Adding Chiropractic Care to Usual Care for Treating Acute Low Back Pain

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Chiropractic care consisted of spinal manipulative therapy, rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies.
Chiropractic care consisted of spinal manipulative therapy, rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies.

A combination of usual medical care and chiropractic care may be more effective than usual care alone in treating acute low back pain and associated disability in active duty military personnel, according to a study published in JAMA Network Open.

The clinical trial (ClinicalTrials.gov identifier: NCT01692275) took place during a 6-week period and included 750 active duty US service members (mean age, 30.9 years) with low back pain.

The control group (n=375) received usual medical care (ie, medication, physical therapy and pain clinic referral), and the intervention group (n=375) also received chiropractic care (ie, spinal manipulative therapy, rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies). Patients were recruited and assessed at 3 locations: 2 large military medical centers and 1 smaller hospital at a military training site.

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Adjusted means differences between groups overall were found to be consistently in favor of the intervention group at all 3 sites at week 6 for both primary outcomes: low back pain intensity (mean difference, −1.1; 95% CI, −1.4 to −0.7) and disability (mean difference, −2.2; 95% CI, −3.1 to −1.2). Follow-up analysis at week 12 revealed similar results, but with a slightly smaller magnitude of difference (low back pain intensity: −0.9 [95% CI, −1.2 to −0.5]; disability: −2.0 [95% CI, −3.0 to −1.0]).

Three secondary outcomes were assessed: perceived global improvement, satisfaction with care, and medication use. Patients in the intervention group reported greater perceived improvement (overall odds ratio, 0.18; 95%CI, 0.13-0.25) and satisfaction (mean difference, 2.5; 95% CI, 2.1-2.8), as well as lower pain medication use (odds ratio, 0.73; 95% CI, 0.54-0.97) at week 6 across all sites. No serious related adverse events were reported.

Several limitations to the study were noted, including patient heterogeneity resulting from an inability to determine specific diagnosis for low back pain of musculoskeletal origin.

"This trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines," concluded the study authors.

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Reference

Goertz C, Long C, Vining R, Pohlman K, Walters J, Coulter I. Effect of usual medical care plus chiropractic care vs usual medical care alone on pain and disability among US service members with low back pain [published online May 18, 2018]. JAMA Network Open. doi: 10.1001/jamanetworkopen.2018.0105

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