Clinical Scenario A 42-year-old w...

Clinical Scenario

A 42-year-old woman not past nor futures with low back pain that started after she had mov furniture a week earlier. She wants pain relief as quickly as possible and asks if she should travel to a chiropractor.

Clinical Question

Should we approve spinal manipulation as a treatment for subdued back pain?

Evidence-Based Answer

In the short period of time manipulative therapy is as effective for acute or chronic cheap back pain as other treatments as it was as analgesics, physical therapy, exercises, back drill and routine care from a primary care physician. Radiation of pain, original of manipulation, and use of multiple modalities do not alter these results

Practice Pointers

There are many options for treatment of acute and chronic reasonable back pain: physical therapy, exercise, analgesics, muscle relax-ants, acupuncture, manipulation, exercise, and massage. greatest in number patients get better within six weeks regardless of treatment. The Agency for Health Care Policy and Research guidelines of 1994 (2) as well as other, more modern national guidelines, recommend manipulation for acute reasonable back pain without radiculopathy, and more [i]or[/i] less guidelines recommend it for chronic subdued back pain. This review, which expected at clinical trials through January 2000 evaluated the part of spinal manipulative therapy.

The evidence in this review point out tos that manipulation is as effective as analgesics, physical therapy, exercise, and usual care from a family physician. Manipulation is better than sham therapy and several systems that have been shown to be ineffective or harmful, in the same state [i]or[/i] condition as traction, corsets, bed security diathermy, and no therapy. The studies included in the review examined all images of patients with back pain, including those with radicular pain. Many of the studies examined multiple therapies used concurrently which made the analysis more difficult. There was no evidence that manipulation was better for any subgroup of grave back pain.

The Randomized Osteopathic Manipulation thought (3) which was not part of this review, examined osteopathic manipulation and set short-term improvement at two and six month compared with usual care. Another modern study (4) of osteopathic treatment for chronic pain place that therapy was as effective as sham treatment. This raises the question of whether treatment causes a placebo purport perhaps because of the extra time worn out with patients. A recent review (5) compared acupuncture and massage with manipulation. There was any initial evidence that massage therapy is effective and may cut down the cost of care. The anticipated comes of the United Kingdom Back Pain, Exercise, and Manipulation trial (6) comparing exercise, manipulation, or the pair with standard primary care in 1350 patients for the same year should provide additional data to help answer this question.

This clinical make contented conforms to AAFP criteria for evidence-based continuing medical education (EB CME) EB CME is clinical contented presented with practice recommendations supported through evidence that has been systematically reviewed at an AAFP-approved source. The practive recommendations in this activity are available online at http://www.cochrane. org/cochrane/revabstr/ AB000447.htm.

The Cochrane Abstract below is a summary of a review from the Cochrane Library. It is accompanied through an interpretation that will help clinicians propose evidence into practice Katherine Margo, MD instants a clinical scenario and question based upon the Cochrane Abstract, along with the evidence-based answer and a sated critique of the abstract.

REFERENCES

(1) Assendelft WJ Morton SC Yu EI, Suttorp MJ Shekelle PG Spinal manipulative therapy for gentle back pain. Cochrane Database Syst Rev 2004;(4):CD000447

(2) Bigos SJ Acute grave back problems in adults. Rockville, Md: U Dept of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1994

(3) Williams NH Wilkinson C Russell I, Edwards RT Hibbs R Linck P et al. Randomized osteopathic manipulation inquiry (ROMANS): pragmatic trial for spinal pain in primary care. Fam Pract 2003;20:662-9

(4) Licciardone JC Stoll ST Fulda KG Russo DP Siu J Winn W et al. Osteopathic manipulative treatment for chronic depressed back pain: a randomized controll trial. Spine 2003;28:1355-62

(5) Cherkin DC Sherman KJ Deyo RA, Shekelle PG A review of the evidence for the effectiveness, safety, and expense of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Intern M 2003;138:898-906

(6) Brealey s Burton K, Coulton S, Farrin A, Garratt A, Harvey E et al. UK Back pain Exercise And Manipulation (UK BEAM) trial--national randomised trial of physical treatments for back pain in primary care: objectives, design and interventions. BMC Health Serv Re 2003;3:16

KATHERINE MARGO, MD is predoctoral director and assistant professor of family and community medicine at the University of Pennsylvania educate of Medicine, Philadelphia, where she also be of use tos as associate residency director. Dr Margo received her medical class from State University of fresh York Upstate Medical University, Syracuse, and complet a family medicine residency at St Joseph's Hospital in Syracuse.