When you wrench your back, your first impulse may be to rummage through the medicine cabinet for an over-the-counter pain drug or even ask your doctor to prescribe a strong opioid painkiller such as Percocet or Vicodin.

But an analysis published April 11 in the Journal of the American Medical Association finds that spinal manipulation can ease your backache and get you moving again without the risk of medication side effects.

A new Consumer Reports survey of more than 3,500 back-pain sufferers reached similar conclusions: Nearly 90 percent of people who tried spinal manipulation found it helpful.   

Spinal manipulation involves a healthcare provider applying controlled forces to the spine to improve alignment and allow the muscles and joints to move more easily. While it’s usually done by a chiropractor, some doctors of osteopathic medicine (D.O.) and physical therapists also use the technique.

For the JAMA analysis, researchers from the Department of Veterans Affairs and elsewhere combined results from 26 studies involving more than 3,000 patients with low-back pain lasting six weeks or less. Patients treated with spinal manipulation were able to move through daily activities with less pain than people who didn’t get the therapy.

On average, people treated with spinal manipulation said that their pain improved about 10 points on a 100-point scale.

“The beneficial effects on pain and function are real, but modest—like most other therapies for short-term low-back pain,” says Paul G. Shekelle, M.D., chief of general internal medicine at the Greater Los Angeles VA Healthcare system, and an author of the JAMA study.


Find out how to stop back pain without drugs.
 

The Strength of a Nondrug Approach

Recent guidelines from the American College of Physicians recommend trying spinal manipulation or other nondrug measures such as acupuncture and massage before turning to OTC pain medications such as ibuprofen (Advil, Motrin IB, and generic) or naproxen (Aleve and generic). They also strongly discourage the use of prescription opioid painkillers because of the risk of addiction and overdose.

“The real strength of spinal manipulation is that it is equally effective to other forms of commonly used treatments, and it’s safer,” says Paul Dougherty, D.C., chief of chiropractic care at the Canandaigua Veterans Affairs Medical Center in Canandaigua, N.Y., and a co-author of the JAMA review.

None of the studies included in the JAMA analysis reported that spinal manipulation had serious adverse effects. Minor side effects included headaches, soreness, and muscle stiffness, but those were generally short-lived.

“It’s common for people having spinal manipulation for low-back pain to have some soreness, similar to what you might have after a session of exercise,” Dougherty says.

Pain medications, on the other hand, carry more serious risks. Opioids commonly cause nausea, vomiting, and constipation, and make you feel drowsy and “fuzzy-headed.” And a recent study by the Centers for Disease Control and Prevention found that taking an opioid painkiller for more than a few days sharply increases the risk of getting hooked on the drug.

OTC anti-inflammatory drugs are safer than opioids for most people but—especially when taken long term—they can cause serious harm, including kidney problems, bleeding in the stomach or elsewhere in the digestive tract, and an increased risk of heart attack or stroke.

Part of an Overall Strategy

If you’re interested in spinal manipulation, check with your health insurance company for a list of licensed chiropractors and doctors of osteopathic medicine in your area, and ask your primary care physician for a referral.

Our survey found that health insurance provided better coverage for chiropractic care than other forms of nondrug therapies, such as acupuncture and massage. Still, more than one in four respondents said they paid for the entire cost of treatment out of pocket.

At your first visit, a provider should get your medical history and do a thorough exam, says William J. Lauretti, D.C., an associate professor of chiropractic clinical sciences at the New York Chiropractic College and a spokesman for the American Chiropractic Association. He or she should ask about “red flag” symptoms, including loss of bowel or bladder control or weakness and loss of feeling in the legs. They can indicate a serious health problem and require a referral to an orthopedist or other specialist.

Spinal manipulation is safe for most other patients, but tell your provider if you have osteoporosis (brittle bones), because he or she will adjust techniques to use less force.

People with routine back pain can expect treatment to take two to three visits weekly for about three weeks. “You should notice improvement after the first couple of visits,” Lauretti says. “If there’s no change after six treatments, then it’s time to reassess the diagnosis and think about a different treatment approach.”

You should expect some homework, too. “At the first visit, we’ll show you a stretch or two you can do at home, and little by little we’ll add to that to get you doing exercises to strengthen your back,” Lauretti says. “Spinal manipulation is just one part of an overall treatment strategy to get you actively engaged in taking care of yourself to get past this episode and prevent future recurrences.”

People who have persistent or recurring pain may require more visits. But Lauretti advises avoiding signing long-term contracts. “After every few visits, the doctor should assess your progress and remaining symptoms and decide whether it's appropriate to reduce the frequency of visits, refer you to another professional, or discharge you from care,” he says.

Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).