Costly treatments no good for back pain

16 November, 2007

Costly therapies help little or nothing to alleviate back pain. Instead, taking Paracetamol and keeping active are the best cures for the all-too-common ailment.

Dr Mark Hancock, from the University of Sydney, Australia, and colleagues studied 240 patients with acute low-back pain who had been treated by general practitioners.

It has been estimated that Australians spend over $1 billion a year for treating lower-back pain.

Back pain is the biggest single cause of sickness-related absence from work.

Though chiropractors and physiotherapists provide expensive forms of treatment for lower-back pain, sufferers usually resort to over-the-counter, anti-inflammatory drugs soon after the pain starts.

It was the costly treatment that prompted Dr Mark Hancock from the Back Pain Research Group of the University of Sydney and his team to research whether costly treatments were really needed for back pain.

The patients who participated in the study were assigned to four treatment groups. Only one of the groups received both diclofenac and genuine spinal manipulative therapy.

The other groups were treated with diclofenac and “dummy” spinal manipulation, genuine spinal manipulation plus a “dummy” drug, or both a dummy drug and fake spinal manipulation.

The results of the study, published in British medical journal The Lancet, showed that neither diclofenac nor spinal manipulative therapy lessened the number of days till recovery substantially.

In all, 237 of the total 240 patients recovered in the 12-week period, and 22 patients suffered from adverse reactions, including stomach disturbances, dizziness and heart palpitations.

The authors of the study wrote in The Lancet, “These results are important because both diclofenac and spinal manipulative therapy have potential risks and additional costs for patients. If patients have high rates of recovery with baseline care and no clinically worthwhile benefit from the addition of diclofenac or spinal manipulative therapy, then general practitioners can manage patients confidently without exposing them to increased risks and costs associated with non-steroidal anti-inflammatory drugs (NSAIDs) or spinal manipulative therapy.”

Dr Bart Koes from the department of general practice at Erasmus University, the Netherlands, who wrote an accompanying article in The Lancet, observed that the results were probably applicable to other non-steroidal anti-inflammatory drugs like Ibuprofen.

However, Tony Metcalfe, president of the British Chiropractic Association, has cautioned that the therapy in the study could not be compared with the treatment provided by chiropractors in the United Kingdom. He explained that “spinal manipulation is just a part of a package of care offered by the British Chiropractic Association’s chiropractors which also includes lifestyle and posture advice, rehabilitation and specific exercises.”

Spinal manipulation therapy, Tony Metcalfe emphasized, is a safe treatment and none of the participants in the study reported serious adverse reactions.