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 Based on data from 47 previously conducted trials involving a total
of 9,211 mostly middle-aged adults, spinal manipulation eased lower
back pain as much as exercise, non-steroidal anti-inflammatory drugs
(NSAID) and painkillers. Spinal manipulation also appeared better
for improving short-term function.
"At the moment, spinal manipulation is considered a second-line or
adjunctive treatment option in international guidelines," said lead
study author Sidney Rubinstein of the Vrije Universiteit in
Amsterdam.
"These results would suggest that spinal manipulation is certainly
on-par with these other recommended therapies, and can be considered
an option," Rubinstein said by email.
Lower-back pain is one of the leading causes of disability and
doctor visits for adults worldwide. It often goes away within a few
weeks. But when it persists, lower-back pain might be treated with
spinal manipulation, medications like painkillers or muscle relaxers,
heat, exercise or physical therapy.
Spinal manipulation is often done by chiropractors but may also be
offered by physical therapists or physicians. It can include
manually moving joints, massage and exercise. This type of treatment
is designed to relieve pressure on joints and curb inflammation and
it's often used for back, neck or shoulder pain as well as for
headaches.
For the current study, researchers focused on the gold standard for
determining the effectiveness and safety of medical treatments:
randomized controlled trials that compare outcomes for patients who
are randomly assigned to a specific treatment or to a dummy
treatment or no treatment at all.
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Spinal manipulation worked better for pain relief than
non-recommended interventions like light tissue massage, the current
analysis found.
It also worked better than sham manipulation treatments, but the
evidence was low-quality, Rubinstein's team notes in The BMJ.
About half of the studies looked at side effects of spinal
manipulation and found little evidence to conclude whether or not
this is safer than other approaches. In one study, researchers found
one serious adverse event that could potentially have been
associated with spinal manipulation.
One limitation of the analysis is that the studies of spinal
manipulation were done in different settings, tested different
techniques and measured the effectiveness of this intervention in
different ways, the study authors note.
"Spinal manipulation may decrease pain from muscle strain,
inflammation and spasm in your back muscles and/or impact the way
that your body perceives pain through either the brain or the spinal
cord," said Christine Goertz, chief executive officer of the Spine
Institute for Quality in Oskaloosa, Iowa.
"The most common side effects resulting from spinal manipulation are
mild to moderate joint or muscle pain and/or stiffness," Goertz, who
wasn't involved in the study, said by email. "These symptoms
generally go away on their own within a day or two."
SOURCE: https://bit.ly/2I7Y1as The BMJ, online March 13, 2019.
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