PainScience.com Sensible advice for aches, pains & injuries
 
 
bibliography * The PainScience Bibliography contains plain language summaries of thousands of scientific papers and others sources, like a specialized blog. This page is about a single scientific paper in the bibliography, Jüni 2009.

Spinal manipulative therapy same as standard care for acute low back pain

updated
Jüni P, Battaglia M, Nüesch E, Hämmerle G, Eser P, van Beers R, Vils D, Bernhard J, Ziswiler HR, Dähler M, Reichenbach S, Villiger PM. A randomised controlled trial of spinal manipulative therapy in acute low back pain. Ann Rheum Dis. 2009 Sep;68(9):1420–7. PubMed #18775942.
Tags: back pain, bad news, spinal adjustment, controversy, devices, chiropractic, pain problems, spine, treatment, debunkery, manual therapy

PainSci summary of 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 at the bottom of the page, as often as possible. ★★★☆☆?3-star ratings are for typical studies with no more (or less) than the usual common problems. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.

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

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.

related content

These three articles on PainScience.com cite Jüni 2009 as a source:


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.