Lower back Relief
Spinal manipulative therapy, including chiropractic care, provides modest relief from pain and improvements in function for those with acute lower back pain, a new study finds.
In general, the benefit of SMT was about the same as nonsteroidal anti-inflammatory drugs, the study stated. The quality of evidence for benefit was “moderate.”
The meta-analysis encompassing 26 randomized controlled trials can be found at j.mp/lbackpain. The first author was Dr. Neil M. Paige, and the senior author was Dr. Paul G. Shekelle. Both are of West Los Angeles Veterans Affairs Medical Center.
Benefits came with some minor temporary costs for more than half of patients, including “increased pain, muscle stiffness, and headache, ” the study stated.
The study confined itself to acute cases, defined as lasting 6 weeks or less. It didn’t examine the effect of the therapy on chronic back pain.
Results varied widely from patient to patient, the study found, and no association could be found between benefit and the type of manipulation or category of clinician providing the therapy.
Additionally, no association could be found between benefits and whether SMT was given as a monotherapy or with other treatments.
Study limitations include the low quality of a number of studies in the meta-analysis, although higher quality studies reported more benefit.
Also, “the minimum clinically important difference for these outcomes has not been well established, raising questions about the size of the clinical benefit, ” the study stated.
An accompanying editorial in JAMA highlighted the longstanding conflict over the role of chiropractors in spinal manipulation.
“Chiropractic therapy is not widely accepted by some traditional health care practitioners. This may be, at least in part, because some early practitioners of chiropractic care rejected the germ theory, immunizations, and other scientific advances, ” stated the editorial by Dr. Richard A. Deyo.
“However, chiropractic care is popular today with the US public, ” Deyo stated. “According to a 2012 report, among patients with back or neck pain, approximately 30 percent sought care from a chiropractor. In a 2013 survey by Consumer Reports magazine involving 14.000 subscribers with low back pain, chiropractic care had the largest proportion of ‘highly satisfied’ patients.”
The study is consistent with another review and clinical guideline from the American College of Physicians, Deyo wrote. That review found most patients with acute lower back pain improve over time regardless of treatment, Deyo wrote.
“Thus, therapy is often directed simply at symptom relief while natural healing occurs, ” the editorial stated. “The guideline also concluded that patients with acute or subacute low back pain should consider nonpharmacological treatment with heat, massage, acupuncture, or SMT.”