Spinal manipulation clinically superior to medication or placebo for Relieving Low Back Pain

Key Findings

• “There was a clear difference between the treatment groups: the subjects [receiving] spinal manipulation showed a faster and quantitatively more distinct reduction in the RMS” compared to subjects receiving medication. (RMS is a scale measuring disability or function)
• “Subjects [also] noticed a faster and quantitatively more distinct reduction in [their] subjective estimation of pain after manipulation. … A similar observation was made when comparing the somatic part of the SF-12 inventory … indicating that the subjects experienced better quality of life after the spinal manipulation compared to diclofenac.”
• “The rescue medication was calculated both for the mean cumulative dose (numbers of 500 mg paracetamol tablets) and for the number of days on which rescue medication was taken. … In the diclofenac arm, the patients on average took almost 3 times as many tablets and the number of days [taking the tablets] was almost twice as high” compared to patients in the manipulation group. Though more study is warranted, these result suggest that spinal manipulation is more effective vs. drug therapy (because even if both patient groups had taken the same amount of rescue medication for the same number of days, it wouldn’t discount the fact that patients in the manipulation group showed significant improvement on outcome variables compared to patients in the medication group)

Reference: von Heymann WJ, Schloemer P, Timm J, Muehlbauer B. Spinal high-velocity low-amplitude manipulation in acute nonspecific low back pain: a double-blinded, randomized controlled trial in comparison with diclofenac and placebo. Spine, April 2013;38(7):540-48.