UW-Group Health study finds no difference in back-pain treatments

UW and Group Health researchers comparing methods of treating low-back pain found no significant differences in outcomes among patients who were treated by chiropractic spinal manipulation, treated with a popular form of physical therapy called the McKenzie method, or simply given an educational booklet and not treated.

The study was led by Dr. Daniel Cherkin, affiliate professor of family medicine and health services and an investigator at the Group Health Center for Health Studies — the research arm of Group Health Cooperative of Puget Sound. The second author is Dr. Richard Deyo, professor of medicine and health services and a nationally known expert on treatment for lower back pain.

According to the study, which appears in the Oct. 8 New England Journal of Medicine, the chiropractic and physical therapy patients were much more satisfied with their treatment than were the patients given the booklet. However, the short-term pain relief experienced by the chiropractic and physical therapy patients was only marginally better than that of the no-treatment group.

Furthermore, there were no significant differences among the three groups at any of the follow-up points (one, four, 12 and 52 weeks after initial treatment) in their ability to function or in disability —days spent in bed, home from work or school, or cutting down on usual activities. In addition, neither chiropractic manipulation of the spine nor McKenzie physical therapy reduced recurrence of back pain, subsequent visits, or costs of back care.

The study was based on 321 adult low back pain patients aged 20 to 64 seen in a primary care clinic. They were randomly selected for one of the three groups.

The study is one of several funded by the federal Agency for Health Care Policy and Research (AHCPR) to examine the effectiveness and cost-effectiveness of the various ways used to treat low-back pain — a problem that may affect up to half of all Americans in any given year and costs an estimated $50 billion to $100 billion annually, half of which goes to direct medical care, according to AHCPR. More information on AHCPR outcomes research is available on the agency’s Web site at http://www.ahcpr.gov