Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Spinal Manipulative Therapy for Acute Low Back Pain
JAMA; ePub 2017 Apr 11; Paige, Miake-Lye, et al
Modest improvement in pain and function were reported among patients with acute low back pain who were initiated on manipulative therapy (SMT), a recent study found. The systematic review and meta-analysis included 26 randomized clinical trials (RCTs) from January 1, 2011, through February 6, 2017. The study examined the effectiveness and harms of SMT for acute (≤6 weeks) low back pain. Main outcomes included pain, function, or any harms measured within 6 weeks. Researchers found:
- 15 RCTs (1,711 patients) provided moderate-quality evidence that SMT has a statistically significant association with improvements in pain.
- 12 RCTs (1,381 patients) provided moderate-quality evidence that SMT has a statistically significant association with improvements in function.
- Minor transient adverse events including increased pain, muscle stiffness, and headache were reported 50% to 67% of the time in large case series of patients treated with SMT.
Paige NM, Miake-Lye IM, Booth MS, et al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain. Systematic review and meta-analysis. JAMA. 2017;317(14):1451-1460. doi:10.1001/jama.2017.3086.
Low back pain is common and often frustrating because the range of treatments—including acetaminophen, NSAIDs, opioid analgesic, and heat and massage—all help but often not as well as we would like them to. Spinal manipulative therapy is a term that encompasses a variety of manual therapies. The degree of benefit found for relieving pain was about the same as achieved with either NSAIDs or acetaminophen. The present study strongly supports the efficacy of spinal manipulative therapy, either chiropractic or osteopathic, as a very reasonable and effective nondrug option for patients with acute low back pain. —Neil Skolnik, MD