Clinical bottom line:
Based on a small, poor quality set of trials, there is no convincing
evidence for long-term benefits of chiropractic interventions for acute or
chronic low back pain. There may be some short-term pain relief, especially
in patients with acute pain.
Better quality evidence is required before the question of
efficacy can be answered adequately.
Chiropractic is one of the manipulative therapies often used
to treat acute and chronic pain. For acute and chronic back pain, chiropractors
often use spinal manipulation techniques, although other trained therapists
also use this technique.
Assendelft WJJ, Koes BW, Van der Heijden GJMG, Bouter LM. The
effectiveness of chiropractic for treatment of low back pain: An update and
attempt at statistical pooling. Journal of Manipulative and Physiological
Therapeutics. 1996; 19(8): 499-507
- Date review completed: June 1995
- Number of trials included: 8
- Number of patients: 1774
- Control group: other treatment or placebo
- Main outcomes: successful treatment, pain rating, functional status
Inclusion criteria were randomised controlled trials of
chiropractic treatment for low back pain; treatment included manipulation or
mobilisation of the spine; follow-up period greater than one day; English
language reports; full journal publication.
Chronic pain was defined as duration greater than three
weeks, and acute pain was defined as pain "d3 weeks.
It was not possible to pool results from trials, so reviewers
carried out a vote-counting review based on the main out come measure for each
Four trials were in chronic pain, three trials reported on
both acute and chronic pain, and one mixed acute and chronic together. Trials
were of poor methodological quality, with different patients, interventions,
outcomes, follow-up periods
Acute pain (approximately 300 patients)
Three of three trials reported short-term benefit from
chiropractic intervention (approximately three weeks). Where longer-term data
were available, these benefits appear to have been lost.
Chronic pain (approximately 1,500 patients)
Six trials had relevant data. One trial reported benefit for
chronic patients, but reviewers were unable to agree with this finding since
there were no statistically significant differences in the original report (6
week outcome). One trial reported some benefit at two but not at four weeks.
Two trials reported no benefit of chiropractic over control.
Of two trials mixing acute and chronic patients, both
reported positive overall findings at >3 weeks.
Adverse effects were not covered in this review.