Oh my achin' back.

Back pain accounts for a whole lot of misery, missed work, missed workouts, and crabby moods. What do you do when your back hurts? Hit the bed? Call your orthopedist? Call the chiropractor? Growl and groan?

Researchers at the University of Washington, Seattle, and the University of Alberta, Canada, compared physical therapy, chiropractic manipulation, and the effect of an education booklet on patients with low back pain. The study included 321 patients aged 20 to 64 whose low back pain persisted two weeks after seeing their primary care doctor. The study did not include patients with sciatic nerve pain.

Participants were divided into three groups--two treatment groups and one group receiving only an education booklet. The patients were treated either with physical therapy or chiropractic manipulation for one month, or up to nine sessions. All participants were observed for two years. Patients were rated on how bothersome their symptoms were and their level of disability.

The two treatment groups were only slightly more effective than the education booklet. For all outcomes, there was no significant difference between the physical therapy group and the chiropractic group. The treatment groups were both happier with the care they received than the booklet group. About 75% of the subjects in the treatment groups rated their care as very good or excellent. Only about 30% of the booklet group felt that satisfied. Well, that was predictable.

Eliminating patients with nerve root (sciatic) pain, leaves a group of patients who nearly always get better on their own. Some physicians believe that for those patients, excessive hands-on therapy conveys the message that there is something seriously wrong. For them, cost effective patient education literature may be a wise use of resources.

(The New England Journal of Medicine, 1998, Vol. 339, No. 15, pp. 1021-1029)