By Lisa Rapaport

(Reuters Health) – – Spinal manipulation therapy isn’t routinely recommended as the initial treatment for low back pain, but a research review suggests this approach may work as well as interventions that doctors typically prescribe first.

Based on data from 47 previously conducted trials involving a total of 9,211 mostly middle-aged adults, spinal manipulation eased lower back pain as much as exercise, non-steroidal anti-inflammatory drugs (NSAID) and painkillers. Spinal manipulation also appeared better for improving short-term function.

“At the moment, spinal manipulation is considered a second-line or adjunctive treatment option in international guidelines,” said lead study author Sidney Rubinstein of the Vrije Universiteit in Amsterdam.

“These results would suggest that spinal manipulation is certainly on-par with these other recommended therapies, and can be considered an option,” Rubinstein said by email.

Lower-back pain is one of the leading causes of disability and doctor visits for adults worldwide. It often goes away within a few weeks. But when it persists, lower-back pain might be treated with spinal manipulation, medications like painkillers or muscle relaxers, heat, exercise or physical therapy.

Spinal manipulation is often done by chiropractors but may also be offered by physical therapists or physicians. It can include manually moving joints, massage and exercise. This type of treatment is designed to relieve pressure on joints and curb inflammation and it’s often used for back, neck or shoulder pain as well as for headaches.

For the current study, researchers focused on the gold standard for determining the effectiveness and safety of medical treatments: randomized controlled trials that compare outcomes for patients who are randomly assigned to a specific treatment or to a dummy treatment or no treatment at all.

Spinal manipulation worked better for pain relief than non-recommended interventions like light tissue massage, the current analysis found.

It also worked better than sham manipulation treatments, but the evidence was low-quality, Rubinstein’s team notes in The BMJ.

About half of the studies looked at side effects of spinal manipulation and found little evidence to conclude whether or not this is safer than other approaches. In one study, researchers found one serious adverse event that could potentially have been associated with spinal manipulation.

One limitation of the analysis is that the studies of spinal manipulation were done in different settings, tested different techniques and measured the effectiveness of this intervention in different ways, the study authors note.

“Spinal manipulation may decrease pain from muscle strain, inflammation and spasm in your back muscles and/or impact the way that your body perceives pain through either the brain or the spinal cord,” said Christine Goertz, chief executive officer of the Spine Institute for Quality in Oskaloosa, Iowa.

“The most common side effects resulting from spinal manipulation are mild to moderate joint or muscle pain and/or stiffness,” Goertz, who wasn’t involved in the study, said by email. “These symptoms generally go away on their own within a day or two.”

SOURCE: https://bit.ly/2I7Y1as The BMJ, online March 13, 2019.