When treating persistent back pain, it can be difficult to accurately predict how well a patient will recover from symptoms resulting from non-specific pain. Will the patient be plagued with a lifetime of back pain or can the symptoms be resolved in a matter of months? Although several factors influence the prognosis of back pain, studies suggest that prognosis may differ depending on which treatments patients receive. The identification of which patients are more likely to respond to specific treatments would have valuable clinical implications, yet little research has been done in this area.
A team of researchers recently sought to identify predictors of response to three conservative treatments for low back pain: spinal manipulation (SM), individual physiotherapy (IP), or back school (BS). The research involved 210 patients with chronic, non-specific low back pain. Each was randomly assigned to one of the treatment groups.
Significant improvement was found following all three intervention types. However spinal manipulation provided more functional recovery and pain relief than either of the other interventions studied. Overall 34% of the patients did not respond to treatment but spinal manipulation showed the lowest rate of non-responders.
The researchers then sought to identify specific patterns of response to treatment in order to identify predictors of outcome. They found that age, quality of life, work status, pain duration, patients’ beliefs, and other variables studied did not predict response to treatment. Patients were more likely to benefit from spinal manipulation than from back school or physiotherapy, regardless of their baseline disability score and other clinical characteristics.
A lower initial disability score predicted poor outcome for back school and for individual physiotherapy, but not for patients treated with spinal manipulation. The researchers concluded that patients with chronic lower back pain and related disability should first consider spinal manipulation before other conservative treatments.
Other research has shown that combining chiropractic adjustments with exercise therapies can enhance back-pain treatment.
Cecchi F, et al. Predictors of functional outcome in patients with chronic low back pain undergoing back school, individual physiotherapy or spinal manipulation. European Journal of Physical and Rehabilitation Medicine 2012; 48: 371-8.