HVLA manipulation comes out top for low-back pain

By Lucy Piper, Senior medwireNews Reporter

Spinal high-velocity-low-amplitude (HVLA) manipulation for the treatment of nonspecific low-back pain (LBP) has shown to be superior to a nonsteroidal anti-inflammatory drug, researchers report.

The results showed that HVLA manipulation was more effective than diclofenac in terms of improvement in Roland and Morris Disability Score (RMS), pain, quality of life, the need for rescue medication, and time taken off work.

The researchers note, however, that the trial was limited to a subgroup of patients with acute nonspecific LBP and no other health problems.

"The positive results of spinal manipulation may not be valid for patients with comorbidities like osteoarthritis of osteoporosis of the spine, chronic LBP, obesity or for elderly patients," they caution.

For the trial, patients with acute LBP (<48 hours) were randomly assigned to receive spinal HVLA manipulation and placebo (n=37), sham manipulation and diclofenac (n=38), or sham manipulation and placebo (n=25).

The patients were followed up during a 12-week period. Due to a high number of dropouts in the group receiving no active treatment, this group was stopped early.

In all, 93 patients were assessed, of whom 36 received diclofenac and 35 spinal HVLA manipulation.

The patients receiving HVLA manipulation showed a faster and significantly greater reduction in RMS scores compared with patients receiving diclofenac, with an average reduction relative to pretreatment values of 7.71 versus 4.75.

The findings were similar for secondary outcomes including visual analog scores for pain and quality of life.

The need for rescue medication, in terms of cumulative dose and the number of days on which it was needed, was reduced to a significantly greater degree in spinal manipulation patients compared with those taking diclofenac.

After spinal manipulation, patients took an average cumulative 2.22 paracetamol tablets (500 mg) on an average 1.19 days. By comparison, patients given diclofenac took almost three times as many tablets (6.41) and the number of days they were needed was almost double (1.92). However, the differences were not statistically different due to large interindividual variation.

Similarly, time taken off work was numerically, but not statistically, different, at 1.24 days following manipulation versus 1.80 after diclofenac.

Wolfgang von Heymann (orthopedic practice, Bremen, Germany) and colleagues write: "The consistent data of all variables measured (primary as well as secondary) fit very nicely. The trial terminates with a very robust observation."

They therefore conclude: "HVLA manipulation can be recommended for the therapy of acute non-specific LBP."

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