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Review finds spinal manipulation yields minor improvement in chronic back pain

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Spinal manipulative therapy has “significant, but very small” benefits for patients with chronic low back pain, according to a review article in the June 1 issue of Spine.

“High-quality evidence suggests that there is no clinically relevant difference between [spinal manipulative therapy (SMT)] and other interventions for reducing pain and improving function in patients with low back pain,” lead author Sidney M. Rubinstein, DC, MSc, and co-authors wrote in the report.

The review consisted of 26 randomized trials including 6,070 patients with chronic low back pain who underwent SMT. In all studies, the patients were randomly assigned to either SMT or a comparison treatment: either an active treatment such as exercise or physical therapy, or a placebo treatment. SMT was defined as any type of hands-on spinal treatment, which was most commonly delivered by chiropractors or physical therapists.

When compared to other interventions, SMT was found to have a “small, significant, but not clinically relevant short-term effect on pain relief and functional status,” the authors wrote, adding there was evidence of varying quality that SMT in conjunction with another intervention was found to have a “significant short-term effect on pain relief and functional status.”

Furthermore, the authors noted, the benefits appeared to decrease over time and were no longer significant after 1 year.

Overall, the authors found no strong evidence of SMT being more efficacious than inactive or placebo treatments.

“There is evidence that SMT is neither superior nor inferior to other effective treatments for patients with chronic low-back pain,” the authors wrote. “The decision to refer to SMT should be based on costs, preferences of the patient and providers, and relative safety of the treatment options.”

The authors added there is a need for cost-effectiveness studies, as well as further studies of SMT for the indication of low back pain.

References:

• Rubinstein SM, van Middelkoop M, Assendelft WJJ, et al. Spinal manipulative therapy for chronic low-back pain: An update of a Cochrane review. Spine. 2011. doi: 10.1097/BRS.0b013e3182197fe1
• www.lww.com

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