Spinal manipulation could help low back pain patients

Spinal manipulation therapy could be the way to go for low back pain patients as a new study has found modest improvements in pain and function in patients with temporary minor musculoskeletal harms.

According to the study published in JAMA, low back pain is one of the most common problems faced by adults after a certain age. Physicians ask their patients to undergo different treatments including analgesics, muscle relaxants, exercises, physical therapy, heat, spinal manipulative therapy (SMT) but none of these treatment options yield 100 per cent results and none of them is better than the other.

Authors of the study including Paul G. Shekelle, M.D., Ph.D., of the West Los Angeles Veterans Affairs Medical Center, Los Angeles, conducted a review and meta-analysis of previous studies to assess the effectiveness and harms associated with spinal manipulation compared with other nonmanipulative therapies for adults with acute (six weeks or less) low back pain.

Of 26 eligible randomized clinical trials (RCTs) identified, 15 RCTs (1,711 patients) provided moderate-quality evidence that SMT has a statistically significant association with improvements in pain. Twelve RCTs (1,381 patients) produced moderate-quality evidence that SMT has a statistically significant association with improvements in function.

No RCT reported any serious adverse event. Minor transient adverse events such as increased pain, muscle stiffness, and headache were reported 50 percent to 67 percent of the time in large case series of patients treated with SMT. Heterogeneity (differences) in study results was large, and was not explained by type of clinician performing SMT, type of manipulation, study quality, or whether SMT was given alone or as part of a package of therapies.

The authors write that the size of the benefit of SMT for acute low back pain is about the same as the benefit from nonsteroidal anti-inflammatory drugs, according to the Cochrane review on this topic.