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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, Senna 2011.

Does maintained Spinal manipulation therapy for chronic non-specific low back pain result in better long term outcome?

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Tags: treatment, chiropractic, spinal adjustment, controversy, back pain, manual therapy, debunkery, spine, pain problems

PainSci summary of Senna 2011?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. ★★☆☆☆?2-star ratings are for studies with flaws, bias, and/or conflict of interest; published in lesser journals. 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.

Contrary to the popular theory that spinal manipulation is mainly just good for acute low back pain, this study in a good medical journal surprisingly conclude “SMT is effective for the treatment of chronic non specific LBP” and recommended “maintenance spinal manipulations after the initial intensive manipulative therapy.” There was some excitement about this, of course. Neil O’Connell of Body In Mind:

The email from the industry was effusive. In a cock-a-hoop, caps lock-happy frenzy it bellowed “ALL MANUAL MEDICINE PROVIDERS SHOULD BE AWARE OF THIS STUDY.”

Or not. Neil readily identified numerous serious problems with it.

It is of course possible that the results of this study are accurate and maintenance manipulations are effective, but these problems make it difficult to judge. The message from this one back pain trial might seem appealing and I can see why the email was so enthusiastic. But by focusing on one particular cherry that seems so ripe and juicy we might miss the bigger picture from the rest of the tree. And there is always the chance that the tastiest cherries contain a few artificial sweeteners. Personally I would lay off the caps lock for now.

original abstract

STUDY DESIGN: A prospective single blinded placebo controlled study was conducted.

OBJECTIVE: to assess the effectiveness of spinal manipulation therapy (SMT) for the management of chronic non-specific low back pain (LBP) and to determine the effectiveness of maintenance SMT in long-term reduction of pain and disability levels associated with chronic low-back conditions after an initial phase of treatments.

SUMMARY OF BACKGROUND: SMT is a common treatment option for low back pain. Numerous clinical trials have attempted to evaluate its effectiveness for different subgroups of acute and chronic LBP but the efficacy of maintenance SMT in chronic non-specific LBP has not been studied.

SUBJECTS AND METHODS: 60 patients with chronic, nonspecific LBP lasting at least 6 months were randomized to receive either (1) 12 treatments of sham SMT over a one-month period, (2) 12 treatments, consisting of SMT over a one-month period, but no treatments for the subsequent nine months, or (3) 12 treatments over a one-month period, along with "maintenance spinal manipulation" every two weeks for the following nine months. To determine any difference among therapies, we measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline and at 1-month, 4-month, 7-month and 10-month intervals.

RESULTS: Patients in second and third groups experienced significantly lower pain and disability scores than first group at the end of 1-month period (P = 0.0027 and 0.0029 respectively). However, only the third group that was given spinal manipulations during the follow-up period showed more improvement in pain and disability scores at the 10-month evaluation. In the no maintained SMT group, however, the mean pain and disability scores returned back near to their pretreatment level.

CONCLUSION: SMT is effective for the treatment of chronic non specific LBP. To obtain long-term benefit, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy.

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One article on PainScience.com cites Senna 2011 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.