The Canada Post Corporation, comprised of Canada’s postal service and several joint ventures, has the nation’s sixth largest workforce, the majority of who are represented by a postal workers’ union. Being a postal worker entails not only the typical workforce challenges, but like nurses and mechanics, they are at higher risk for lower back pain. Canada Post reported that diagnosed musculoskeletal complaints rose from 53 percent in 2001 to 59 percent in 2003, with sharp increases in physiotherapy, chiropractic and massage care.

In an effort to establish whether naturopathic medical treatment might be of benefit to postal workers with low back pain, Canada Post and the 55,000-member Canadian Union of Postal Workers funded a joint study to be conducted by the Canadian College of Naturopathic Medicine (CCNM). The purpose of the study was to establish what, if any, effect existed between naturopathic medical treatment (using a combination of acupuncture, mind-body therapy, lifestyle and dietary counseling) and pain management and quality of life for employees with lower back pain. Neither organization had a role in the conduct or analysis of the investigation.

A New Study
The study is entitled A Randomized Controlled Parallel Group Study to Determine the Impact of Naturopathic Treatment on Canadian Postal Workers with Low Back Pain. The research team was comprised of Orest Szczurko, ND, of the Canadian College of Naturopathic Medicine, Toronto, CN and the Noumena Health Clinic, Mississauga, CN; Kieran Cooley, ND, of the Canadian College of Naturopathic Medicine, Toronto, CN; Edward Mills, DPH, MSc, FRSH, PhD, of the Division of Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, CN and the Department of Clinical Epidemiology & Biostatistics, McMaster University, Ontario, CN; Dugald Seely, ND, MSc (Cand.), the Division of Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, CN and the Institute of Medical Science, University of Toronto, CN; Jason Busse, DC, MSc, PhD (Cand.), Department of Clinical Epidemiology & Biostatistics, McMaster University, Ontario, CN; Bob Bernhardt, the Canadian College of Naturopathic Medicine, Toronto, CN; Gordon H. Guyatt and Qi Zhou, both of the Department of Clinical Epidemiology & Biostatistics, McMaster University, Ontario, CN.

The researchers will discuss their findings at the 21st Annual Meeting of the American Association of Naturopathic Physicians (AANP) (http://www.Naturopathic.org), being held August 9-12, 2006 at the Oregon Convention Center, Portland, OR.

Methodology
A total of 80 participants, primarily letter sorters, were randomly selected to enter either the naturopathic treatment (active) or control group for a 12-week period (36 completed the trial in each group). Care was administered on site at one of the Post’s largest processing plants in Canada. Most participants were already on site, although some letter carriers came from surrounding depots to be seen.

Treatment for those in the naturopathic group included: (1) acupuncture once per week; (2) relaxation exercises to relax the muscles (which the patient did twice per day; once in the morning and once before bedtime); (3) lifestyle counseling (proper sleep habits and finding an enjoyable hobby); and (4) diet advice (high vegetable consumption; decreasing sugar and caffeine consumption).

The control group received a treatment protocol that has previously been published in the British Medical Journal. They received basic exercise and lifestyle counseling and a booklet of general information about lower back pain. Visits with the control group were made every two weeks to offer additional lifestyle advice, counseling, or to answer any questions.

Three measures were given to participants: The Oswestry (low back pain questionnaire), Roland & Morris (low back pain questionnaire used to back up the Oswestry), and the Short Form (SF)-36 (general qualify of life questionnaire) survey. Information from these surveys was used to assess baseline back health and quality of life. Pain medication, adjunctive therapies, and lumbar flexion (functional measure) were also established at baseline. Oswestry, Roland & Morris, SF-36, and forward lumbar flexion were recorded at 4, 8, and 12 weeks. Medication and therapy use was recorded at each visit.

Results
After 12 weeks, the investigators observed the following:

Scores for those with specific low back pain decreased by 20.0 percent in the naturopathic care group vs. an increase of 8.8 percent for control (p&lt 0.0001), per the Roland & Morris survey.

Scores for general low back pain decreased by 11.1 percent among the naturopathic group vs. an increase of 1.7 percent in the control (p&lt 0.0001), per the Oswestry questionnaires.

There was improvement in all of the eight categories that make up the overall quality of life survey (SF-36) among those receiving naturopathic care. By contrast, only two categories improved slightly among those in the control group while the remaining six remained the same or dropped below baseline.

Patients in the naturopathic study section had more limber measurements in the spine, increasing from 29.55 to 33.85 cm vs. a decrease in the control group from 31.58 to 30.28 cm (p< 0.0001).

Conclusions
Postal workers in this study who underwent naturopathic treatment for lower back pain reported improvement in their physical and emotional health and their overall quality of life. In contrast, those in the control group indicated they did not have positive outcomes during the test period. This study provides evidentiary support for further examination of the link between naturopathic care and treatment of lower back pain among Canadian postal workers.

Provided by ArmMed Media
Revision date: June 18, 2011
Last revised: by Jorge P. Ribeiro, MD