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Chiropractic Spinal Manipulation Treatment for Back Pain? A Systematic Review of Randomised Clinical Trials

Abstract Background: Back pain is a common condition for which chiropractic treatment is often recommended. Aim: To evaluate critically the evidence for or against the effectiveness of chiropractic spinal manipulation for back pain. Data sources: Five independent literature searches were carried out and bibliographies were searched. Study selection: Only randomised clinical trials of chiropractic spinal manipulation with patients suffering from back pain were included. Data extraction: The authors extracted data on trial design, methodological quality, sample size, patient characteristics, nature of intervention, outcome measures, follow-up and results. Main results: Twelve studies could be included. They related to all forms of back pain. Many trials had significant methodological shortcomings. Some degree of superiority of chiropractic spinal manipulation over control interventions was noted in 5 studies. More recent trials and those with adequate follow-up periods tended to be negative. Conclusions: The effectiveness of chiropractic spinal manipulation is not supported by compelling evidence from the majority of randomised clinical trials.