The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—A pragmatic randomized controlled trial

Andreas Eklund ,Irene Jensen,Malin Lohela-Karlsson, Jan Hagberg, Charlotte Leboeuf-Yde, Alice Kongsted, Lennart Bodin, Iben Axén: Published: September 12, 2018; https://doi.org/10.1371/journal.pone.0203029

Abstract

The Evolving Evidence on Chiropractors for Low Back Pain

New research suggests spinal adjustments may help.

The majority of people experience low back pain at some point during their lives—and it can be a miserable experience. Research shows that low back pain is the most common cause of missed work days.

To provide relief, doctors have typically prescribed oral medications. In some cases, surgery can repair back problems. But the traditional medical establishment has long frowned upon chiropractic care for lower back pain—until now.

Last month, the American College of Physicians issued a formal recommendation that doctors include spinal manipulation in the tools they use to treat back pain. The change comes after two new systematic reviews found a visit to the chiropractor can provide improvements for people with low back pain.  Let’s take a closer look at the evidence.

As recently as 2012, a systematic review by the Cochrane Collaborationanalyzed 20 randomized-controlled trials and found that spinal manipulations were no more effective than other intervention for back pain and no more effective than “sham” or fake spinal manipulations, where a medical provider pretended to adjust the spine. The authors did note that spinal manipulations were safe, and that the evidence in the review was of “low to very low quality.”

This year, a new review published in the Journal of the American Medical Association found the opposite—that spinal adjustments helped improve pain and function for people with low back pain. The authors evaluated a total of 26 randomized-controlled trials conducted since the previous Cochrane Collaboration review. Of them, 15 studies including more than 1,700 patients found evidence that spinal manipulation improved low back pain by about 10 points on a 100-point scale. Separately, 12 randomized-controlled trials including nearly 1,400 patients found that spinal manipulation improved the function of people with low back pain.

A second systematic review published this year in the Annals of Internal Medicine evaluated a wide range of alternative treatments for back pain, including tai chi, exercise, acupuncture, massage and spinal manipulation. The analysis found some evidence that spinal manipulation helps to reduce pain for people with chronic low back pain.

On the whole, the evidence suggests that seeing a chiropractor can reduce pain levels and increase function for people with chronic low back pain. There is another take-home message here too: The evidence on medical treatments—whether traditional or not—is constantly evolving as researchers better understand how to design studies and evaluate data. 

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