Spinal manipulative therapy same as standard care for acute low back pain
Three articles on PainSci cite Jüni 2009: 1. The Complete Guide to Low Back Pain 2. The Chiropractic Controversies 3. Does Spinal Manipulation Work?
PainSci commentary on Jüni 2009: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
In this good test of SMT, researchers took a hundred patients with nasty, fresh cases of low back pain, and delivered half of them into the care of chiropractors, and the other half into “standard care” — advice and ordinary pain medications, namely. Note that it has often been argued that SMT is best for acute low back pain, not chronic, so this is right in chiropractic’s strike zone: if there is anything remotely impressive about SMT, it should have done well in this contest. It should have pulled out a can of whupass on “advice and meds.” It did not.
SMT and standard care did equally well — or equally poorly, if you prefer. All the patients had the same experience that pretty much everyone with chronic back pain has. The researchers found that “SMT is unlikely to result in relevant early pain reduction in patients with acute low back pain.”
~ Paul Ingraham
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
OBJECTIVE: To determine whether treatment with spinal manipulative therapy (SMT) administered in addition to standard care is associated with clinically relevant early reductions in pain and analgesic consumption.
METHODS: We randomised 104 patients with acute low back pain to SMT in addition to standard care (n=52) or standard care alone (n=52). Standard care consisted of general advice and paracetamol, diclofenac or dihydrocodein as required. Other analgesic drugs or non-pharmacological treatments were not allowed. Primary outcomes were pain intensity assessed on the 11 point box scale (BS-11) and analgesic use based on diclofenac equivalence doses during days 1 to 14. An extended follow-up was performed at 6 months.
RESULTS: Pain reductions were similar in experimental and control groups, with the lower limit of the 95% confidence interval (95%-CI) excluding a relevant benefit of SMT (difference 0.5 on the BS-11, 95%-CI -0.2 to 1.2, p=0.13). Analgesic consumptions were also similar (difference -18 mg diclofenac equivalents, 95%-CI -43 mg to 7 mg, p=0.17), with small initial differences diminishing over time. There were no differences between groups in any of the secondary outcomes and stratified analyses provided no evidence for potential benefits of SMT in specific patient groups. The extended follow-up showed similar patterns.
CONCLUSIONS: SMT is unlikely to result in relevant early pain reduction in patients with acute low back pain.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.
- Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople 1994 Spine (Phila Pa 1976).
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.
- Is there a relationship between throbbing pain and arterial pulsations? Mirza 2012 J Neurosci.