Spinal Manipulation: Modest Benefit in Acute Low Back Pain
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Sunday, April 16, 2017 12:55 PM

The Journal of the American Medical Association adds to a growing body of recent research supporting the use of spinal manipulative therapy as a first line treatment for acute low back pain.  Researchers found that spinal manipulation was associated with statistically significant improvements in pain and function for up to six weeks with no serious adverse side effects. 


new study published in the Journal of the American Medical Association (JAMA) adds to a growing body of recent research supporting the use of spinal manipulative therapy (SMT) as a first line treatment for acute low back pain.  Researchers found that spinal manipulation was associated with statistically significant improvements in pain and function for up to six weeks with no serious adverse side effects. The JAMA study, published April 11, comes on the heels of new low back pain treatment guidelines by the American College of Physicians (ACP) that recommend first using non-invasive, non-drug treatments, including spinal manipulation, before resorting to drug therapies.

Spinal manipulation modestly improves pain and function in acute low back pain, the new systematic review and meta-analysis has found.   “The principal conclusion of this review was that SMT [spinal manipulation therapy] treatments for acute low back pain were associated with statistically significant benefit in pain and function at up to 6 weeks, that was, on average, clinically modest," lead author Paul G. Shekelle, MD, PhD, from the West Los Angeles Veterans Affairs Medical Center, California, and colleagues write.

Citing a Cochrane Review, the authors note that the amount of benefit was about the same as for non steroidal anti-inflammatory drugs (NSAIDs). Back pain represents one of the most common reasons why patients seek care, with an estimated 50% or more of people experiencing back pain in their lifetime, the authors explain. 

To update past reviews, researchers searched four different databases for studies about spinal manipulation in the treatment of acute low back pain, with a follow-up of 6 weeks or shorter. The analysis included 26 studies published between January 2011 and February 2017, and excluded patients with sciatica and chronic low back pain.

Fifteen randomized controlled trials (RCTs) covering 1711 patients had moderate-quality evidence suggesting spinal manipulation significantly improves lower back pain.

Twelve RCTs covering 1381 patients had moderate-quality evidence showing spinal manipulation significantly improves function.

No serious adverse events were reported. Review of large case series showed that 50% to 67% of patients who received spinal manipulation only experienced minor, transient adverse events, including increased pain, muscle stiffness, and headache.

If manipulation is at least as effective and as safe as conventional care, it may be an appropriate choice for some patients with uncomplicated acute low back pain. This is an area in which a well-informed patient’s decisions should count as much as a practitioner's preference.

“As the nation struggles to overcome the opioid crisis, research supporting non-drug treatments for pain should give patients and health care providers confidence that there are options that help avoid the risks and dependency associated with prescription medications,” said ACA President David Herd, DC.

Just last month, ACA’s House of Delegates formally approved a resolution to adopt ACP’s low back pain treatment guidelines, in conjunction with chiropractic-specific guidelinesfrom the Clinical Compass. The Clinical Compass guidelines focus on the management or co-management of low-back pain patients within a chiropractic office.

“By identifying and adopting guidelines that ACA believes reflect best practices based on the best available scientific evidence on low back pain, we hope not only to enhance outcomes but also to create greater consensus regarding patient care among chiropractors, other health care providers, payers and policy makers,” added Dr. Herd.

According to a 2016 Gallup survey, more than 35 million people visit a chiropractor annually.

Widely known for their expertise in spinal manipulation, chiropractors practice a hands-on, drug-free approach to health care focused on disorders of the musculoskeletal system. Chiropractors are trained to diagnose and manage cases of back pain and refer patients to appropriate medical specialists when necessary.


Source:  http://www.medscape.com/viewarticle/878443