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Osteopathy for back pain


Clinical bottom line

Osteopathic spinal manipulation was no better than standard medical therapy for low back pain, but reduces NSAID use


GB Andersson et al. A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. New England Journal of Medicine 1999 341: 1426-1431.


Patients aged 20-59 with low back pain lasting at least three weeks but less than six months were the target population. A range of sensible exclusions were made, from root nerve compressions and other neurological causes of the back pain, to pregnancy. The presence of a lesion suitable for manipulation was comfirmed by a doctyor of psteopathy.

Patients were then randomised to osteopathic manipulation, or standard medical treatment. The osteopathic treatment was given by one of three physicians at the Chicago College of Osteopathic Medicine. Standard medical care involved using analgesics and other therapies like heat, cold, corsets and TENS. Osteopathy was in addition to this, and all patients saw a 10 minute educational video on back pain.

Outcomes were a number of pain and back scales and questionnaires, plus measurements of flexion and extension. These were done on the 12th week by an evaluator who was blind to the treament allocation, and who was not connected to partcipants, therapists or organiser of the triall.


Randmisation of 178 patients occurred, and 23 patients subsequently fdropped out of the trial, mostly for unknown reasons, and early in the study. There were 83 evaluable patients given osteopathy and 72 given usual care. They were well matched at baseline.

There was no significant difference between the groups for any result. Pain at the 12-week bisit was an average of 18 mm on a 100 mm sclae, a reduction of 30 mm on average. Over 90% of the patients felt that treatment met their expectations, over 90% would have the treatment again, and over 97% would recommend it to a friend - again, the same for both treatments.

One difference was that NSAIDs were prescribed for 54% of patients receiving standard care and 24% receiving osteopathy. Muscle relaxants were also prescribed more frequently in standard care.


Almost, but not quite, profoundly negative. There was no difference in overall result obtained with standard care and osteopathy, but osteopathy achieved that result and prescribed fewer medicines (NSAIDs and muscle relaxants). For many people who find NSAIDs hard to tolerate, that is a bonus, and for people who do not like taking medicines, that also would be a bonus.

So a more positive result for osteopathy than at first sight.