Back pain
Here you will find summaries of research studies on the effectiveness of chiropractic for back pain.


Effectiveness and Cost-Effectiveness of Chiropractic vs Medical Treatment of Back Pain
A group of chronic low-back patients who underwent chiropractic treatment showed higher pain relief and satisfaction with the care and lower disability scores than a group that underwent medical care, according to an October 2005 study in the Journal of Manipulative and Physiological Therapeutics (JMPT).

Specifics of the study: The study involved 2780 patients with mechanical low-back pain who referred themselves to 60 doctors of chiropractic and 111 medical doctors in 64 general practice community clinics in Oregon and one in Vancouver, Wa. Chiropractic care included spinal manipulation, physical therapies, an exercise plan, and self-care patient education. Medical care consisted of prescription drugs, an exercise plan, self-care advice, and a referral to a physical therapist (in approximately 25 percent of cases).

The costs of treatment and patients' pain, disability, and satisfaction with their health care were assessed at 3 and 12 months after the initial visit to the doctor. The office costs alone for chiropractic treatment of low-back pain were higher than for medical care. However, when costs of advanced imaging and referral to physical therapists and other providers were added, chiropractic care costs for chronic patients were 16 percent lower than medical care costs. The study did not include over-the-counter drug, hospitalization, or surgical costs.

Both acute and chronic patients showed better outcomes in pain and disability reduction and higher satisfaction with their care after undergoing chiropractic treatment.

J Manipulative Physiol Ther. 2005 Oct;28(8):555-63. Haas M, Sharma R, Stano M.
Click here to read the PubMed abstract and link to the full text.





Low-back Pain: What Is The Long-term Course? A review of studies of general patient populations.
It is often claimed that up to 90% of low back pain (LBP) episodes resolve spontaneously within 1 month. In order to investigate the long-term course of LBP, a comprehensive search of the topic was carried out utilizing Medline, EMBASE, and other databases. Journal articles following the course of LBP without any known intervention were included, as long as the subjects were representative of the general patient population and there was follow-up after at least 12 months. The articles were then independently assessed for quality, leaving thirty-six articles qualified for inclusion.

The results of the review showed that after 12 months, 60% of patients still reported pain or relapses of pain, and 33% had relapses of work absence due to LBP. The average reported presence of LBP in individuals with previous episodes was 56%, which compared with 22% for those without a prior history of LBP. In other words, the occurence of LBP was consistently two-and-a-half times greater for those with a history of LBP. The results of this review show that, despite the variations in methods and the lack of comparable definitions, the overall picture is that LBP does not resolve itself when ignored.

Eur Spine J. 2003 Apr;12(2):149-65.Hestbaek L, Leboeuf-Yde C, Manniche C.
Click here to read the PubMed abstract and link to the full text.



The Course of Untreated Low-Back Pain in a General Population: Results from a 5-year prospective study.
To investigate the course of untreated low back pain (LBP) in the general population of Denmark, 813 people were evaluated with follow-up for 5 years. They could be divided into 3 groups with regard to LBP: no pain, short-term pain, and long-lasting/recurring pain.

-More than one third of people who experienced LBP in the previous year did so for more than 30 days.

-Forty percent of people with LBP for more than 30 days at baseline remained in that group 1 and 5 years later.

-Only 9% with LBP for more than 30 days at baseline were pain-free after 5 years.

-People with LBP at baseline were 4 times more likely to have LBP one year later, and 2 times more likely to be affected five years later.

CONCLUSIONS: Low back pain should not be considered transient and therefore neglected since the condition rarely seems to be self-limiting, but presents with periodic attacks and remissions.

J Manipulative Physiol Ther. 2003 May;26(4):213-9.Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche C.
Click here to read the PubMed abstract and link to the full text.



The RAND study
The RAND corporation, one of the most prestigious centers for research in public policy and health, released a study in 1991 which found that spinal manipulation is appropriate for specific kinds of low back pain. RAND's groundbreaking analysis of spinal manipulation that showed this intervention does benefit many people with acute low-back pain. This study directly influenced the Agency for Healthcare Research and Quality to include positive recommendations on spinal manipulation in its 1994 clinical practice guidelines on low-back pain.

Shekelle PG, Adams A, et al. "The Appropriateness of Spinal Manipulation for Low-Back Pain: Indications and Ratings by a Multidisciplinary Expert Panel." RAND corporation, Santa Monica, California; 1991.

Summary reprinted by permission from the Foundation for Chiropractic Education and Research, Copyright 2003.


Chronic spinal pain - a randomized clinical trial comparing medication, acupuncture, and spinal manipulation.
A randomized, controlled clinical trial published in the journal Spine reveals that chiropractic adjustment (manipulation) is superior to both drugs and acupuncture in the treatment of chronic spinal pain (people with pain lasting more than 13 weeks). The study, conducted at a multidisciplinary spinal pain outpatient unit in an Australian public hospital, involved 115 patients randomly assigned to receive one of three interventions: medication, needle acupuncture or chiropractic manipulation.

The patients were assessed four times: at the initial visit, and two, five and nine weeks after the initial treatment. While a number of patients didn't finish the study, due to noncompliance or treatment changes, the statistical significance of the results was maintained for most outcomes. At the end of the study, the group receiving manipulation experienced the most recovered patients (9) compared with three for the acupuncture group and only two for the medication group. This was significant, considering the nature of chronic spine pain.

One of the study's most remarkable findings was that patients in the manipulation group reported a 47 percent improvement on a general overall health questionnaire, compared to only 15 percent for the acupuncture group and 18 percent for the medication group.

Giles LGF, Muller R.Spine 2003;28:1490-1503.

Click here to read the PubMed abstract and link to the full text


Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes.
OBJECTIVE: To assess and compare the long-term benefits of medication, needle acupuncture, and spinal manipulation as exclusive and standardized treatment regimens in patients with chronic (>13 weeks) spinal pain syndromes.

Patients from the previous short-term study were followed up and assessed again 1 year after the start of the study. The main analysis was restricted to 40 patients who had received exclusively the randomly allocated treatment for the whole observation period since randomization.

RESULTS: Comparisons of initial and extended follow-up questionnaires to assess absolute efficacy showed that only the application of spinal manipulation revealed broad-based long-term benefit: 5 of the 7 main outcome measures showed significant improvements compared with only 1 item in each of the acupuncture and the medication groups.

CONCLUSIONS: In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit.

J Manipulative Physiol Ther. 2005 Jan;28(1):3-11 Muller R, Giles LG.
Click here to read the PubMed abstract and link to the full text


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