Introduction

Manipulation of the spine has been used extensively to treat acute low back pain, with success. However, its role in more chronic low back pain is still unclear. We aren't yet sure of its effect on the evolution of pain and the back's function. A group of American investigators, including specialists in osteopathic medicine, have conducted an elegant study comparing the effects of osteopathic spinal manipulation with those of standard care, to try to clarify the picture.

Methods

The study was performed in 178 patients suffering from low back pain lasting for at least 3 weeks but no longer than 6 months. The purpose was to compare standard, or conventional, treatment with osteopathic therapy. The conventional treatment included the use of anti-inflammatory painkillers and muscle relaxant medicines, active physical therapy, procedures such as ultrasound, diathermy, transcutaneous electrical stimulation, cold or hot packs, and wearing a corset. The osteopathic treatment was provided by trained specialists, and consisted of applications of manipulative techniques (termed variously: thrust, muscle energy, counter-strain, articulation release and myofascial release) to selected body parts.

All the subjects in the study viewed an educational videotape on back pain before being given any treatment. After treatment started, they were seen every week for the first 4 weeks, and then every fortnight up to a total of 3 months. Measurements of effectiveness included evaluation of pain and loss of function due to pain, the frequency of pain, and how bothersome it was. Back mobility (the range of motion) was also measured.

Results

Both treatments considerably improved all the measurements of pain and function, to the extent that 92% of patients in one group and 95% in the other considered that the treatment received had met their expectations. There was no difference between the two methods with respect to the benefits perceived by the patients or measured by the physicians. However, the number of drug prescriptions for pain was lower in the group receiving osteopathic treatment. Specific non-steroidal anti-inflammatory agents (NSAIDs of the COX-2 inhibitor type) were prescribed at 50% of patient visits in the conventional group, but at only 25% of visits in the osteopathy group. Likewise, prescriptions for a muscle relaxant were written at 25% of all visits in the conventional group, compared with only 6% in the osteopathy group. The number of consultations required for osteopathic manipulation was, however, higher than visits for conventional treatment.

Conclusions and Recommendations

The results of this study show that conventional treatment is as effective as osteopathy in the treatment of non-serious low back pain lasting more than 3 weeks but less than 6 months. Manipulation has the advantage of decreasing the number of drug prescriptions, but at the same time it imposes a greater number of consultations. For some, an increased number of consultations are regarded as an additional benefit of care. For others, the use of specific COX-2 inhibitors presents too high a cost, while non-specific NSAIDs can sometimes have more adverse effects. As a patient, you can make your choice.

If you have had a good result previously with either of the two types of treatment, it's not likely that you'll get a better result with the other type. On the other hand, if you think you could do better with the other treatment, why not give it a try (if you can afford it)? The present study suggests you shouldn't expect a big difference with respect to pain and function between the two types of treatment, even though one might appear more satisfactory than the other. As usual, consult your doctor, and get guidance to help you make the best choice, depending on your personal needs or health profile.