Spinal manipulative therapy for low back pain.

Area of Science:

• Orthopedics
• Pain Management
• Evidence-Based Medicine

Background:

• Low-back pain represents a significant health burden and economic cost.
• Spinal manipulative therapy (SMT) is a frequently recommended treatment for low-back pain.
• Previous systematic reviews have yielded conflicting conclusions regarding SMT's effectiveness.

Purpose of the Study:

• To reconcile discrepancies in existing research on SMT for low-back pain.
• To provide updated effectiveness estimates by comparing SMT with other therapies.
• To incorporate recent high-quality randomized controlled trials (RCTs) into the analysis.

Main Methods:

• Conducted a comprehensive electronic search of major databases (Cochrane, MEDLINE, EMBASE, CINAHL) up to January 2000.
• Included RCTs evaluating SMT for low-back pain with at least one day of follow-up and clinically relevant outcomes.
• Data extraction and meta-analysis were performed independently by two reviewers, comparing SMT against seven categories of interventions.

Main Results:

• Thirty-nine RCTs were analyzed, with meta-regression models for acute/chronic and short/long-term outcomes.
• For acute low-back pain, SMT showed superiority only over sham therapy or ineffective treatments.
• SMT demonstrated no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school for acute or chronic pain.

Conclusions:

• Current evidence does not support the superiority of spinal manipulative therapy over other standard treatments for low-back pain.
• The effectiveness of SMT is comparable to conventional care, including analgesics and physical therapy.
• No specific factors like pain radiation, study quality, or manipulator's profession altered these findings.