Back and Neck Pain: The Chiropractic Therapy Debate

Spinal manipulation, in which a chiropractor or osteopath "adjusts" the spine using various kinds of thrusts, is no more effective than other kinds of treatment at reducing lower back pain, a new review of 20 previous trials involving more than 2,600 adults finds.

And, in a second hit at this kind of treatment, doctors warned that spinal manipulation for neck pain should be abandoned because of the danger of serious injury, including stroke, from tears in neck arteries.

According to the National Institutes of Health, lower-back pain strikes nearly everyone at some point; it's the most common neurological ailment, second only to headaches, and often affects middle-aged adults. Americans spend at least $50 billion each year on treating their aching lower backs.

A recent review by The Cochrane Library studied the results from 20 randomized controlled trials involving 2,674 participants with lower-back pain lasting less than six weeks, according to the nonprofit Center for Advancing Health. Reviewers concluded that spinal manipulation was no better at reducing pain or speeding recovery than other options, such as exercise, the use of over-the-counter pain medications or physical therapy.

However, Mitchell Freedman, an osteopath and the director of physical medicine and rehabilitation at Thomas Jefferson University Hospitals in Philadelphia, disagreed. "There are different kinds of manipulation, some more aggressive and some limited to stretching. Also, while spinal manipulation is not useful in all circumstances, it can be in some," Freedman told Health Behavior News Service.

Opinions were more dramatically divided over manipulation for neck pain, which some doctors warn could lead to "catastrophic events," including a torn neck artery and stroke.

An earlier Cochrane review of randomized trials of neck manipulation - which concluded that the treatment offered little meaningful long-term benefit - sparked an online debate among doctors in June at the British Medical Journal website, bmj.com.

The experts argued that cervical spine manipulation carries "the potential for serious neurovascular complications" and that the technique "should be abandoned as part of conservative care for neck pain."

A study last year by American surgeons also found that "chiropractic manipulation of the cervical spine" can result in "severe" injuries to neck arteries, causing death or permanent disability.

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Photos: National Institutes of Health