New JAMA Study Backs Spinal Manipulation

Alert, sufferers of low back pain…and there are a lot of you. New research shows that spinal manipulation therapy may help improve pain and function. The benefits lasted up to six weeks, with temporary minor musculoskeletal issues.

The study, “Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis,” was published in the April 11, 2017 edition of JAMA.

Paul G. Shekelle, M.D., Ph.D., of the West Los Angeles Veterans Affairs Medical Center, Los Angeles, and colleagues conducted a review and meta-analysis of existing studies. They compared spinal manipulation with other non-manipulative therapies for adults with low back pain for six weeks or less.

The authors wrote, “Of 26 eligible randomized clinical trials (RCTs) identified, 15 RCTs (1,711 patients) provided moderate-quality evidence that SMT [spinal manipulative therapy] has a statistically significant association with improvements in pain. Twelve RCTs (1,381 patients) produced moderate-quality evidence that SMT has a statistically significant association with improvements in function. No RCT reported any serious adverse event. Minor transient adverse events such as increased pain, muscle stiffness, and headache were reported 50% to 67% of the time in large case series of patients treated with SMT.”

Dr. Shekelle told OTW, “The Department of Veterans Affairs (VA), for whom I work, commissioned this review. The VA has had integrated chiropractic care for a number of years now, and VA was interested in knowing what was the evidence regarding the use of spinal manipulative therapy for acute low back pain. Spinal manipulative therapy is a manual treatment provided by chiropractors, some physical therapists, some osteopathic physicians, and even some allopathic physicians.”

“I think the main take home message is that on average SMT is associated with improvements in pain and function, but that the size of the improvement is small. This makes it similar to NSAIDs [nonsteroidal anti-inflammatory drugs], muscle relaxants, and other acute back pain therapies in that the effects are on average small. SMT is one of a number of treatments that have real but small effects for acute low back pain. However, it is very likely that some patients respond much better, and some respond not at all, rather than everyone getting exactly the same, average, benefit. This is consistent with how other treatments work.”

“I think most orthopedic surgeons see patients who are usually a little more complex than the typical patient seen in these randomized trials of SMT for acute low back pain. However, if an uncomplicated acute low back pain patient does seek orthopedic surgeon care, then the surgeon can know that SMT is one additional tool he or she has at their disposal to use for symptomatic treatment if home care therapies and advice to stay active are not sufficient.”