Chiropractic Manipulation in the Treatment of Acute Back Pain and Sciatica With Disc Protrusion: A Randomized Double-Blind Clinical Trial of Active and Simulated Spinal Manipulations

Spine J. Mar-Apr 2006;6(2):131-7. doi: 10.1016/j.spinee.2005.08.001. Epub 2006 Feb 3.

Abstract

Background context: Acute back pain and sciatica are major sources of disability. Many medical interventions are available, including manipulations, with conflicting results.

Purpose: To assess the short- and long-term effects of spinal manipulations on acute back pain and sciatica with disc protrusion.

Study design/setting: Randomized double-blind trial comparing active and simulated manipulations in rehabilitation medical centers in Rome and suburbs.

Patient sample: 102 ambulatory patients with at least moderate pain on a visual analog scale for local pain (VAS1) and/or radiating pain (VAS2).

Outcome measures: Pain-free patients at end of treatment; treatment failure (proportion of patients stopping the assigned treatment for lack of effect on pain); number of days with no, mild, moderate, or severe pain; quality of life; number of days on nonsteroidal anti-inflammatory drugs; number of drug prescriptions; VAS1 and VAS2 scores; quality of life and psychosocial findings; and reduction of disc protrusion on magnetic resonance imaging.

Methods: Manipulations or simulated manipulations were done 5 days per week by experienced chiropractors, with a number of sessions which depended on pain relief or up to a maximum of 20, using a rapid thrust technique. Patients were assessed at admission and at 15, 30, 45, 90, and 180 days. At each visit, all indicators of pain relief were used.

Results: A total of 64 men and 38 women aged 19-63 years were randomized to manipulations (53) or simulated manipulations (49). Manipulations appeared more effective on the basis of the percentage of pain-free cases (local pain 28 vs. 6%; p<.005; radiating pain 55 vs. 20%; p<.0001), number of days with pain (23.6 vs. 27.4; p<.005), and number of days with moderate or severe pain (13.9 vs. 17.9; p<.05). Patients receiving manipulations had lower mean VAS1 (p<.0001) and VAS2 scores (p<.001). A significant interaction was found between therapeutic arm and time. There were no significant differences in quality of life and psychosocial scores. There were only two treatment failures (manipulation 1; simulated manipulation 1) and no adverse events.

Conclusions: Active manipulations have more effect than simulated manipulations on pain relief for acute back pain and sciatica with disc protrusion.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Double-Blind Method
  • Female
  • Humans
  • Intervertebral Disc Displacement / complications
  • Intervertebral Disc Displacement / therapy*
  • Low Back Pain / etiology
  • Low Back Pain / therapy*
  • Male
  • Manipulation, Chiropractic*
  • Middle Aged
  • Pain Measurement
  • Sciatica / etiology
  • Sciatica / therapy*
  • Severity of Illness Index
  • Treatment Outcome