Chiropractic Treatment Helps Back-Related Leg Pain
Spinal Manipulation and Home Exercise With Advice for Subacute and Chronic Back-Related Leg Pain: A Trial With Adaptive Allocation
Gert Bronfort, DC, PhD; Maria A. Hondras, DC, MPH;
Craig A. Schulz, DC, MS; Roni L. Evans, DC, PhD;
Cynthia R. Long, PhD; and Richard Grimm, MD, PhD
University of Minnesota,
Northwestern Health Sciences University,
and Berman Center for Outcomes and Clinical Research
at the Minneapolis Medical Research Foundation,
Minneapolis, Minnesota, and
Palmer Center for Chiropractic Research,
|Chiropractic Treatment Helps Back-Related Leg Pain
FROM: MedPage Today ~ September 16, 2014
By Shara Yurkiewicz , Staff Writer, MedPage Today
Patients with back-related leg pain who received spinal manipulative therapy (SMT) plus home exercise and advice (HEA) had less leg pain, lower back pain, and disability after 12 weeks than patients who received home exercise and advice alone, researchers reported.
At 1 year, those differences were no longer significant, wrote Gert Bronfort, DC, PhD, at Northwestern Health Sciences University in Bloomington, Minn., and colleagues in a study appearing in Annals of Internal Medicine. But patients experienced more global improvement, higher satisfaction, and lower medication use, the researchers reported.
The findings suggest that SMT in addition to HEA could be a safe and effective conservative, short-term treatment approach for back-related leg pain, the authors said.
“Prior to this study, SMT was considered a viable treatment option of what is known as ‘uncomplicated low back pain,’ which is low back pain without radiating pain to the leg,” authors Bronfort and Roni Evans, DC, PhD, at the University of Minnesota in Minneapolis, wrote in an email to MedPage Today.
“This study shows that for patients without progressive neurological deficits and serious identifiable causes (e.g., spinal fracture, etc.) SMT, coupled with home exercise and advice, may be helpful, and should be considered,” they added.
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Background: Back-related leg pain (BRLP) is often disabling and costly, and there is a paucity of research to guide its management.
Objective: To determine whether spinal manipulative therapy (SMT) plus home exercise and advice (HEA) compared with HEA alone reduces leg pain in the short and long term in adults with BRLP.
Design: Controlled pragmatic trial with allocation by minimization conducted from 2007 to 2011. (ClinicalTrials.gov: NCT00494065)
Setting: 2 research centers (Minnesota and Iowa).
Patients: Persons aged 21 years or older with BRLP for least 4 weeks.
Intervention: 12 weeks of SMT plus HEA or HEA alone.
Measurements: The primary outcome was patient-rated BRLP at 12 and 52 weeks. Secondary outcomes were self-reported low back pain, disability, global improvement, satisfaction, medication use, and general health status at 12 and 52 weeks. Blinded objective tests were done at 12 weeks.
Results: Of the 192 enrolled patients, 191 (99%) provided follow-up data at 12 weeks and 179 (93%) at 52 weeks. For leg pain, SMT plus HEA had a clinically important advantage over HEA (difference, 10 percentage points [95% CI, 2 to 19]; P = 0.008) at 12 weeks but not at 52 weeks (difference, 7 percentage points [CI, −2 to 15]; P = 0.146). Nearly all secondary outcomes improved more with SMT plus HEA at 12 weeks, but only global improvement, satisfaction, and medication use had sustained improvements at 52 weeks. No serious treatment-related adverse events or deaths occurred.
Limitation: Patients and providers could not be blinded.
Conclusion: For patients with back-related leg pain (BRLP), spinal manipulative therapy (SMT) plus home exercise and advice (HEA) was more effective than HEA alone after 12 weeks, but the benefit was sustained only for some secondary outcomes at 52 weeks.
Primary Funding Source: U.S. Department of Health and Human Services.