title: Spinal high-velocity low amplitude manipulation in acute nonspecific low back pain: a double-blinded randomized controlled trial in comparison with diclofenac and placebo.
abstract: METHODS
  A randomized, double-blinded, placebo-controlled, parallel trial with 3 arms.
  
  
  OBJECTIVE
  To investigate in acute nonspecific low back pain (LBP) the effectiveness of spinal high-velocity low-amplitude (HVLA) manipulation compared with the nonsteroidal anti-inflammatory drug diclofenac and with placebo.
  
  
  BACKGROUND
  LBP is an important economical factor in all industrialized countries. Few studies have evaluated the effectiveness of spinal manipulation in comparison to nonsteroidal anti-inflammatory drugs or placebo regarding satisfaction and function of the patient, off-work time, and rescue medication.
  
  
  METHODS
  A total of 101 patients with acute LBP (for <48 hr) were recruited from 5 outpatient practices, exclusion criteria were numerous and strict. The subjects were randomized to 3 groups: (1) spinal manipulation and placebo-diclofenac; (2) sham manipulation and diclofenac; (3) sham manipulation and placebo-diclofenac. Outcomes registered by a second and blinded investigator included self-rated physical disability, function (SF-12), off-work time, and rescue medication between baseline and 12 weeks after randomization.
  
  
  RESULTS
  Thirty-seven subjects received spinal manipulation, 38 diclofenac, and 25 no active treatment. The placebo group with a high number of dropouts for unsustainable pain was closed praecox. Comparing the 2 active arms with the placebo group the intervention groups were significantly superior to the control group. Ninety subjects were analyzed in the collective intention to treat. Comparing the 2 intervention groups, the manipulation group was significantly better than the diclofenac group (Mann-Whitney test: P = 0.0134). No adverse effects or harm was registered.
  
  
  CONCLUSIONS
  In a subgroup of patients with acute nonspecific LBP, spinal manipulation was significantly better than nonsteroidal anti-inflammatory drug diclofenac and clinically superior to placebo.
authors.affiliation: Competence Center for Clinical Studies, University of Bremen, Bremen, Germany. vonheymann@aerzteseminar-mwe.de
authors.forename: Wolfgang J
authors.initials: WJ
authors.lastname: von Heymann
authors.forename: Patrick
authors.initials: P
authors.lastname: Schloemer
authors.forename: Juergen
authors.initials: J
authors.lastname: Timm
authors.forename: Bernd
authors.initials: B
authors.lastname: Muehlbauer
mesh_terms: D000041:Absenteeism; D000082:Acetaminophen / Q000627:therapeutic use; D059787:Acute Pain / Q000188:drug therapy / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D004008:Diclofenac / Q000627:therapeutic use*; D004185:Disability Evaluation; D004311:Double-Blind Method; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy / Q000628:therapy*; D008499:Medical Records; D008875:Middle Aged; D026201:Musculoskeletal Manipulations; D009985:Orthopedics; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D000082:Acetaminophen