Research Supports Spinal Manipulation Therapy for Back Pain

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In chronic low back pain patients, spinal manipulation therapy (SMT) can be equally effective at relieving pain and better at providing short-term function improvement compared to recommended treatments, according to recent research.

While SMT is widely used to treat low back pain, disagreement over its effectiveness still exists. In a review study published in the British Medical Journal, researchers compared pain relief achieved by SMT to recommended therapies (such as exercise and pain relievers), non-recommended therapies (such as light-tissue massage), sham SMT, and SMT as an adjuvant therapy. They defined SMT as any hands-on treatment of the spine, including mobilization and manipulation.

To assess SMT effectiveness, investigators analyzed 47 international randomized controlled trials that included 9,211 participants who were mostly middle-aged (ages 35-60). Pain assessments, recorded on a 100-point scale, were evaluated at 1, 3, 6, and 12 months.

Researchers divided study evidence into two categories. Moderate-quality evidence suggested SMT had similar effects to recommended therapies for short-term pain relief and small, clinically-better function improvement. High-quality evidence indicated SMT, compared to non-recommended SMT, had small, not clinically-better short-term pain relief and small-to-moderate clinically-better function improvement.

According to results, moderate-quality evidence indicated SMT provided more statistically-significant pain relief than recommended therapies at six months, but the difference wasn’t clinically relevant. Compared to non-recommended interventions, high- and moderate-quality data showed while SMT relieved pain in a small, statistically-significant way at one, six and 12 months, the improvement wasn’t clinically better. However, SMT did achieve small-to-moderate statistically- and clinically-significant back pain improvement during the same time period.

Additionally, evidence showed no statistically-significant SMT pain improvement over sham SMT. However, very-low to low-quality evidence indicated SMT resulted in moderate-to-strong statistical and clinical back function improvement. As an adjuvant therapy, results suggested SMT provided small, statistically-significant-but not clinically better-pain improvement and created small statistically- and clinically-better functional improvements.

Data analysis showed no increased risk of adverse events, but clinicians should still play a role in whether and how their patients use SMT, investigators said.

“To prevent inappropriate behavior and to empower patients to take control of their condition, it is vital that practitioners impart the proper message to their patients,” wrote Rubinstein S, de Zoete A, et al., BMJ.

REFERENCE

Rubinstein S, de Zoete A, van Middelkoop M, Assendelft W, de Boer MR, van Turner MW, Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomized controlled trials. British Medical Journal (2019), doi: 10.1136/BMI.1689.