WEDNESDAY, July 6 (HealthDay News) -- For the millions of
Americans with chronic low back pain, a silver bullet to alleviate
the condition has yet to be identified, a new study suggests.
Reviewing 26 studies comparing spinal manipulative therapy (SMT)
to other treatments such as medication, exercise or physical
therapy, researchers from the Netherlands found that SMT appears to
be no better or worse than other options at relieving back pain
The analyses indicated that SMT -- which involves manual
manipulation of the spine and surrounding muscles -- has only a
short-term impact on pain relief, although it eases pain faster
than other treatments.
"In short, no single therapy is better than another, although some individuals are likely to have more success with one therapy than another," said study author Sidney Rubinstein, a research fellow at VU University Medical Center in Amsterdam.
"Current studies are focusing on which subjects are more likely to benefit from spinal manipulation, exercise, or other therapies," he added. "Spinal manipulation should be considered a viable treatment option for those with non-specific, chronic low back pain."
The study was recently published in the journal
More than 6,000 patients were included in the compilation of
results, which the study authors said were sparse in data
indicating participants' overall recovery, quality of life and
ability to return to work. The studies also varied in quality, with
only nine of 26 considered "low [in] bias," according to background
information accompanying the study.
In all evaluations, patients were randomly assigned to SMT or
another comparison treatment, including active treatments such as
exercise or inactive placebo treatments.
About two-thirds of the studies were not included in a previous
review published in 2004, and all patients had suffered from lower
back pain for 12 weeks or longer.
While chiropractors often perform SMT on patients, it is also
administered by physical therapists and osteopaths. But which
treatment is right for any patient depends not only on their
specific pain, but their doctor's recommendations and their own
comfort level with various options, said Stephen Perle, a spokesman
for the American Chiropractic Association.
The cost of SMT sessions varies widely depending on the region,
"Nobody has the answer at this time," Perle said. "I guess people in almost every profession like to say, 'We have a compelling treatment and it will work almost every time,' but that's just not the case."
"With low back pain, there are many reasons people don't get better," added Perle, also a professor of clinical sciences in the College of Chiropractic at the University of Bridgeport in Connecticut. "So the finding was not unexpected."
An unrelated study of 401 patients with low back pain, published
July 5 in
Annals of Internal Medicine, suggested that massage may be better than medication or exercise for short-term pain relief.
Seattle researchers found that those who received either
relaxation massage or structural massage, which involved
manipulation of muscles and ligaments, had less pain and better
functioning for up to a year compared to those getting "usual
medical care," which included medication and physical therapy.
The U.S. National Institute of Neurological Disorders and Stroke
has more information about
low back pain.