spinal manipulative therapy (SMT) for low back pain (LBP)

Last edited 06/2022 and last reviewed 07/2022

Chiropractors are portal-of-entry providers that treat a variety of musculoskeletal conditions, the most common of which is LBP (low back pain)

• the most common treatment chiropractors employ is spinal manipulative therapy (SMT), also called chiropractic SMT (CSMT)
  • systematic reviews have found evidence supporting this treatment for acute LBP(1), chronic LBP (2) and radicular LBP (3)
    • among patients with acute low back pain, spinal manipulative therapy was associated with modest improvements in pain and function at up to 6 weeks, with transient minor musculoskeletal harms. However, heterogeneity in study results was large (1)
    • produces similar effects to recommended therapies for chronic low back pain but results in clinically better effects for short term improvement in function compared with non-recommended therapies, sham therapy, or when added as an adjuvant therapy (2)
  • evidence shows that receiving SMT for newly diagnosed LBP is associated with reduced odds of receiving a benzodiazepine prescription during follow-up (4)

Reference:

• Paige NM et al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. JAMA 2017;317:1451-60.doi:10.1001/jama.2017.3086 pmid:http://www.ncbi.nlm.nih.gov/pubmed/28399251
• Rubinstein SM et al. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ 2019;364:l689.doi:10.1136/bmj.l689pmid:http://www.ncbi.nlm.nih.gov/pubmed/30867144
• Lewis RA et al. Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. Spine J 2015;15:1461-77.doi:10.1016/j.spinee.2013.08.049pmid:http://www.ncbi.nlm.nih.gov/pubmed/24412033
• Trager RJ, Cupler ZA, DeLano KJ, et al. Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA. BMJ Open 2022;12:e058769. doi: 10.1136/bmjopen-2021-05876