Spinal Manipulation vs. Diclofenac for Acute Low Back Pain

Spinal High-Velocity Low Amplitude Manipulation in Acute Nonspecific Low Back Pain: A Double-Blinded Randomized Controlled Trial in Comparison With Diclofenac and Placebo

Spine, April 2013;38(7):540-48.

Von Heymann, Wolfgang J. Dr. Med^*; Schloemer, Patrick Dipl. Math^†; Timm, Juergen Dr. RER, NAT, PhD^†; Muehlbauer, Bernd Dr. Med^*


 A recent article in Spine Journal, one of the most renown Scientific Journals for Spinal Disorders, compared the effects of Spinal Manipulation, high velocity low amplitude thrust, vs. Diclofenac in a Double Blinded RCT.

Diclofenac is a common NSAID (non-steroidal Anti-inflammatory) drug taken to reduce inflammation and as an analgesic.

A total of 101 patients with acute low back pain, defined as less than 48 hours in duration, were recruited from 5 outpatient clinics. The subjects were randomized to 3 groups: (1) spinal manipulation and placebo-diclofenac; (2) sham manipulation and diclofenac; (3) sham manipulation and placebo-diclofenac.

Thirty-seven subjects received spinal manipulation, 38 diclofenac, and 25 no active treatment. The placebo group with a high number of dropouts for unsustainable pain was closed praecox. Comparing the 2 active arms with the placebo group the intervention groups were significantly superior to the control group. Ninety subjects were analyzed in the collective intention to treat. Comparing the 2 intervention groups, the manipulation group was significantly better than the diclofenac group (Mann-Whitney test: P = 0.0134). No adverse effects or harm was registered.

Conclusion. In a subgroup of patients with acute nonspecific LBP, spinal manipulation was significantly better than nonsteroidal anti-inflammatory drug diclofenac and clinically superior to placebo.