Supplemental Care With Medication-Assisted Manipulation Versus Spinal Manipulation Therapy Alone for Patients With Chronic Low Back Pain

Kohlbeck, Frank J.; Haldeman, Scott; Hurwitz, Eric L.; Dagenais, Simon

doi:10.1016/j.jmpt.2005.03.003

« Previous Next »Journal of Manipulative and Physiological Therapeutics
Volume 28, Issue 4 , Pages 245-252, May 2005

Supplemental Care With Medication-Assisted Manipulation Versus Spinal Manipulation Therapy Alone for Patients With Chronic Low Back Pain

Frank J. Kohlbeck, DC
- PhD Program, Department of Health Services, University of California Los Angeles, School of Public Health, Los Angeles, Calif
- Research Assistant, Southern California University of Health Sciences, Whittier, Calif
- Submit requests for reprints to: Scott Haldeman, MD, PhD, 1125 East 17th St, Suite West #127, Santa Ana, CA 92701.
Scott Haldeman, MD, PhD
- Research Assistant, Southern California University of Health Sciences, Whittier, Calif
- Voluntary Clinical Professor, Department of Neurology, University of California, Irvine, Calif
- Adjunct Professor, Department of Epidemiology, University of California Los Angeles, School of Public Health, Los Angeles, Calif
Eric L. Hurwitz, DC, PhD
- Research Assistant, Southern California University of Health Sciences, Whittier, Calif
- Associate Professor in Residence, Department of Epidemiology, University of California Los Angeles, School of Public Health, Los Angeles, Calif
Simon Dagenais, DC, PhD
- Research Director, CAM Research Institute, Irvine, Calif

Objectives

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.

Study Design

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).

Conclusion

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.