Spinal Manipulation Holds Its Own in the Treatment of Back Pain

If back pain is ailing you, a new review of existing research might be of interest to you. It finds that hands-on spinal manipulation performed by a chiropractor is as helpful as other common treatments, such as painkillers.

The researchers also found that spinal manipulation is safe. Lead author Sidney Rubinstein claims that 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.”

Surveys indicate that half of working Americans suffer from back pain each year. An estimated 25 percent of American adults reported that they endured back pain for at least a day within the last three months, according to a 2006 report from the Centers for Disease Control and Prevention. Lower back pain is also the fifth most common reason people go to the doctor.

Often, patients turn to painkillers, which can pose side effects and be addictive. Alternatively, patients look to physical therapy, which is time-consuming and expensive. This new review looks a third option: spinal manipulation.

The review authors looked for randomized controlled studies, which researchers consider to be the most reliable form of medical research. The investigators reviewed 26 studies with 6,070 participants that met their criteria for inclusion in their review.

The researchers discovered that spinal manipulation was about as effective as other treatments. It appears to work well in particular for certain types of patients, including those with restricted spinal movement, those without psychological issues, and those without symptoms below the knee related to the sciatic nerve.

According to Rubenstein, studies have shown that spinal manipulation helps about two thirds of patients. Still, other researchers claim that the therapy has a modest impact at best. Physician and researcher, Dr. Roger Chou, claims that most treatments for lower-back pain “aren’t all that effective, even the ones we think that work.”

He adds, "Right now the best we can say is that clinicians and patients have a number of moderately effective treatment options to consider, including exercise, 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. In general, I think exercise is a preferred option since it has a lot of other health benefits.


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