Recent Study Reinforces Effectiveness of Spinal Manipulation, Says American Chiropractic Association

The American Chiropractic Association (ACA) is applauding a new study from the Medical Research Council (MRC) that shows that spinal manipulation – the primary form of care performed by doctors of chiropractic – combined with an exercise program offers effective treatment for those suffering from back pain. The study, published in the Nov. 19 issue of the British Medical Journal [see abstract below], found that a collective approach to back pain treatment provided “significant relief of symptoms and improvements in general health.” Specifically, the study found that the greatest reduction of pain and the greatest improvement in back function was experienced by patients who received a treatment approach consisting of spinal manipulation and exercise in addition to care from their general practitioner. The MRC is based in the United Kingdom where its research is funded by the country’s taxpayers. The council promotes medical and related science research with the aims of improving the health and quality of life of the general public. The MRC is independent in its choice of which research to support. “The costs of back pain and other musculoskeletal conditions on the country's economy and workforce productivity are staggering - conservatively estimated at about $50 billion per year,” commented ACA President Donald J. Krippendorf, DC. “The ACA is pleased that research such as this is being conducted and brought to the attention of the public through journals such as the British Medical Journal. With reports such as these, we can offer our patients the best care possible.” The MRC trial included more than 1,300 patients from across the United Kingdom, whose back pain had not improved after receiving care from a general practitioner. Treatment options were: • A physical exercise program • Spinal manipulation alone • A combined package of spinal manipulation followed by a exercise regimen The results showed that patients in all treatment groups reported improved back function and reduced pain over time, but to varying degrees. However, the greatest improvement was found in the patients assigned to combined manipulation and exercise. According to the ACA, the MRC study is one of a number of recent studies regarding chiropractic’s effectiveness for back pain over traditional medical care. A March 2004 study in the Journal of Manipulative and Physiological Therapeutics found that chiropractic care is more effective than medical care at treating chronic low-back pain in patients' first year of symptoms. And a study published in the July 15, 2003, edition of the medical journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than does a variety of medications. ACA Press Release. November 29, 2004. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care ABSTRACT Objective: To assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise ("combined treatment") to "best care" in general practice for patients consulting with low back pain. Design: Stochastic cost utility analysis alongside pragmatic randomised trial with factorial design. Setting: 181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom. Participants: 1287 (96%) of 1334 trial participants. Main Outcome Measures: Healthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months. Results: Over one year, mean treatment costs relative to "best care" were £195 ($360; 279 euro; 95% credibility interval £85 to £308) for manipulation, £140 (£3 to £278) for exercise, and £125 (£21 to £228) for combined treatment. All three active treatments increased participants' average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost £3800; in economic terms it had an "incremental cost effectiveness ratio" of £3800. Manipulation alone had a ratio of £8700 relative to combined treatment. If the NHS was prepared to pay at least £10 000 for each extra QALY (lower than previous recommendations in the United Kingdom), manipulation alone would probably be the best strategy. If manipulation was not available, exercise would have an incremental cost effectiveness ratio of £8300 relative to best care. Conclusions: Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise. UK BEAM Trial Team. British Medical Journal.