A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain.
BACKGROUND
The adult lifetime incidence for low back pain is 75% to 85% in the United States. Investigating appropriate care has proven difficult, since, in general, acute pain subsides spontaneously and chronic pain is resistant to intervention. Subacute back pain has been rarely studied.


OBJECTIVE
To compare the relative efficacy of chiropractic adjustments with muscle relaxants and placebo/sham for subacute low back pain.


METHODS
A randomized, double-blind clinical trial.


METHODS
Subjects (N = 192) experiencing low back pain of 2 to 6 weeks' duration were randomly allocated to 3 groups with interventions applied over 2 weeks. Interventions were either chiropractic adjustments with placebo medicine, muscle relaxants with sham adjustments, or placebo medicine with sham adjustments. Visual Analog Scale for Pain, Oswestry Disability Questionnaire, and Modified Zung Depression Scale were assessed at baseline, 2 weeks, and 4 weeks. Schober's flexibility test, acetaminophen usage, and Global Impression of Severity Scale (GIS), a physician's clinical impression used as a secondary outcome, were assessed at baseline and 2 weeks.


RESULTS
Baseline values, except GIS, were similar for all groups. When all subjects completing the protocol were combined (N = 146), the data revealed pain, disability, depression, and GIS decreased significantly (P <.0001); lumbar flexibility did not change. Statistical differences across groups were seen for pain, a primary outcome, (chiropractic group improved more than control group) and GIS (chiropractic group improved more than other groups). No significant differences were seen for disability, depression, flexibility, or acetaminophen usage across groups.


CONCLUSIONS
Chiropractic was more beneficial than placebo in reducing pain and more beneficial than either placebo or muscle relaxants in reducing GIS.
Hoiriis
Kathryn T
KT
College of Chiropractic, Chiropractic Sciences Division, Life University, Marietta, Ga 30060, USA. khoiriis@life.edu
Pfleger
Bruce
B
McDuffie
Frederic C
FC
Cotsonis
George
G
Elsangak
Omar
O
Hinson
Roger
R
Verzosa
Gregoria T
GT
D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000639:Amitriptyline / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002328:Carisoprodol / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003863:Depression / Q000209:etiology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D008297:Male; D026882:Manipulation, Chiropractic; D008721:Methocarbamol / Q000627:therapeutic use*; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000627:therapeutic use*; D010147:Pain Measurement; D010349:Patient Compliance; D011859:Radiography; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D009125:Muscle Relaxants, Central; D008721:Methocarbamol; D000639:Amitriptyline; D002328:Carisoprodol; D000082:Acetaminophen; C004704:cyclobenzaprine