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Manual
Therapy Research
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| Paper
Title |
A RANDOMIZED CLINICAL TRIAL
COMPARING CHIROPRACTIC ADJUSTMENTS TO MUSCLE RELAXANTS FOR SUBACUTE LOW
BACK PAIN |
| Author(s) |
Kathryn
T. Hoiriis, DC, Bruce Pfleger, PhD, Frederic C. McDuffie, MD, George
Cotsonis, MA, Omar Elsangak, MBBCh, DC, Roger Hinson, DC, and Gregoria T.
Verzosa, DC |
| Journal
Reference |
Journal
of Manipulative Physioligcal Therapeutics 2004;27:388-98 |
| Background |
The adult lifetime incidence
for low back pain is 75% to 85% in the United States. Investigating
appropriate care has proven difficult, since, in general, acute pain
subsides spontaneously and chronic pain is resistant to intervention.
Subacute back pain has been rarely studied. |
| Objective |
To compare the relative
efficacy of chiropractic adjustments with muscle relaxants and
placebo/sham for subacute low back pain. |
| Design |
A
randomized, double-blind clinical trial. |
| Methods |
Subjects (N = 192)
experiencing low back pain of 2 to 6 weeks’ duration were randomly
allocated to 3 groups with interventions applied over 2 weeks.
Interventions were either chiropractic adjustments with placebo medicine,
muscle relaxants with sham adjustments, or placebo medicine with sham
adjustments. Visual Analog Scale for Pain, Oswestry Disability
Questionnaire, and Modified Zung Depression Scale were assessed at
baseline, 2 weeks, and 4 weeks. Schober’s flexibility test,
acetaminophen usage, and Global Impression of Severity Scale (GIS), a
physician’s clinical impression used as a secondary outcome, were
assessed at baseline and 2 weeks. |
| Results |
Baseline values, except GIS,
were similar for all groups. When all subjects completing the protocol
were combined (N = 146), the data revealed pain, disability, depression,
and GIS decreased significantly (P < .0001); lumbar flexibility did not
change. Statistical differences across groups were seen for pain, a
primary outcome, (chiropractic group improved more than control group) and
GIS (chiropractic group improved more than other groups). No significant
differences were seen for disability, depression, flexibility, or
acetaminophen usage across groups. |
| Authors' Conclusions |
Chiropractic was more
beneficial than placebo in reducing pain and more beneficial than either
placebo or muscle relaxants in reducing GIS. |
| Clinical
Significance |
Of
the strengths of this study were the consistent description of adjustments
delivered in a drop-piece style procedure. The authors endeavored to
clearly define differences between spinal manipulation performed by
medical doctors or physiotherapists from chiropractic adjustments.
However, this definition of treatment style may or may not hold true to
all chiropractic practices.
Chiropractic was demonstrated to be significantly superior in pain and
severity scores to the muscle relaxant treatment, yet, results must be
considered relative to the very specific approach taken in this study that
may, or may not be truly representative of standard chiropractic approaches
to treatment as they pertain to the training from various chiropractic
colleges and teachings of specific chiropractic name
techniques.
Nonetheless, the positive outcome of this study shines a positive light on
chiropractic management of subacute low back pain relative to a
pharmacological approach. |
| NOTE:
The clinical significance review is the opinion of Dr Ken Mueller based
upon the information available at the time of posting. Unauthorized
use of the section on clinical significance is prohibited by Canadian
Copyright. The above research abstract is based on information
posted on the JMPT
website.
For further information, please refer to the original article utilizing
the publication information provided. January 3, 2005 |
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