By Amy Norton
TUESDAY, April 11, 2017 (HealthDay News) – Chiropractors can help relieve some cases of lower back pain, although their treatments may not be better than taking an over-the-counter pain reliever, according to a new analysis.
The review of 26 clinical trials found that spinal manipulation can provide “modest” relief to people with acute lower back pain – pain that has lasted no more than six weeks.
Chiropractors perform spinal manipulations, as do some doctors, physical therapists, and other health professionals. According to the American Chiropractic Association, most insurers, Medicare and Medicaid, pay for some chiropractic services.
But spinal manipulation isn’t a magic bullet, said the researchers behind the new study. The benefits appear to be similar to those of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen.
It seems that no one found a quick fix for back pain.
That didn’t stop the American College of Physicians (ACP) from releasing new guidelines for managing lower back pain earlier this year.
The guidelines recommend non-drug options first – including tactics like heat packs, acupuncture, massage, exercise, and spine manipulation.
While they are recommended, none of these options seem extremely effective. An ACP evidence review found that everyone had “small” to “moderate” benefit.
Instead, time might be the best healer, the researchers said.
“Most acute back pain goes away on its own in a few days to weeks,” said review author Dr. Paul Shekelle, chief physician of general internal medicine, VA Greater Los Angeles Health System.
“Most treatments – whether they’re NSAIDs or muscle relaxants or spinal manipulation therapy – have little effect on average,” Shekelle said.
“Some patients have much greater effects,” he said. “But on average there is no miracle cure for back pain.”
One thing that seems important, Shekelle said, is that people stay active when they have acute back pain. That seems to speed up the recovery process.
Back pain is one of the most common health ailments among Americans. According to the US National Institutes of Health, around 80 percent of the population will be affected at some point. Usually the problem area is the lower back.
In some cases, people experience pain caused by compression of a nerve – for example, a herniated disc. Sciatica, where pain radiates down the leg, is a common example.
According to Shekelle, however, most people have what is known as “unspecific” back pain, for which there is no clear cause.
His team analyzed studies testing spinal manipulation in patients with acute back pain – not sciatica or chronic pain (longer than 12 weeks).
In 26 studies, researchers found that 15 reports of “moderate quality” evidence that manipulating the spine provided patients with mild pain relief over six weeks. In 12 studies, patients saw some improvements in their daily functioning on average.
The therapy appeared to be relatively safe. About half of the patients reported developing minor side effects, such as a headache or a temporary increase in pain or muscle stiffness.
The review was published in the Journal of the American Medical Association on April 11th.
Shekelle said many of the studies in the review compared spinal manipulation with tactics that were not expected to be effective, such as: B. the provision of an educational brochure for patients.
Another problem is that spinal manipulation is often combined with other therapy, including exercise. That makes it harder to know how effective spine manipulation alone was.
“And then of course there are all the things a patient can do about their back pain that are not part of the study,” said Shekelle, “like using heat or massaging home or who knows what else.” “”
The good news is that most people with acute back pain “almost certainly will improve over time,” said Dr. Richard Deyo, professor at Oregon Health and Science University in Portland.
“It is perfectly reasonable for people to self-medicate with things like heat packs,” said Deyo, who wrote an editorial that was published with the study.
For people with more severe pain, choice of therapy often depends on what’s practical and affordable, according to Deyo.
Why does spine manipulation help some people with lower back pain? “We don’t know,” said Deyo, “but there are theories.”
For example, the therapy can relieve muscle tension, reposition disc material, or stimulate large nerves in a way that disrupts pain signals.
“Or maybe,” said Deyo, “it’s partly the practical nature and the ongoing relationship with the vendor.”