Spinal manipulation ineffective for low back pain

Going to a chiropractor for spinal manipulation or taking the non-steroidal anti-inflammatory drug diclofenac probably won’t speed recovery from acute low back pain, a study shows.

Following your doctor’s advice on managing the pain and taking acetaminophen is probably the best way to deal with acute low back pain, the study suggests. 

"These results are important because both diclofenac and spinal manipulative therapy have potential risks and additional costs for patients,” the researchers point out in Saturday’s issue of The Lancet.

The new study involved 240 patients who had seen their regular doctor and were given advice for managing their back pain and paracetamol (acetaminophen). The subjects were randomly assigned to receive diclofenac (50 mg twice daily), spinal manipulation, both therapies, or placebo.

Active therapy alone or in combination did not hastened recovery, lead author Dr. Mark J. Hancock, from the University of Sydney in Australia, and colleagues report.

Possible adverse reactions, including dizziness, heart palpitations, and gastrointestinal disturbances, were seen in 22 patients. Half of these subjects had been given diclofenac and half had not. One case of suspected allergic reaction was noted in a diclofenac user.

In a related editorial, Dr. Bart W. Koes, from Erasmus University Medical Centre in the Netherlands questions if the study findings can be generalized because the spinal manipulation used primarily involved low-velocity, not high-velocity, techniques.

However, Koes also notes that there is no convincing evidence from randomized trials or systematic reviews that outcomes would have been any better if high-velocity techniques had been used instead.

“The important message is that the management of acute low back pain in primary care (advice and prescription of paracetamol) is sufficient for most patients,” he states.

SOURCE: The Lancet, November 10, 2007. 

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