Low back pain is a common and disabling disorder. Adequate treatment of low back pain is therefore important for patients, clinicians, and healthcare policymakers. Spinal manipulative therapy (SMT; i.e., hands-on treatment of the spine, including mobilization and manipulation, as in chiropractic) is used widely to treat patients with chronic low back pain; however, its effectiveness is unclear.
Dr Sidney M Rubinstein and colleagues conducted a study to assess the benefits and harms of spinal manipulative therapy (SMT) for the treatment of chronic low back pain.
The data sources for researchers included Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Physiotherapy Evidence Database (PEDro), Index to Chiropractic Literature, and trial registries up to 4 May 2018 and Randomised controlled trials examining the effect of spinal manipulation or mobilisation in adults (≥18 years) with chronic low back pain with or without referred pain were included in the study. But Studies that exclusively examined sciatica were excluded.
In a systematic review and meta-analysis, researchers identified 47 randomized trials in which adults with chronic low back pain were treated with SMT. Duration of pain generally was months or years. Most trials were of moderate-to-high quality; seven sham SMT trials were judged to be of low quality. Compared with recommended treatments (e.g., exercise, nonsteroidal anti-inflammatory drugs), SMT provided similar pain relief at 1, 6, and 12 months and clinically better function at 1 month (but not at 6 or 12 months).
Compared with non recommended treatments (e.g., soft-tissue massage), SMT provided similar pain relief and better clinical function at all time points.
As an adjuvant to any other therapy, SMT did not provide additional pain relief at any time but did improve function at 1 and 12 months.
SMT was not harmful.
The researchers concluded that SMT produces similar effects to recommended therapies for chronic low back pain, whereas SMT seems to be better than non-recommended interventions for improvement in function in the short term. But clinicians should inform their patients of the potential risks of adverse events associated with SMT.
For more details click on the link: https://doi.org/10.1136/bmj.l689
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