Spine manipulation might help with low back pain

(Reuters Health) - - Spinal manipulation therapy may work as well for easing lower back pain as anti-inflammatory medications, a research review concludes.

Based on data from 15 previously conducted trials involving a total of 1,711 adults, the study team found that spinal manipulation achieved meaningful reductions in pain and improvements in function after six weeks of treatment. The effect on pain was modest, and similar to what other studies have found with non-steroidal anti-inflammatory drugs (NSAIDS).

“Most doctors and patients have a good sense of what NSAIDs do - work great in some patients, don’t seem to work much at all in others, work somewhat in many more,” said senior study author Dr. Paul Shekelle of the West Los Angeles Veterans Affairs Medical Center.

“I think spinal manipulation therapy is much the same,” Shekelle said by email.

Lower back pain is one of the leading causes 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.

Spinal manipulation is often done by chiropractors but may also be offered by physical therapists or physicians. It can include manually moving joints, massage and exercise. This type of treatment is designed to relieve pressure on joints and curb inflammation and it’s often used for back, neck or shoulder pain as well as for headaches.

For the current study, Shekelle and colleagues focused on the gold standard for determining the effectiveness and safety of medical treatments: randomized controlled trials that compare outcomes for patients who are randomly assigned to a specific treatment or to a dummy treatment or none at all.

In an analysis of data from 15 trials, they found spinal manipulation offered a meaningful reduction of pain within six weeks. Based on a review of 12 trials, the researchers also found spinal manipulation associated with statistically meaningful improvements in functional abilities.

None of the trials uncovered serious side effects of spinal manipulation. However, minor side effects like pain, muscle stiffness and headache were common.

One limitation of the analysis is that the original studies included in the review had a wide variety of designs, involved various kinds of providers with different training and compared spinal manipulation to assorted other types of treatment, the authors note.

There’s also not much agreement in the medical community about how big the reduction in back pain or improvement in function needs to be to make a clinically meaningful difference for patients, the researchers point out in JAMA.

Plus, back pain often clears up on its own within six weeks, the time frame researchers examined in the study, noted Dr. Richard Deyo, author of an accompanying editorial and a researcher at Oregon Health and Science University in Portland.

“Many patients don’t even need to see a doctor, and many episodes of back pain are like the common cold: extremely frustrating, but rarely serious, and usually destined to improve,” Deyo said by email.

Often, people may feel better after applying heat or taking over-the counter medications, Deyo said.

When that fails, new guidelines released this year from the American College of Physicians recommend non-drug options like spinal manipulation, massage, acupuncture and yoga before patients try prescription NSAIDs or muscle relaxants. (

“This study incorporates the most recent data and seems to confirm that spinal manipulation is at least as effective as conventional care,” Deyo added. “It is also one of the few systematic reviews to rigorously address safety, and concludes that serious complications are extremely rare.”

SOURCE: JAMA, online April 11, 2017.