The relative effectiveness of spinal manipulative therapy compared to Diclofenac sodium, in the management of mechanical low back pain

Abstract

Hendler et al. (1995) describes low back pain as the most common, costly and disabling musculosketetal condition. Giles (1997: 28) supports this, stating that the annual incidence of low back pain in the adult population is between two and five percent, with a lifetime prevalence of well over 50%. For clinicians to choose the most appropriate therapy for managing this common condition it is essential for research to be carried out to define the most effective treatment. Shekelle (1994) explains that spinal manipulative therapy is an effective treatment for patients with low back pain, while Cherkin et al. (1995) states that there is strong evidence to support the use of nonsteroidal antiinflammatory drugs in the management of mechanical low back pain. It is therefore the purpose of this investigation to determine the relative effectiveness of spinal manipulative therapy compared to Diclofenac Sodium, in terms of subjective and objective measures, in the management of mechanical low back pain. This randomized controlled trial consisted of sixty patients between the ages of 18 and 65, complaining of mechanical low back pain. The sixty patients were randomly divided into two treatment groups of thirty each. One group received spinal manipulative therapy and the remaining thirty were administered Diclofenac Sodium. These patients were carefully screened to allow the researcher to diagnose the patient, with Lumbar Facet Syndrome, Sacroiliac Syndrome or Myofascial Pain Syndrome; or any combination of these syndromes. This is in accordance with Kirkaldy-Willis (1992: 105 - 119) classification system. The thorough examination ensured that each patient had no contra-indications to spinal manipulative therapy or Diclofenac Sodium.