Maintenance Care for Low Back Pain

Third-party payers, medical-model providers and other health care stakeholders who question the value of maintenance care, particularly for low back pain (LBP), should consider findings from a new study published in the journal Spine, which asks (and then answers) the question, "Does Maintained Spinal Manipulation Therapy for Chronic Non-Specific Low Back Pain Result in Better Long-Term Outcome?"

The study suggests patients with low back pain of at least six months duration experience greater improvement following one month (12 treatments) of spinal manipulative therapy (SMT) followed by "maintenance spinal manipulation" every two weeks for nine months than subjects who receive one month of SMT only (12 treatments) or 12 treatments of "sham" SMT for one month. Patients in the manipulation and manipulation-plus-maintenance groups improved with respect to pain and disability after one month compared to the sham group. After 10 months, only the group receiving maintenance care reported significant improvement, whereas the one-month-only group's pain and disability scores had returned "near to their pretreatment level."

According to the investigators, even greater differences were seen with respect to disability scores over the duration of the study: "By the end of the first phase [one month], SMT significantly reduced the disability score in the no-maintained-SMT group and maintained SMT when compared to the sham group. Analysis of the data after the 10-month period showed that while the disability score of the patients in the no-maintained-SMT group returned back nearly to their pretreatment level, the score was significantly lower in patients who received maintenance SMT. In the maintained SMT group, the disability score was reduced by an average of 18.98 points lower than baseline level."

Measurements of forward bending and lateral bending also revealed sustained improvements in subjects receiving maintenance SMT, while improvements in the no-maintenance group during the initial phase of care decreased to near the pretreatment level by the end of the second phase.

Source: Adapted from Senna MK, Machaly SA. Spine (published ahead of print), Jan. 17, 2011. doi: 10.1097/BRS.0b013e3181f5dfe0