Chronic low-back pain is one of the most common and costly health complaints. It can be debilitating, and it remains a tough condition to diagnose, treat, and study. Spinal manipulative therapy is often used to treat a large portion of low-back pain in the United States, and is included in current clinical practice guidelines for treatment of this condition. Yet, recommendations for duration and frequency vary widely and there is no consensus on its efficacy. This is in part because there has been little, if any, evidence from dose-response studies to advise researchers on the average optimal dose, or the number of spinal manipulation sessions provided. A new NCCAM-funded study published in The Spine Journal, led by Mitchell Haas, D.C., is the largest and most rigorous, randomized dose-response study of spinal manipulative therapy for chronic low-back pain, and its findings will help guide future research in this area.
One of the several important findings to note from this study is that all four groups had significant reductions in pain intensity and functional disability by 6 weeks, with the largest reduction occurring at 12 weeks in the group that had received 12 sessions of spinal manipulative therapy. These improvements were sustained out to 52 weeks, and the effects of dose were significant, though modest, on both pain intensity and disability.
It’s hard, also, not to be struck by the fact that over half of the participants in the study did not respond to treatment. Sadly this is a recurrent theme in back pain studies. For those patients, and for the many others who suffer from chronic low-back pain, more effective management strategies are desperately needed. We have a long way to go with research for back pain, but as this study demonstrates, it’s an important investment.
This is just one example of the type of important research that can help inform and provide guidance on health care policy. At NIH, we are committed to building an evidence base to help inform the decisionmaking processes of clinicians, health policymakers, and consumers, particularly in areas such as chronic pain.