The mystery of low back pain and how to treat it continues. Pain, loss of function, and chronic disability can become the end result of an episode of acute nonspecific low back pain. Nonspecific means there's no fracture, infection, or tumor. Some aspect of joint, soft tissue, and/or biomechanics (the way things move) is amiss.
Until scientists can pinpoint the exact cause of nonspecific low back pain, treatment is usually symptomatic: decrease pain as quickly as possible and restore normal movement. To that end, researchers have managed to find evidence-based clinical practice guidelines (CPGs) to direct conservative (nonoperative) care. Despite many publications outlining those guidelines, there are still many health care providers who do not follow them.
In this study, chiropractors from the School of Chiropractic and Sports Science in Perth, Australia attempt to give meaningful numbers to results of treatment for acute low back pain. They compare two groups of patients who have experienced nonspecific low back pain of less than six weeks' duration. The two main measures of clinical outcome include disability scores and pain. As a second measure, they asked patients to quantify their level of satisfaction.
The first group of patients (the control group) received "usual" care from a chiropractor consisting of spinal manipulation, soft tissue treatments, exercise, and education or advice. The second group (experimental group) received care as outlined by evidence-based clinical practice guidelines.
First and foremost, patients received advice and education. A special book (The Back Book) was given to each patient. This book emphasizes self-care and provides information about the causes, course, expected course, and treatment of low back pain. Participants in this group were encouraged to stay active and return to work as soon as possible. Spinal manipulation, joint mobilization, and gentle soft tissue work was also provided.
The use of exercise therapy, massage, heat and cold, traction, corsets or supports, and electrotherapy was not employed. There is not strong, consistent, or reliable evidence that these types of treatments are effective.
Everyone in the study (both groups) was treated up to seven times over a period of four weeks. Results were measured at week two (mid-way through treatment) and at the end of week four (final treatment). Tools used to measure outcomes included the Oswestry Low Back Disability Index (ODI), Visual Analog Scale (VAS), and Patient Satisfaction Questionnaire (PSQ).
The results showed no difference in final outcomes at the end of four weeks. What was particularly striking was the fact that patients in the experimental group (following clinical practice guidelines) were significantly better after two weeks compared with the control group who received usual conservative care.
So for faster results which could mean getting back on-the-job or back to daily activities sooner than later, the evidence-based guidelines remain the first choice for treatment of acute episodes of low back pain. The authors note that this 'less-is-more' approach has been confirmed effective by other studies as well. Two sessions of spinal manipulation has been shown to reduce pain and disability by 50 per cent and should continue to be the first treatment choice for this type of problem.
Reference: Gregory F. Parkin-Smith, MTech(Chiro), MSc, DrHC, et al. A Structured Protocol of Evidence-Based Conservative Care Compared with Usual Care for Acute Nonspecific Low Back Pain: A Randomized Clinical Trial. In Archives of Physical Medicine. January 2012. Vol. 93. No. 1. Pp. 11-20.