Chiropractic for Chronic Spinal Pain

In 2003, a randomized clinical trial published in the research journal Spine demonstrated that chiropractic manipulation is superior to needle acupuncture and "medication."^1,2 The results of a follow-up study were recently released in the Journal of Manipulative and Physiological Therapeutics (JMPT), generating data on patient improvement over one year after care was initially provided.³

The Original Study

The 2003 study¹ examined care for chronic patients with more than 13 weeks of spinal pain. After randomization, the chiropractic manipulation group was found to be the most chronic - the "average duration of spinal pain symptoms was 8.3 years for the spinal manipulation group, 6.4 years for the medication group, and 4.5 years for the acupuncture group."

In that study, the investigators utilized a number of evaluation instruments to measure patient status: the Oswestry Back Pain Disability Index (Oswestry), the Neck Disability Index (NDI), the Short-Form-36 Health Survey questionnaire (SF-36), and visual analog scales (VAS) of pain intensity and ranges of movement. These instruments were administered to the study participants before care began and again at two, five and nine weeks after the onset of treatment.

Initially, the patients were randomly divided into three groups: acupuncture, chiropractic manipulation, and medication. Those in the acupuncture and chiropractic manipulation groups were given "two treatments per week."

The medication group was given one of three drugs, based upon what other drugs they may have already tried. Patients in the medication group were given Celebrex (200-400 mg/day), unless it had previously been tried. The next drug of choice was Vioxx (12.5-25 mg/day), followed by paracetamol (up to 4 g/day).

The results of the 2003 study found that the "highest proportion of early (asymptomatic status) recovery was found for manipulation (27.3%), followed by acupuncture (9.4%) and medication (5%)." The chiropractic manipulation group achieved the best overall results.

The original study demonstrated very clearly that chiropractic manipulation was superior to both acupuncture and medication in all of the above areas, with the one exception being the VAS neck score. And according to the investigators, medication "apparently did not achieve a marked improvement in chronic spinal pain and caused adverse reactions in 6.1% of the patients."

The Follow-Up Study

The follow-up study³ reapplied the same measurement instruments to the patients after more than a year. The results of this follow-up study demonstrated that: "Comparisons of initial and extended follow-up questionnaires to assess absolute efficacy showed that only the application of spinal manipulation revealed broad-based, long-term benefit." (emphasis ours)

And while there were observed improvements in each group, statistical testing "revealed that only in the manipulation group, 5 of the 7 observed improvements were statistically significant, which compares with only 1 item in each of the acupuncture and the medication groups, respectively." The medication group again "did not achieve an improvement in chronic spinal pain."

The investigators made additional comments that emphasize the strength of their findings:

"It seems noteworthy that the comparison of the percentages of those who had to change the treatment modality (because of side effects or unsatisfactory results) also appears to favor manipulation, in that manipulation showed by far the lowest proportion (38.7%) of changeovers compared with acupuncture (53.3%) and medication (81.2%). Consequently, spinal manipulation appeared to provide the highest satisfaction.

"Overall, patients who have chronic mechanical spinal pain syndromes and received spinal manipulation gained significant broad-based beneficial short-term and long-term outcomes. In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit."

References

1. Giles LGF, Muller R. Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine 2003;28:1490-1503.
2. Chiropractic best for chronic spine pain: new research shows manipulation superior to acupuncture, drugs. Dynamic Chiropractic, Sept. 1, 2003: www.chiroweb.com/archives/21/18/18.html.
3. Muller R, Giles LGF. Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes. J Manipulative Physiol Ther 2005;28:3-11.