New JAMA report shows benefits of spinal manipulation for low back pain

Canadian Chiropractor staff
April 12, 2017
Written by Canadian Chiropractor staff
A new study published in the Journal of the American Medical Association (JAMA) adds to a growing body of recent research supporting the use of spinal manipulative therapy (SMT) as a first line treatment for acute low back pain, according to the American Chiropractic Association (ACA).

The review examined randomized controlled trials, systematic reviews and other published research since 2011 to determine the effectiveness and safety of SMT for low back pain patients. Researchers found that spinal manipulation was associated with statistically significant improvements in pain and function for up to six weeks with no serious adverse side effects. The JAMA study, published April 11, comes on the heels of new low back pain treatment guidelines by the American College of Physicians (ACP) that recommend first using non-invasive, non-drug treatments, including spinal manipulation, before resorting to drug therapies.

"As the nation struggles to overcome the opioid crisis, research supporting non-drug treatments for pain should give patients and health-care providers confidence that there are options that help avoid the risks and dependency associated with prescription medications," said ACA president Dr. David Herd.

Just last month, ACA's House of Delegates formally approved a resolution to adopt ACP's low back pain treatment guidelines, in conjunction with chiropractic-specific guidelines from the Clinical Compass. The Clinical Compass guidelines focus on the management or co-management of low-back pain patients within a chiropractic office.

"By identifying and adopting guidelines that ACA believes reflect best practices based on the best available scientific evidence on low back pain, we hope not only to enhance outcomes but also to create greater consensus regarding patient care among chiropractors, other health-care providers, payers and policy makers," Herd said.

According to a 2016 Gallup survey, more than 35 million people visit a chiropractor annually.

The Canadian Chiropractic Association did not immediately respond to Canadian Chiropractor's request for comment.

The British Columbia Chiropractic Association (BCCA), meanwhile, welcomed the new study, saying reports like the JAMA review provide the needed evidence to support what patients and practitioners are seeing in practice.

"In BC, approximately a million people per year utilize chiropractic and have experienced the benefits associated with spinal manipulative therapy," Dr. Jay Robinson, president of the BCCA, and Angie Knott, BCCA communications manager, said in a statement. "We are hoping that endorsements and studies such as this will help our stakeholders and governments improve their positions towards chiropractic involvement in health care."

These types of research will also help increase support for further integration of chiropractic in interprofessional, collaborative health care teams, the BCCA officials added.

"With an aging population and increasing numbers of people suffering from musculoskeletal conditions more research like this, providing solid evidence supporting the work of chiropractors, is needed in order to further support the integration of chiropractic into collaborative care teams that benefit the patient and free up family practitioners' time to focus care on other medical conditions," they said.

The Ontario Chiropractic Association (OCA) also welcomed the study saying it confirms the "vital role" that chiropractors play in managing low back pain. Dr. Ayla Azad, president of the OCA, also noted the relevance of this study amid the growing opioid crisis that is plaguing both the U.S. and Canada.    

"This is especially relevant given the challenges that our health-care system is facing in managing opioid dependency and its impact on patients, providers and our health-care system," Azad said in a statement.

"This recent study is part of a growing body of evidence that confirms how SMT can be a foundational approach to managing acute low back pain and enhancing patient outcomes, and the vital role that chiropractors can play as a first line of defence to help manage these conditions before more costly interventions need to take place."

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