Spinal manipulation is also safe, researchers found. Ultimately, “the decision to refer for manipulation should be based upon costs, preferences of the patient and providers, and relative safety of all treatment options,” said review lead author Sidney Rubinstein, a chiropractor in private practice and a postdoctoral researcher at the VU University Medical Center in Amsterdam.
The findings appear in the latest issue of The Cochrane Library. The journal is a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
Lower-Back Pain Statistics
Surveys suggest that half of working Americans suffer from back pain each year. In fact, according to the American Chiropractic Association, more than 31 million Americans experience low-back pain at any given time and Eight to ninety percent of all adults will suffer from low back pain at some point in their life. An estimated 25% of American adults reported that they suffered from back pain for at least a day within the last three months, according to a 2006 Centers for Disease Control and Prevention report, and lower back pain is the second most common reason for visits to the doctor's office, outnumbered only by upper-respiratory infections. Low back pain is also the leading cause of disability in people under forty five years of age. The annual cost of back pain in the United States range from $20-$75 billion, and as much as $100 billion worldwide.
Lower-Back Pain Causes
The back is a complicated structure of bones, joints, ligaments and muscles. You can sprain ligaments, strain muscles, rupture disks, and irritate joints, all of which can lead to lower-back pain. While sports injuries or accidents can cause lower-back pain, sometimes the simplest of movements-for example, picking up a book from the floor- can have painful results and cause lower-back pain. In addition, arthritis, poor posture, obesity, and psychological stress can cause or complicate lower-back pain. Lower-back pain can also directly result from disease.
Lower-Back Pain Treatments
Patients suffering from chronic low back pain frequently turn to anti-inflammatory drugs, also known as NSAIDs and painkillers. NSAIDs can irritate or damage the stomach, while pain killers can also cause side effects and be addictive. Other chronic lower-back pain treatment options include physical therapy, which is time-consuming and expensive and chiropractic spinal manipulation.
Spinal manipulation, used primarily by Doctors of Chiropractic (DCs) for the last century, has been largely ignored by most others in the health care community until recently. Now, with today's growing emphasis on treatment and cost effectiveness, spinal manipulation is receiving more widespread attention. The new review looks at spinal manipulation effectiveness compared to other common lower-back pain treatments.
In North America, Rubinstein said, chiropractors perform most spinal manipulation. Practitioners move their hands around a patient’s spine and joints, often producing an audible crack.
Spinal Manipulation Controversial
“The effectiveness of this spinal manipulation therapy has long been controversial,” said Rubinstein. “Some spinal manipulation proponents are slowly starting to view spinal manipulation as effective for chronic low-back pain. The results of this review will support that view.”
Spinal Manipulation an Effective Treatment Option for Low-back Pain
The reviewers looked for randomized controlled studies, which researchers consider as the most reliable forms of medical research. The researchers found 26 studies − with 6,070 participants − that met their criteria for inclusion in their review, but deemed only nine studies to be of high quality.
The researchers found that spinal manipulation worked about as well as the other chronic low-back pain treatments. Spinal manipulation appears to work well in particular for certain kinds of patients with chronic low-back pain, Rubinstein said, including those with restricted movement in the back, those without psychological issues, and those without symptoms below the knee related to the sciatic nerve.
Spinal manipulation “appears to be no better or worse than other existing therapies for patients with chronic low-back pain,” the review says.
There is one small caveat, however. In medical research, scientists often compare a treatment to a placebo. This is difficult when you are talking about something that's difficult to fake − like spinal manipulation.
Three of the studies reviewed the kind of spinal manipulation that produces a crack sound and tried to fool some patients into not realizing they were getting a placebo treatment for their low-back pain. However, it is unclear if they succeeded, said Rubinstein. One study appeared to show that patients with low-back pain receiving treatment could distinguish whether they were getting a placebo treatment or the real spinal manipulation, which could make the study results flawed.
So how well do the chronic low-back pain treatments examined in the review − work overall? Rubinstein said studies have shown that the treatments help about 66% of patients. Other researchers say they have a modest impact at best.
A Variety of Treatment Options for Lower-Back Pain Exist
“Right now the best we can say is that clinicians and patients have a number of moderately effective treatment options for lower-back pain to consider, including exercise, spinal manipulation, acupuncture, yoga, massage, cognitive behavioral therapy and some of the analgesic medications, and that it should be a decision between the clinician and patient,” Chou said. “In general, I think exercise is a preferred option since it has a lot of other health benefits.”
Spinal Manipulation Recommended as the Safest Treatment for Lower-back Pain
Chiropractic spinal manipulation is a safe and effective spine pain treatment. It reduces pain, decreases medication, rapidly advances physical therapy, and requires very few passive forms of treatment, such as bed rest. In fact, after an extensive study of all currently available care for low back problems, the Agency for Health Care Policy and Research-a federal government research organization-recommended that low back pain sufferers choose the most conservative care first. And it recommended spinal manipulation as the only safe and effective, drugless form of initial professional treatment for acute low back problems in adults.
Rubinstein SM, et al. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2.
Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No.14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services, December, 1994.