Among patients with acute low back pain, spinal manipulation therapy (SMIT) was associated with modest improvements in pain and function at up to 6 weeks, with temporary minor musculoskeletal harms, according to a study published by JAMA.
Back pain is among the most common symptoms prompting patients to seek care. Lifetime prevalence estimates of low back pain exceed 50%. Treatments for acute back pain include analgesics, muscle relaxants, exercises, physical therapy, heat, SMT, and others, with none established as superior to others.
Paul G. Shekelle, MD, West Los Angeles Veterans Affairs Medical Center, Los Angeles, California, and colleagues conducted a review and meta-analysis of previous studies to assess the effectiveness and harms associated with SMIT compared with other non-manipulative therapies for adults with acute (≤6 weeks) low back pain.
Of 26 eligible randomised clinical trials (RCTs) identified, 15 RCTs comprising data from 1,711 patients provided moderate-quality evidence that SMT has a significant association with improvements in pain. Twelve RCTs comprising data on 1,381 patients produced moderate-quality evidence that SMT has a significant association with improvements in function.
No RCT reported any serious adverse event. Minor transient adverse events such as increased pain, muscle stiffness, and headache were reported 50% to 67% of the time in large case series of patients treated with SMT. Heterogeneity in study results was large, and was not explained by type of clinician performing SMT, type of manipulation, study quality, or whether SMT was given alone or as part of a package of therapies.
The authors noted that the size of the benefit of SMT for acute low back pain is about the same as the benefit from nonsteroidal anti-inflammatory drugs.