Chiropractic for low back pain

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.

Systematic review

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 trial.

Findings

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