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Long-Term Follow-up of a Randomized Clinical Trial Assessing the Efficacy of Medication, Acupuncture, and Spinal Manipulation for Chronic Mechanical Spinal Pain SyndromesJ Manipulative Physiol Ther 2005 (Jan); 28 (1): 3–11
The results of this “fastidious” approach were able to add some information regarding the efficacy of treatment regimens in patients with chronic spinal pain syndromes. Overall, patients who have chronic mechanical spinal pain syndromes and received spinal manipulation gained significant broad-based beneficial short-term and long-term outcomes. For patients receiving acupuncture, consistent improvements were also observed, although without reaching statistical significance (with a single exception). For patients receiving medication, the findings were less favorable. Larger studies are now clearly justified.
Chronic Mechanical Neck Pain in Adults Treated by Manual Therapy: A Systematic Review of Change Scores in Randomized Clinical TrialsJ Manipulative Physiol Ther 2007 (Mar); 30 (3): 215–227
There is moderate- to high-quality evidence that subjects with chronic neck pain not due to whiplash and without arm pain and headaches show clinically important improvements from a course of spinal manipulation or mobilization at 6, 12, and up to 104 weeks post treatment. The current evidence does not support a similar level of benefit from massage.
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- U.S. Government Agency Report. In 1994, the Agency for Health Care Policy and Research published Clinical Practice Guideline 14-Acute Low Back Problems in Adults (Bigos et al. 1994). The guideline defined acute low-back pain, evaluated various treatments, and made recommendations concerning the efficacy of those treatments. According to the Guideline, spinal manipulation is one of the most safe and effective treatments for most cases of acute low-back pain. Regarding the guideline, the following editorial comments appeared in the Annals of Internal Medicine: "The Agency for Health Care Policy and Research (AHCPR) recently made history when it concluded that ... spinal manipulation hastens recovery from acute low back pain and recommended that this therapy be used in combination with or as an alternative to nonsteroidal antiinflammatory drugs... Perhaps most significantly, the guidelines state that... spinal manipulation offers both pain relief and functional improvement" (Micozzi 1998, 65).
- Shekelle et al. (1992): doctors of medicine and doctors of chiropractic from RAND, UCLA Schools of Medicine and Public Health, and other research organizations, conducted a literature review of 25 controlled trials and a meta-analysis of nine studies addressing chiropractic treatment of low-back pain. The literature review was published in the Annals of Internal Medicine and concluded, "spinal manipulation hastens recovery from acute uncomplicated low-back pain" (594).
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- Van Tulder, Koes, and Bouter (1997), researchers in the Netherlands funded by the Dutch Health Insurance Board, retrieved and evaluated evidence from 48 randomized controlled trials conducted worldwide that addressed the treatment of acute and chronic low-back pain. Researchers found "strong evidence" for the effectiveness of spinal manipulation in the treatment of chronic low-back pain.
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- Bronfort (1999) conducted a systematic review of literature concerning the efficacy of chiropractic treatment of low-back pain. The author found evidence "of short-term efficacy for SMT [spinal manipulative therapy] in the treatment of acute LBP [low-back pain]" (107). Additionally, the author found a combination of spinal manipulation and mobilization to be effective for chronic low-back pain "compared with placebo and commonly used therapies such as general medical practitioner management" (98).
- In a study reported in 1992, Anderson et al. conducted a meta-analysis of twenty-three randomized controlled clinical trials of the effectiveness of spinal manipulation in the treatment of back pain. The researchers stated, "the trend for spinal manipulation to produce better results than any form of treatment to which it was compared was consistent and strong" (193). For 86% of the outcomes, spinal manipulation was more effective than any other treatment.
- In a study conducted for the Ontario Ministry of Health, Manga et al. (1993) reported that spinal manipulation is the most effective treatment for low-back pain and that spinal manipulation is "safer than medical management of low-back pain" (11).
- Following a 1993 study, researchers Cassidy, Thiel, and Kirkaldy-Willis of the Back Pain Clinic at the Royal University Hospital in Saskatchewan concluded that "the treatment of lumbar intervertebral disk herniation by side posture manipulation is both safe and effective" (102).
- A study conducted by T.W. Meade, a medical doctor, and reported in the British Medical Journal concluded, after two years of patient monitoring, that "for patients with low-back pain in whom manipulation is not contraindicated, chiropractic almost certainly confers worthwhile, long-term benefit in comparison with hospital outpatient management" (Meade 1990, 1431).
- Chiropractors and Low Back Pain
The Lancet, July 28, 1990, p. 220
The editors of THE LANCET review the June 2nd 1990 British Medical Journal article by Meade: Low back pain of mechanical origin: randomized comparison of chiropractic and hospital outpatient treatment. The study used 741 patients. They note:
The article “showed a strong and clear advantage for patients with chiropractic.” The advantage for chiropractic over conventional hospital treatment was “not a trivial amount” and “reflects the difference between having mild pain, the ability to lift heavy weights without extra pain, and the ability to sit for more than one hour, compared with moderate pain, the ability to lift heavy eights only if they are conveniently positioned, and being unable to sit for more than 30 minutes.”
“This highly significant difference occurred not only at 6 weeks, but also for 1, 2, and even (in 113 patients followed so far) 3 years after treatment.”
“Surprisingly, the difference was seen most strongly in patients with chronic symptoms.”
“The trial was not simply a trial of manipulation but of management” as 84% of the hospital-managed patients had manipulations.
“Chiropractic treatment should be taken seriously by conventional medicine, which means both doctors and physiotherapists.”
“Physiotherapists need to shake off years of prejudice and take on board the skills that the chiropractors have developed so successfully.”
- A 1988 study of 10,652 Florida workers' compensation cases was conducted by Wolk and reported by the Foundation for Chiropractic Education and Research. According to Wolk, back injury patients treated by chiropractors versus medical doctors or osteopaths were less likely to develop compensable injuries (injuries resulting in time lost from work and therefore requiring compensation) and less likely to require hospitalization. The author explained that chiropractors are more effective in treating low-back injuries because "chiropractic treatment, in providing more services to the patient at the outset of injury, may produce more immediate therapeutic results and may reduce the amount of time lost from work" (56).
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- Hurwitz et al. (1996), a doctor of medicine and doctors of chiropractic from RAND and several academic institutions, conducted a review of literature on treatments for neck pain. The authors found manipulation to be more effective than mobilization or physical therapy in treating some subacute or chronic neck pain and noted that "all 3 treatments are probably superior to usual medical care" (1755).
- Doctors of medicine and other professionals from the Netherlands conducted two randomized clinical trials comparing the outcomes of various treatments of chronic back and neck complaints. Spinal manipulative therapy was compared to physiotherapy, treatment by a general practitioner, and a placebo. The authors found faster and greater improvement in the spinal manipulation groups (Koes et al. 1992; Koes et al. 1992a).
- Several studies (Howe, Newcombe, and Wade 1983; Verhoef, Page, & Waddell 1997) have found spinal manipulation to improve neck mobility and decrease neck pain. As Verhoef, Page, and Waddell (1997) concluded, "patients suffering from back and/or neck complaints experience chiropractic care as an effective means of resolving or ameliorating pain and functional impairments" (240).
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