58p back pain book `as good as' a pounds 25 visit to the chiropractor

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CHIROPRACTIC, one of the best established alternative treatments for back pain, is of marginal benefit and it is probably not worth the cost, according to a new study.

Patients with low back pain who were treated by a chiropractor for one month were little better off two years later than patients given a booklet which explained the causes of back pain, and suggested activities for relieving it.

Chiropractic involves manipulation of the spine and is widely recommended by doctors in Britain and the US as a treatment for back pain. There are about 1,200 chiropractors in Britain, who charge an average of pounds 20 to pounds 30 a session, but in the US they are the third most common group of health professionals - after doctors and dentists - who treat their own patients.

The US study of 320 adults, carried out by researchers at the University of Seattle, also examined a second physical therapy, the McKenzie method, in which patients are taught special exercises but this was found to be no more effective than chiropractic. The number of days of reduced activity, days in bed and days off work were similar in all three groups.

The results, published in the New England Journal of Medicine , show that patients spent an average of $230 US dollars each (pounds 135) on the physical treatments compared with $1 US dollar (58p) on the booklet. However, three quarters of the physical treatment groups rated their care as very good or excellent, compared with only 30 per cent of the booklet group.

The researchers say: "Although chiropractic manipulation and physical therapy may slightly reduce symptoms, their main benefit for patients with low back pain appears to be increased satisfaction with care."

They go on to add: "Whether the small benefits of these therapies are worth their additional costs is open to question. Given the limited benefits and high costs, it seems unwise to refer all patients with low back pain for chiropractic or McKenzie therapy."

Chiropractic is also claimed to be effective as a treatment for other conditions, but a second study by colleges of chiropractic in Toronto and Los Angeles of 80 children with asthma, published in the same issue of the Journal, found it had no effect on their symptoms.

An editorial in the Journal warns, however, that chiropractic should not be judged too harshly. "We must remember that many existing medical interventions ... provide equally small benefits - or even none at all."