Adding chiropractic to back pain care may reduce disability

(Reuters Health) - Adding chiropractic care to standard medical care for low back pain may help reduce discomfort and disability, a U.S. study suggests.

Researchers studied 750 active-duty U.S. military service members being treated for lower back pain. All of them received usual care like physical therapy and drugs to ease pain and inflammation. In addition, half of them received chiropractic care that could include spinal manipulation, rehabilitation exercises and treatment with cold or heat.

After six weeks, patients receiving chiropractic care reported larger reductions in low back pain and less related disability than people who didn’t get these treatments, the study found.

“Spinal manipulation (often referred to Hias chiropractic adjustment) may help heal tissues in your body that form as a result of injury, decreasing pain and improving your body’s ability to move correctly,” said lead study author Dr. Christine Goertz, who did the research while affiliated with the Palmer College of Chiropractic in Davenport, Iowa.

“It is also possible that manipulation impacts the way that your body perceives pain through either the brain or the spinal cord and/or decreases pain from muscle strain, inflammation and/or spasm in the muscles next to your spine,” Goertz said by email.

Lower back pain is a leading cause 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.

It’s estimated that one in five U.S. adults have lower back pain. Direct costs of treatment and indirect costs like lost productivity exceeded $234 billion in 2010, researchers note in JAMA Network Open.

Amid a worsening opioid addiction crisis in the U.S., doctors are increasingly looking for less addictive medications and alternative treatments for lower back pain, they add.

Chiropractic care in the study included spinal manipulation to help restore proper alignment in the lower back and surrounding areas.

Participants assigned to chiropractic care received an average of two to five treatments, depending on their treatment facility.

After six weeks, people who received chiropractic care reported average levels of pain intensity that were about 1.1 points lower on a pain scale of 1 to 10 than individuals who didn’t have the chiropractic treatments. This difference persisted, but was less pronounced, after 12 weeks.

Of 43 instances of side effects reported by people receiving chiropractic care, most cases were described as joint or muscle stiffness. Some people reported these side effects when they weren’t getting chiropractic care, and in this group three people had drug side effects and four had side effects from epidural injections.

One limitation of the study is that back pain is difficult to diagnose and confirm, and outcomes of treatment reported by patients are hard to verify, the authors note. It’s also possible that results from predominantly male and young service members might not reflect what would happen in the broader population of people with back pain.

Even so, the results add to evidence suggesting that offering chiropractic care in addition to other back pain treatments can improve outcomes, said Daniel Cherkin of the Kaiser Permanente Washington Health Research Institute in Seattle.

Chiropractic care, like other forms of alternative treatments such as massage, acupuncture and yoga, has been found to reduce pain and improve function for people with low back pain, Cherkin, author of an accompanying editorial, said by email.

“All of these treatments have lower risks of harms than medications, injections and surgery,” Cherkin said. “Because it has not been possible to predict which patients will benefit most from a specific treatment, trying several of these alternative treatments to find one that works is a sensible strategy.”

SOURCE: and JAMA Network Open, online May 18, 2018.