Complementary therapies in addition to medication for patients with nonchronic, nonradicular low back pain: a systematic review

Background. 2.7 million patients present to US EDs annually for management of low back pain (LBP). Despite optimal medical therapy, 48% remain functionally impaired 3 months later. We performed a systematic review to address the following question: among patients with non-chronic LBP, does spinal manipulation, massage, exercise, or yoga, when combined with standard medical therapy, improve pain and functional outcomes more than standard medical therapy alone. Methods. We used published searches to identify relevant studies, supplemented with our own updated search. Studies were culled from the Cochrane Register of Controlled Trials, Medline, EMBASE, CINAHL and the Index to Chiropractic Literature. Our goal was to identify randomized studies that included patients with non-radicular LBP of <12 weeks duration that compared the complementary therapy to usual care, sham therapy, or to interventions known not to be efficacious, while providing all patients with standard analgesics. The outcomes of interest were improvement in pain scores or measures of functionality. Results. We identified two RCTs in which chiropractic manipulation + medical therapy failed to show benefit versus medical therapy alone. We identified four RCTS in which exercise therapy + medical therapy failed to show benefit versus medical therapy alone. We did not identify any eligible studies of yoga or massage therapy. Conclusions. In conclusion, for patients with non-chronic, non-radicular low back pain, available evidence does not support the use of spinal manipulation or exercise therapy in addition to standard medical therapy. There is insufficient evidence to determine if yoga or massage is beneficial.