Surely A Large Human
Date registered: Jun 2006
Vehicle: '08 C219
Location: Between Earth and Mars
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Going to a chiropractor to treat back pain could be a waste of time, according to a new study which found that having your spine manipulated does nothing to speed up recovery.
Current treatment guidelines for acute back pain recommend that, in the first instance, GPs advise patients to remain active and avoid bed rest and take paracetamol for the pain. If that does not work, patients are referred for spinal manipulative therapy and given non-steroidal anti-inflammatory (NSAID) drugs such as ibuprofen and diclofenac to treat the pain.
Mark Hancock, of the back pain research group at the University of Sydney, studied 240 patients with short-term lower back pain who had already been given both advice and paracetamol. The patients were randomly allocated to four groups and given different treatments: NSAIDs with placebo manipulative therapy; manipulative therapy with placebo drugs; drugs with therapy; or double placebo.
"Neither diclofenac nor spinal manipulative therapy gave clinically useful effects on the primary outcome of time to recovery," the researchers wrote in the Lancet today. "If patients have high rates of recovery with baseline care, and no clinically worthwhile benefit from the addition of diclofenac or spinal manipulative therapy, then GPs can manage patients confidently without exposing them to increased risks and costs associated with NSAIDs or spinal manipulative therapy."
In an accompanying article in the Lancet, Bart Koes of Erasmus University medical centre in Rotterdam wrote: "The limited or absent beneficial effect of diclofenac for acute lower back pain after adequate first-line treatment may have wide implications. NSAIDs are widely prescribed for a range of acute musculoskeletal disorders. The important message is that the management of acute low back pain in primary care (advice and prescription of paracetamol) is sufficient for most patients."
Tony Metcalfe, president of the British Chiropractic Association, said that because the study had only looked at 15 Australian physiotherapists, direct comparisons could not be made with UK practitioners of spinal manipulative therapy.
"The study did not address chiropractic-only spinal mobilisation carried out by physiotherapists. The majority of participants had low velocity mobilisation techniques and only 5% experienced high velocity techniques. Chiropractic manipulation is based predominantly on high velocity techniques, so the results are therefore not comparable with chiropractic treatment."
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