve. Additionally, the patient presented with diminished lower extremity reflexes, muscle strength. The patient’s MRI was significant for right disc bulging and annular tearing at L2-3, and L3-4 disc bulging with foraminal impingement.


This patient had suffered with chronic low back pain for more than 25 years and underwent spinal fusion surgery. The patient stated that symptoms were significantly improved for 3 months post-surgery. However, shortly after her return to work, her back pain returned with greater intensity than prior to her surgery. She then began treatment with opioid pharmacotherapy and traditional physical therapy for 3 months at 3 times per week at Central DuPage Hospital in Winfield, IL to manage her pain. The patient reported that medication and traditional physical therapy failed to meaningfully reduce her pain prior to enrolling in the Illinois back.


At intake the patients Oswestry Disability Index (ODI) score was 50%, demonstrating severe disability. Her Numeric Rating Scale (NRS) was 8/10, Severe Pain, classified as disabling; and unable to perform activities of daily living due to pain in the low back, right and left gluteal areas, and right and left lower extremities. At the completion of the IBI treatment protocol, the patient’s ODI score was 8%, demonstrating minimal disability and improved overall function. Her NRS score was 1, indicating minimal pain (Table 4).


At the completion of treatment, the patient reported a return to regular intimacy with her husband and was able to partake in a normal social life. The patient no longer felt dependent on others, improving her relationships and re-establishing her role within her family. The patient was now able to easily perform daily tasks and return to work without issue. At 41 months post-treatment follow-up, the patient’s ODI and NRS scores were zero, and she was no longer taking any opioid pain or depression medications (Table 4).


Table 4. General Clinical Characteristics Including ODI and NRS Scores Plus Medications

Gianni F. Maddalozzo, PhD, FACSM, Brian Kuo, MS, Walker A. Maddalozzo, Conner D. Maddalozzo, and Johnny W. Galver, MS. Comparison of 2 Multimodal Interventions With and Without Whole Body Vibration Therapy Plus Traction on Pain and Disability in Patients With Nonspecific Chronic Low Back Pain. J Chiropr Med. 2016 Dec; 15(4): 243–251


We recently conducted a comparison study between the Illinois Back Institute (IBI) chronic low back pain treatment protocol and a traditional physical therapy treatment approach typically used to treat chronic low back pain (CLBP). The IBI group consisted of 70 patients while the tradition PT group had 55 patients. All patients had to have confirmed CLBP and a numeric rating scale (NRS) score of ≥7. Table 5

Table 5. Baseline Demographic Characteristics of Participants 

At baseline, no significant differences existed between PT and IBI for NRS and ODI scores. When examining the NRS pain score differences before and after treatment (Table 6), we observed a significant difference within each group. Within the PT group, we estimate an average drop in pain of 2.44 points after treatment, whereas the IBI group averaged a decrease in pain of 5.3 points after therapy treatments.


At the conclusion of treatment, a significant decrease in pain was reported by the NRS pain score scale, with the IBI group’s pain decreased significantly more (Table 6). Additionally, the groups’ differences in percentage of disability (postintervention to preintervention) were obtained from the ODI questionnaire scores. In the PT group we found an average decrease of 9.35 points, whereas the IBI had an average decrease of 22 points (Table 7). The results of this study indicate that patients’ NRS and ODI scores significantly decreased regardless of therapy intervention. However, the IBI group had better outcomes. If the findings of Marchettini et al. [13] are correct, all of the IBI group could potentially successfully return to work as productive employees based on a pain classification of mild or better whereas, the PT groups pain classification of moderate pain (NRS = 5.2) could potentially still make it difficult for these patients to successfully return to.


At intake, 21/70 or 30 percent of the IBI treatment patients were being prescribed opioid medication for their pain. At the conclusion of their treatment, none of the 21 patients were taking opioids to help manage their pain.


Table 6. Baseline and Postintervention Means and Standard Deviations for Numeric Rating Scale Scores 

Table 7. Baseline and Postintervention Means and Standard Deviations for Oswestry Disability Index Baseline and Postintervention Scores 

References

1. Katz, J.N., Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am, 2006. 88 Suppl 2: p. 21-4.

2. Rubin, D.I., Epidemiology and risk factors for spine pain. Neurol Clin, 2007. 25(2): p. 353-71.

3. Crow, W.T. and D.R. Willis, Estimating cost of care for patients with acute low back pain: a retrospective review of patient records. J Am Osteopath Assoc, 2009. 109(4): p. 229-33.

4. NIH, N. Low Back Pain Fact Sheet. December 2014 [cited 2015 03/12/2015].

5. Seth, P., et al., Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants - United States, 2015-2016. MMWR Morb Mortal Wkly Rep, 2018. 67(12): p. 349-358.

6. Bebinger, M. Opioid Overdose Deaths Fell About 8 Percent In 2017 In Mass. 2017 [cited 2018 03/30/2018].

7. Stevens, J.P., et al., The Critical Care Crisis of Opioid Overdoses in the United States. Ann Am Thorac Soc, 2017. 14(12): p. 1803-1809.

8. Maddalozzo, G.F.M., Foley, J.T., Perisic, M., and Harmining, A. A Multimodal approach to treating chronic low back pain in participants with failed back surgery syndrome, bulging discs, degenerative discs, herniated discs, sciatica, spondylolisthesis, stenosis, and opioid use. In review: American Journal of Medicine.

9. Gianni F. Maddalozzo, PhD, FACSM, Brian Kuo, MS, Walker A. Maddalozzo, Conner D. Maddalozzo, and Johnny W. Galver, MS. Comparison of 2 Multimodal Interventions With and Without Whole Body Vibration Therapy Plus Traction on Pain and Disability in Patients With Nonspecific Chronic Low Back Pain. J Chiropr Med. 2016 Dec; 15(4): 243–251. 

10. Maddalozzo, G.F., Akenhead, K.A., and Perisic, M., A Novel Treatment Combination for Failed Back Surgery Syndrome, with 41-Month Follow Up: A Retrospective Case Report. In Press. J Chiropr Med.

11. Solberg, T., et al., Can we define success criteria for lumbar disc surgery? : estimates for a substantial amount of improvement in core outcome measures. Acta Orthop, 2013. 84(2): p. 196-201.

12. Bogaerts, A., et al., Effects of whole body vibration training on postural control in older individuals: a 1 year randomized controlled trial. Gait Posture, 2007. 26(2): p. 309-16.

13. Marchettini P, Lacerenza M, Mauri E, Marangoni C. Painful peripheral neuropathies. Curr Neuropharmacol. 2006;4(3): 175-181. 

At baseline, no significant differences existed between PT and IBI for NRS and ODI scores. When examining the NRS pain score differences before and after treatment (Table 6), we observed a significant difference within each group. Within the PT group, we estimate an average drop in pain of 2.44 points after treatment, whereas the IBI group averaged a decrease in pain of 5.3 points after therapy treatments.



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