Gbj. Andersson et al., A comparison of osteopathic spinal manipulation with standard care for patients with low back pain, N ENG J MED, 341(19), 1999, pp. 1426-1431
Citations number
34
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Background The effect of osteopathic manual therapy (i.e., spinal manipulat
ion) in patients with chronic and subchronic back pain is largely unknown,
and its use in such patients is controversial. Nevertheless, manual therapy
is a frequently used method of treatment in this group of patients.
Methods We performed a randomized, controlled trial that involved patients
who had had back pain for at least three weeks but less than six months. We
screened 1193 patients; 178 were found to be eligible and were randomly as
signed to treatment groups; 23 of these patients subsequently dropped out o
f the study. The patients were treated either with one or more standard med
ical therapies (72 patients) or with osteopathic manual therapy (83 patient
s). We used a variety of outcome measures, including scores on the Roland-M
orris and Oswestry questionnaires, a visual-analogue pain scale, and measur
ements of range of motion and straight-leg raising, to assess the results o
f treatment over a 12-week period.
Results Patients in both groups improved during the 12 weeks. There was no
statistically significant difference between the two groups in any of the p
rimary outcome measures. The osteopathic-treatment group required significa
ntly less medication (analgesics, antiinflammatory agents, and muscle relax
ants) (P<0.001) and used less physical therapy (0.2 percent vs. 2.6 percent
, P<0.05). More than 90 percent of the patients in both groups were satisfi
ed with their care.
Conclusions Osteopathic manual care and standard medical care have similar
clinical results in patients with subacute low back pain. However, the use
of medication is greater with standard care. (N Engl J Med 1999;341:1426-31
.) (C)1999, Massachusetts Medical Society.