A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic

J Altern Complement Med. 2008 Jun;14(5):465-73. doi: 10.1089/acm.2007.0796.


Objectives: To compare outcomes in perception of pain and disability for a group of patients suffering with chronic low-back pain (CLBP) when managed in a hospital by either a regional pain clinic or a chiropractor.

Design: The study was a pragmatic, randomized, controlled trial.

Setting: The trial was performed at a National Health Service (NHS) hospital outpatient clinic (pain clinic) in the United Kingdom.

Subjects and interventions: Patients with CLBP (i.e., symptom duration of >12 weeks) referred to a regional pain clinic (outpatient hospital clinic) were assessed and randomized to either chiropractic or pain-clinic management for a period of 8 weeks. The study was pragmatic, allowing for normal treatment protocols to be used. Treatment was administered in an NHS hospital setting.

Outcome measures: The Roland-Morris Disability Questionnaire (RMDQ) and Numerical Rating Scale were used to assess changes in perceived disability and pain. Mean values at weeks 0, 2, 4, 6, and 8 were calculated. The mean differences between week 0 and week 8 were compared across the two treatment groups using Student's t-tests. Ninety-five percent (95%) confidence intervals (CIs) for the differences between groups were calculated.

Results: Randomization placed 12 patients in the pain clinic and 18 in the chiropractic group, of which 11 and 16, respectively, completed the trial. At 8 weeks, the mean improvement in RMDQ was 5.5 points greater for the chiropractic group (decrease in disability by 5.9) than for the pain-clinic group (0.36) (95% CI 2.0 points to 9.0 points; p = 0.004). Reduction in mean pain intensity at week 8 was 1.8 points greater for the chiropractic group than for the pain-clinic group (p = 0.023).

Conclusions: This study suggests that chiropractic management administered in an NHS setting may be effective for reducing levels of disability and perceived pain during the period of treatment for a subpopulation of patients with CLBP.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Ambulatory Care / statistics & numerical data
  • Chronic Disease / therapy
  • Disability Evaluation*
  • Female
  • Humans
  • Low Back Pain / epidemiology*
  • Low Back Pain / therapy*
  • Male
  • Manipulation, Orthopedic / methods
  • Manipulation, Orthopedic / statistics & numerical data*
  • Middle Aged
  • Odds Ratio
  • Outpatient Clinics, Hospital
  • Pain Measurement / statistics & numerical data
  • Patient Satisfaction / statistics & numerical data
  • Prognosis
  • Severity of Illness Index
  • Surveys and Questionnaires
  • United Kingdom / epidemiology