Back pain? Chiropractic, exercise, pain killers, physical therapy – take your pick. A comparative study has found that all these therapies, conventional or alternative, have more or less the same effectiveness.
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According to lead investigator Dr Paul Shekelle, of RAND in Santa Monica, California, spinal manipulation, the back pain treatment used by chiropractors, is no better or worse than conventional methods when it comes to the treatment of lower back pain.
These findings come from two new studies published in the journal Annals of Internal Medicine.
Shekelle’s team found that no one therapy stood out as being “the best”, but that all methods seemed to be relatively safe. The researchers also found that massage seems to be effective for persistent back pain. But the verdict is still out on acupuncture.
What to do if you have back pain
What are the options available to those who are plagued by back pain? According to Shekelle, most back pain will get better on its own without treatment. In very rare cases, back pain has been known to permanently disable people, but recurrences are common.
There is no magic cure to treat or prevent back pain. The best thing that you can do is to stay active, says Shekelle. Furthermore, all advocated therapies (including exercise and spinal manipulation) are about the same when it comes to efficacy, but some work better on different individuals. Shekelle’s advice: find the one that works best for you.
Comparing conventional and alternative treatments
Not a lot of scientific research has been conducted with regards to how alternative forms of back relief like chiropractic, acupuncture and massage, stand up to conventional methods.
The researchers combined the results of previous studies that had compared the effectiveness of acupuncture, spinal manipulation and massage therapy to mainstream treatments such as medications, exercise, physical therapy and educational material about prevention and pain management.
Evaluating spinal manipulation
First of all, Shekelle’s team evaluated 39 previous studies on spinal manipulation. Spinal manipulative therapy was defined by the research team as any treatment wherein the practitioner used force through his hands to move the vertebrae in order to relieve pain and improve function. Practitioner’s that often perform this treatment include specially trained individuals such as osteopathic physicians, chiropractors or physical therapists.
Shekelle’s team looked at both spinal manipulation – a forceful treatment that produces the “popping” sounds usually associated with chiropractic and spinal mobilisation – a more gentle treatment. The researchers did not try and distinguish between the two treatments as many of the past studies that they looked at did not make it clear which type of therapy was being administered on the patients.
Spinal manipulation is not the best treatment
“There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain," the researchers write.
In the past, there have been studies that found spinal manipulation to be better than placebos, bed rest, the use of a corset or to a collection of therapies loosely labelled “medical therapy”. Advocates of spinal manipulation then used these studies as “proof” that their therapy was the number choice for patients with back pain.
Shekelle’s study demonstrated that, on average, spinal manipulation was no better than other recommended care, like physical therapy, analgesics or exercise.
Massage is the most cost effective
In their second study, Shekelle’s team looked at and combined the results of studies that had assessed the effectiveness, safety and cost effectiveness of acupuncture, massage therapy and spinal manipulation.
They came to the conclusion that spinal manipulation was no better or worse than traditional treatments. They also found the effectiveness of acupuncture to be unclear and that massage therapy did seem to be effective for the treatment of persistent back pain.
The authors write that massage was the most cost effective of all three alternative therapies as it “may reduce the costs of care after an initial course of therapy." – (Health24)
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