Spinal Manipulation for Low Back Pain
June 1, 2017 less than 1 minute read
SOURCE: Paige NM, et al. JAMA 2017;317:1451-1460.
Several interventions for low back pain (LBP) have been demonstrated to improve time to resolution modestly, but no particular treatment has been identified that provides a strong therapeutic advantage over another consistently. Analgesics, anti-inflammatory agents, muscle relaxants, exercise, physical therapy, and spinal manipulation therapy (SMT) each have supportive evidence for the efficacy, but SMT has been the object of contentious arguments.
Paige et al reviewed the efficacy and safety of SMT by including 15 randomized, controlled trials (n = 1,711). They concluded that SMT provides a modest statistically significant improvement in pain: approximately 10 points on a 100-point visual analogue scale. They described the harms of SMT as generally transient and minor. Whether the degree of pain reduction attributed to SMT reported here will satisfy many clinicians is questionable. Previous evidence has indicated that at least a 30% reduction in pain from baseline is what patients recognize as clinically meaningful, and these data only indicate a 10% pain reduction. Additionally, the serious adverse effects that have been noted about high-velocity manual medicine techniques (e.g., arterial dissections and paralysis after cervical spine manipulation) occur with insufficient frequency to be reliably detected within such a limited data set.
Whether the degree of pain reduction attributed to spinal manipulation therapy reported here will satisfy many clinicians is questionable.
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