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Multiple Sclerosis => THE PRACTICAL SIDE OF BEING MULTIPLY SCLEROSED => Topic started by: agate on March 26, 2019, 04:34:20 pm

Title: Spinal manipulative therapy (chiropractic) for chronic low back pain
Post by: agate on March 26, 2019, 04:34:20 pm

From NEJM Journal Watch (March 26, 2019):


SUMMARY AND COMMENT | GENERAL MEDICINE 
March 26, 2019
Spinal Manipulative Therapy for Chronic Low Back Pain (http://response.jwatch.org/t?r=3963&c=8396&l=2&ctl=5196D:504826E9A16F346EF53D2E91812D4AB2D2B71D9A95FA21D3&?query=etoc_jwgenmed&jwd=000100983645&jspc=)

Paul S. Mueller, MD, MPH, FACP (http://response.jwatch.org/t?r=3963&c=8396&l=2&ctl=5196E:504826E9A16F346EF53D2E91812D4AB2D2B71D9A95FA21D3&) reviewing Rubinstein SM et al.

BMJ 2019 Mar 13 SMT provided similar pain relief and improved function compared with recommended therapies.

Spinal manipulative therapy (SMT; i.e., hands-on treatment of the spine, including mobilization and manipulation, as in chiropractic) is used widely to treat patients with chronic low back pain; however, its effectiveness is unclear. In a systematic review and meta-analysis, researchers identified 47 randomized trials in which adults with chronic low back pain were treated with SMT. Duration of pain generally was months or years. Most trials were of moderate-to-high quality; seven sham SMT trials were judged to be of low quality.

The meta-analysis findings were as follows:

• Compared with recommended treatments (e.g., exercise, nonsteroidal anti-inflammatory drugs), SMT provided similar pain relief at 1, 6, and 12 months and clinically better function at 1 month (but not at 6 or 12 months).

• Compared with nonrecommended treatments (e.g., soft-tissue massage), SMT provided similar pain relief and better clinical function at all time points.

• As an adjuvant to any other therapy, SMT did not provide additional pain relief at any time but did improve function at 1 and 12 months.

• SMT was not harmful.

COMMENT

The findings of this meta-analysis suggest that SMT is helpful to some patients with chronic low back pain — as a standalone treatment or in combination with other therapies. Although this study did not show excess risk for harm, the authors note that hundreds of case reports of harm associated with SMT have been published (e.g., fractures, adverse neurological and vascular events).