Spinal manipulation 'has little effect on back pain'

Spinal manipulation practised by osteopaths and chiropractors for symptoms such as back and neck pain is of little help, a review of research published today claims.

Studies into spinal manipulation (SM) have failed to demonstrate that it is an effective intervention for a series of complaints, according to research to be published in next month's Journal of the Royal Society of Medicine.

Experts at the Peninsula Medical School in Exeter, Devon, looked at 16 academic papers on SM where it was practised for conditions such as back pain, neck pain, period pains, asthma and allergy.

They concluded that SM was only effective for back pain where it is superior to "sham" manipulation but not better than conventional treatments.

Considering the possibility of adverse effects, they said, the review did not suggest that SM was a recommendable treatment.

"There is little evidence that spinal manipulation is effective in the treatment of any medical condition," said Professor Edzard Ernst, of the Peninsula Medical School.

"The findings are of concern because chiropractors and osteopaths are regulated by statute in the UK.

"Patients and the public at large perceive regulation as proof of the usefulness of treatment.

"Yet the findings presented here show a gap and contradiction between the effectiveness of intervention and the evidence."

Spinal manipulation is commonly practised by chiropractors and osteopaths and is a popular type of manual treatment for back and neck pain, with an estimated 16,000 licensed chiropractors in the UK.

Prof Ernst's study examined all systematic reviews published on SM between 2000 and May 2005.

He said the findings confirmed fears that in "alternative" medicine, regulation often served as a substitute for research.

"Previous studies have shown that regulation of chiropractors was followed by a decrease in research activity," said Prof Ernst.

"The evidence presented here should be seen as a wake-up call to the chiropractic profession.

"One way forward is more rigorous clinical trials to test the efficacy of spinal manipulation. After all, the treatment is not without risk and chiropractors must demonstrate why it should be a recommendable medical treatment option."

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