Back pain is a common problem seen in daily practice, and a great deal has been written about it. Unfortunately, there is little consensus about types of treatment are most effective. A new study indicates that a multi-disciplinary approach—one that combines medical care, exercise, and chiropractic—may be the best way to reduce long-term disability in patients with low back pain.
This large study from the UK examined 1,334 patients with back pain who sought treatment at 181 general practices throughout the country. The patients were divided into randomized treatment groups: “Of six groups of participants, one received only best care in general practice. The other five received best care plus an intervention—exercise, manipulation in private or NHS premises, or manipulation in private or NHS premises followed by exercise.”
The study participants were given a wide variety of surveys to complete, and they were retested three months after the beginning of treatment, and again at 12 months.
Here’s what the analysis of the data found:
- All of the patients improved from baseline. For instance, the Roland Disability score at the beginning of the study was 9 for all groups. The following graph illustrates the gains experienced by all of the study subjects:
- Pain levels in the “medical treatment plus manipulation” dropped from about 61 before treatment (on a scale of 0 to 100) to 41 after treatment—a significant decrease.
The authors conclude with following key findings:
- “…Exercise improves back function by a small, but statistically significant, margin at three months; it also achieves sustained reductions in disability and pain, and in adverse beliefs about back pain.”
- “Manipulation improves back function by a small to moderate margin at three months and a small but significant margin at 12 months; it also achieves sustained improvements in disability and pain, adverse back beliefs, and general physical health.”
- “Combined treatment improves back function by a moderate margin at three months and a small but significant margin at 12 months; generally it achieves little more than manipulation, except for much greater improvements in beliefs about back pain and fear avoidance.”
This study illustrates that the most effective treatment for back pain is one that involves medical and chiropractic professionals. When medical care is combined with an exercise program and spinal manipulation, the authors found a reduction in disability and an improvement in general health that lasted at least 12 months after initial treatment.
UK Beam Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ 2004;329;1377.