Benefits and Harms of SMT for the Tx of Chronic LBP

Rubenstein S et al. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ: 2019
  • In some countries, spina, manipulative therapy (SMT) is recommended as a first line treatment for low back pain, while in other countries it is a recommended second line treatment, and in others, not recommended at all.
  • The most recent summary of these guidelines considers SMT as a second line treatment after exercise and cognitive behavioral therapy.
  • An earlier Cochrane review by the same authors found high quality evidence that suggested no clinically relevant difference between SMT and other effective interventions at reducing pain and improving function in patients with chronic low back pain.
  • The primary objective of review was to examine effectiveness of SMT on pain relief and function in short (1 month), intermediate (3,6, month), and long term (12 month) between recommended and non-recommended therapies for adults with chronic low back pain.
  • Recommended treatments included exercise, CBT and drug therapies such as NSAIDs and analgesics. Non-recommended therapies included no treatment, wait and see approach, and electrotherapy.
  • 47 trials of 9,211 patients were included in this review
  • Overall, moderate quality evidence suggests that spinal manipulative therapy results in similar outcomes to recommended therapies for short, intermediate, and long term pain relief as well as improvement in function in adults with chronic low back pain.
  • Most studies examined the effect of SMT in a pragmatic setting and therefore can be considered highly robust evidence.
  • Also interesting is the author’s contention questioning at this point whether further studies are necessary, and debatable if studies that examine the effect of SMT compared to non-recommended or sham treatments will shed further light on our understanding of SMT on back pain.