title: Supplemental care with medication-assisted manipulation versus spinal manipulation therapy alone for patients with chronic low back pain.
abstract: OBJECTIVE
  To measure changes in pain and disability for chronic low-back pain patients receiving treatment with medication-assisted manipulation (MAM) and to compare these to changes in a group only receiving spinal manipulation.
  
  
  METHODS
  Prospective cohort study of 68 chronic low-back pain patients.
  
  
  METHODS
  Outcomes were measured using the 1998 Version 2.0 American Association of Orthopaedic Surgeons/Council of Musculoskeletal Specialty Societies/Council of Spine Societies Outcomes Data Collection Instruments. The primary outcome variable was change in pain and disability. All patients received an initial 4- to 6-week trial of spinal manipulation therapy (SMT), after which 42 patients received supplemental intervention with MAM and the remaining 26 patients continued with SMT.
  
  
  RESULTS
  Low back pain and disability measures favored the MAM group over the SMT-only group at 3 months (adjusted mean difference of 4.4 points on a 100-point scale, 95% confidence interval [CI] -2.2 to 11.0). This difference attenuated at 1 year (adjusted mean difference of 0.3 points, 95% CI -8.6 to 9.2). The relative odds of experiencing a 10-point improvement in pain and disability favored the MAM group at 3 months (odds ratio 4.1, 95% CI 1.3-13.6) and at 1 year (odds ratio 1.9, 95% CI 0.6-6.5).
  
  
  CONCLUSIONS
  Medication-assisted manipulation appears to offer some patients increased improvement in low back pain and disability. Further investigation of these apparent benefits in a randomized clinical trial is warranted.
authors.affiliation: Department of Health Services, University of California Los Angeles, School of Public Health, Los Angeles, California, USA.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Kohlbeck
authors.forename: Scott
authors.initials: S
authors.lastname: Haldeman
authors.forename: Eric L
authors.initials: EL
authors.lastname: Hurwitz
authors.forename: Simon
authors.initials: S
authors.lastname: Dagenais
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D002908:Chronic Disease; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D017116:Low Back Pain / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D026882:Manipulation, Chiropractic; D008875:Middle Aged; D011446:Prospective Studies; D014143:Traction; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives