Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain

JAMA Endorses Spinal Manipulation

For the second time in as many months, a prominent medical journal has endorsed spinal manipulation for the management of low back pain. [1]   On April 11th 2017, JAMA published a systematic review of 26 randomized clinical trials in order to evaluate the safety and effectiveness of spinal manipulation for low back pain.

The authors concluded:

“Among patients with acute low back pain, spinal manipulative therapy was associated with improvements in pain and function with only transient minor musculoskeletal harms.”

This study comes on the heels of a February 2017 Clinical Practice Guideline from the American College of Physicians recommending spinal manipulation for acute, sub-acute, and chronic low back pain (LBP). [2]

These high-quality studies in respected medical journals add to a growing list of scientific support for spinal manipulation therapy (SMT). So why are our offices not flooded with medical referrals? An editorial accompanying the JAMA study provides perspective as to why some medical providers may be reluctant to refer to chiropractic physicians:

“Spinal manipulative therapy (SMT) is a controversial treatment option for low back pain, perhaps in part because it is most frequently administered by chiropractors. Chiropractic therapy is not widely accepted by some traditional health care practitioners. This may be, at least in part, because some early practitioners of chiropractic care rejected the germ theory, immunizations, and other scientific advances.

However, chiropractic care is popular today with the US public. According to a 2012 report, among patients with back or neck pain, approximately 30% sought care from a chiropractor. In a 2013 survey by Consumer Reports magazine involving 14,000 subscribers with low back pain, chiropractic care had the largest proportion of “highly satisfied” patients. Among approximately 4000 respondents who had seen a chiropractor, 59% were highly satisfied compared with 55% who saw a physical therapist and 34% who saw a primary care physician.

“Serious complications (related to SMT) are extremely rare… if spinal manipulation is at least as effective and as safe as conventional care, it may be an appropriate choice for patients with uncomplicated low back pain”. [3]

The emerging health care model dictates that all providers embrace proven clinically effective treatments, regardless of long-standing philosophical bias.   If we expect medical providers to advance their thinking to accept validated chiropractic therapies, we must first be willing to reciprocate. By working together to provide evidence-based patient-centric care, we can advance our profession to become the undeniable first choice for both patients and providers.

References:

1. Paige NM, Miake-Lye IM, Booth MS, et al.
   Association of Spinal Manipulative Therapy With Clinical Benefit and Harm
   for Acute Low Back Pain; Systematic Review and Meta-analysis
   JAMA. 2017 (Apr 11);   317 (14):   1451–1460

2. Qaseem A, Wilt TJ, McLean RM, Forciea MA, for the Clinical Guidelines Committee
   of the American College of Physicians.
   Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain:
   A Clinical Practice Guideline From the American College of Physicians
   Ann Intern Med. 2017 (Apr 4);   166 (7):   514–530

3. Deyo RA.
   The Role of Spinal Manipulation in the Treatment of Low Back Pain
   JAMA. 2017 (Apr 11);   317 (14):   1418-1419