Chronic low back pain: spinal manipulation comparable to recommended therapies

  • Rubinstein SM & al.
  • BMJ
  • 13 Mar 2019

  • International Clinical Digest
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Takeaway

  • Spinal manipulative therapy (SMT) offered similar short-, intermediate-, and long-term pain relief and better short-term function than guideline-recommended therapies for chronic low back pain in adults.

Why this matters

  • SMT is not recommended as a first-line treatment for chronic low back pain.

Study design

  • Systematic review and meta-analysis evaluated 47 randomized controlled trials, involving 9211 participants, that examined the effect of SMT in middle-aged adults (age, 35-60 years) with chronic low back pain.
  • Funding: None.

Key results

  • Moderate-quality evidence suggested that SMT was similar to other recommended therapies for short-term pain relief at 1 (mean difference [MD], −3.17; 95% CI, −7.85 to 1.51) and 12 (MD, −1.86; 95% CI, −4.79 to 1.07) months.
  • At 6 months, SMT resulted in statistically significant but not clinically better pain relief vs other recommended therapies (MD, −3.09; 95% CI, −5.42 to −0.77).
  • SMT resulted in small but statistically better improvement in functional status at 1 month (standardized mean differences [SMD], −0.25; 95% CI, −0.41 to −0.09).
    • The effect was not maintained at 6 months (SMD, −0.09; 95% CI, −0.21 to 0.03) and 12 (SMD, −0.09; 95% CI, −0.23 to 0.04) months.

Limitations

  • Limited number of included studies.

Coauthored with Antara Ghosh, PhD