Best Spinal Manipulation Result in LBP May Come From 12 Sessions
For chronic low back pain patients, contribution is modest; recommendation made with caution
TUESDAY, June 24, 2014 (HealthDay News) -- For patients with chronic low back pain (cLBP), 12 sessions of spinal manipulation was found to result in modestly improved outcomes compared to light massage, but such improvements may not be clinically significant, according to a study published in the July issue of The Spine Journal.
Mitchell Haas, D.C., from the University of Western States in Portland, Ore., and colleagues randomized 100 patients with cLBP to four dose levels of care: 0, 6, 12, or 18 sessions of spinal manipulation from a chiropractor (three times per week for six weeks). When manipulation was not assigned, patients received a focused light massage control. At 12- and 24-weeks, the 100-point modified Von Korff pain intensity and functional disability scales evaluated.
The researchers found that mean pain and disability improvement in the manipulation groups were 20 points by 12 weeks and sustainable to 52 weeks. There were small linear dose-response effects reaching about two points per six manipulation sessions at 12 and 52 weeks for both end points (P < .025). The greatest differences from the no-manipulation control were found for 12 sessions at 12 weeks (for pain and disability, P < .025), whereas differences were negligible at 24 weeks. The greatest group differences at 52 weeks were seen for 18 visits (pain and disability, P < .025).
"Overall, 12 sessions of spinal manipulation in 6 weeks from a chiropractor yielded the most favorable pain and functional disability improvement for chronic nonspecific LBP," the authors write. "However, the recommendation is made with caution because the gradient of treatment effects across dose groups was too small to clearly distinguish 12 visits from adjacent dose levels."