Saturday, September 13, 2008

New Study Shows Spinal Manipulation of no Benefit for Low Back Pain

According to the September 5 Online First issue of the Annals of the Rheumatic Diseases, acute low back pain doesn't respond to spinal manipulative therapy (SMT), when used as an addition to routine medical care. Acute low back pain affects many people, and the current study suggests that you might want to think twice before having your back manipulated to treat low back pain.

Though the study was small, and different modalities may certainly be effective for individual pain control, the results are worth noting. The current research involved 104 patients, split into two groups – one assigned to conventional care that included medications and general advice, and the other SMT combined with traditional medical care. Neither group was permitted to use extra treatment, such as non-pharmacologic care or analgesics other than paracetamol, diclofenac, or dihydrocodeine as needed. The end-points were measured using an 11 point pain scale, during days 1 to 14, and an extended follow-up evaluation at 6 months.

The researchers found that pain reduction was similar in both groups, acutely, and with extended follow-up. The authors concluded, "SMT is unlikely to result in relevant early pain reduction in patients with acute low back pain.”

Spinal manipulation for the treatment of low back pain remains somewhat of a mystery. A 2004 Cochrane review showed that it is more effective than sham therapy, but also revealed that it is not any better than traditional measures used to treat low back pain. However, the patient sampling was small, and did not include the use of pain medications.

The take home message is that your doctor may not recommend chiropractic or osteopathic spinal manipulation if you experience sudden low back pain. Evidence seems to be lacking that it helps. It’s more likely that larger studies should be performed.

Nevertheless, it may be important to consider the current findings when making healthcare choices that can cost extra time and money, without proven benefit. No serious events occurred in the study group, which is also worth noting. Interestingly, guidelines issued to physicians for treatment of low back pain in October, 2007 did include spinal manipulation as a self-care option for acute low back pain.

Low back pain is estimated to affect 6% of adults on a daily basis; the prevalence over a lifetime is 60 to 70 percent. According to current guidelines, lumbar supports are of little benefit and the value of exercise for prevention of back injuries is mixed. The COST B13 Working Group on European Guidelines for Prevention in Low Back Pain recommends exercise to prevent work absence, while the US Preventive Services Task Force finds insufficient evidence to recommend for or against the routine use of exercise interventions to prevent back pain. (1)

Most acute episodes of low back pain resolve with conservative measures, according to past studies. Recommendations include continuing normal activities, massage, analgesics, Yoga, and acupuncture, all therapies that your doctor may support to alleviate acute episodes of low back pain.

(1) Am Fam Physician. 2007; 75:1181-1188.

Spinal Manipulation May Not Be Helpful for Low Back Pain


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