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Chiropractic may be okay for short-term relief of acute back pain

Clinical Question:
Is chiropractic treatment effective at reducing pain and disability in patients with low-back pain?

Bottom Line:
Overall, it appears that the quality of studies that compared chiropractic treatment with other interventions is poor, and that if chiropractic treatment is effective, it appears to only decrease short-term pain and disability in patients with acute or subacute back pain. The overall effects are small and not clinically important. (LOE = 1a-)

Reference:
Walker BF, French SD, Grant W, Green S. A Cochrane review of combined chiropractic interventions for low-back pain. Spine 2011;36(3):230-242.  [PMID:21248591]

Study Design:
Systematic review

Funding:
Self-funded or unfunded

Setting:
Outpatient (any)

Synopsis:
In this review for the Cochrane Collaboration, the authors systematically searched several databases for randomized trials of combinations of chiropractic treatments in the care of patients with low-back pain (eg, spinal manipulation, diathermy, massage, nutritional advice, electrotherapy, and so forth). The authors included studies published in any language and also searched for unpublished studies. They excluded studies that only evaluated spinal manipulation as the sole treatment. The main outcomes of interest were pain, disability, function, overall improvement, patient satisfaction, and adverse effects. Two of the authors independently assessed the inclusion of studies and their quality, and they resolved disagreements by discussion, consensus, or (if still unresolved) with a third reviewer. They included 12 studies with 2887 patients, 10 of which used spinal manipulation as part of the chiropractic management. For acute/subacute back pain, only 3 of the studies were considered to be of high enough quality to be at low risk of bias. Short-term pain improvement was greater in the patients receiving chiropractic treatment; the degree of relief, however, was not clinically significant. Four studies, all of poor quality, found that short-term disability was improved with chiropractic care. For chronic back pain, there were no differences in pain relief or disability for the different treatments. Two high-quality studies found no improvement in overall health. Finally, only 4 studies reported on the practice experience of the chiropractors.

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