Study Sizes Up Back Pain Treatments

Back "Realignments" On Par With Other Treatments

By Sid Kirchheimer, MEDSCAPE Medical News ... Reviewed by Michael Smith, MD

June 2, 2003 -- When it comes to back pain, a chiropractic spinal "realignment" is in line with other back pain treatments offered by medical doctors, while acupuncture seems to have holes in its reported effectiveness and massage may help both your pain and pocketbook.

So conclude researchers from the U.S. and the Netherlands. They reviewed previous studies comparing these and other alternative back pain treatments with traditional therapies such as physical therapy, medications, and exercise. Their findings are published in two studies in the latest issue of Annals of Internal Medicine.

'Patients Get Better -- Regardless of Treatment'

In one, the researchers analyzed 39 studies of 5,000 adults and report the most popular alternative back pain treatment -- spinal manipulation therapy or "realignment" -- is neither no better or worse than standard back pain treatments. In spinal manipulation -- usually done by chiropractors but also by osteopaths or physical therapists -- twisting, pulling, or pushing movements realign joints and bones.

In the second report, the researchers also reviewed studies of other back pain treatments -- acupuncture and massage therapy. They found that available studies on acupuncture are generally poor so they say the effectiveness of acupuncture for short- and long-term back pain is unclear.

However, they found that massage therapy appears to offer some benefit, and may be a cheaper alternative than either spinal manipulation or acupuncture after initial treatment.

"While there are several therapies that are of proven effectiveness in treating back pain, most of the effects are modest," Paul G. Shekelle, MD, PhD, who was involved in both studies, tells WebMD. "What was not directly addressed in our study, but is certainly supported by many other studies, is that most patients get better -- regardless of treatment."

More than half of all Americans have back pain in any given year, and spend some $25 billion a year on medical services to treat it -- often trying a variety of back pain treatments that may include standard as well as alternative choices. Chiropractic care is the most popular alternative back pain treatment.

Chiropractors Knew it All Along

"I'm not too surprised by this finding," says George McClelland, DC, spokesman for the American Chiropractic Association, which represents some 35,000 chiropractors in the U.S.

"While they're saying spinal manipulation is not more effective than other interventions, you have to realize there's been quite a transition in treating back pain in the last 10 to 15 years. A lot of the processes now used by physicians and physical therapists are approaches chiropractors have used for many, many years."

A study three weeks ago in the journal Neurology indicated that spinal manipulation therapy on the neck could trigger a particular kind of stroke. This vertebral artery dissection is among the leading causes of stroke before age 45 and occurs when one of the two arteries that wind through the back of the neck to the brain starts to tear. The lining of the artery bleeds and forms a blood clot, which can easily enter the brain. However, this is a very rare occurrence and is highly unlikely to happen in someone with no blood vessel problems.

"It is not my opinion that patients should avoid chiropractors, since the evidence is that they help some patients," Shekelle says. "But I don't think there should be a policy that indicates spinal manipulation should be a preferred treatment for patients with back pain. It is merely one of several options."

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SOURCES: Annals of Internal Medicine, June 3, 2003. Neurology, May 13, 2002. Paul G. Shekelle, MD, PhD, professor, University of California, Los Angeles, School of Medicine; physician, West Los Angeles Veterans Affairs Medical Center; director, the Southern California Evidence-Based Practice Center/RAND, Santa Monica, CA. George McClelland, DC, chiropractor, Christianburg, Va., spokesman, American Chiropractic Association, Arlington, Va.