Research Shows Spinal Manipulation Safe and Effective for Low Back Pain

With low back pain a primary cause of disability worldwide, it’s no wonder that it is a popular research topic.  Researchers in the field of low back pain treatments have conducted many similar studies to ensure that results are valid and not due to anomalies.  Using what they learn to develop parameters that delve into the how and why of their results, researchers can offer more detailed analysis and better recommendations for patients and providers.

From time to time, a gap in understanding is noted by study authors, leading researchers to look into conditions and treatments from a new perspective.  This is the case for a low back pain study published in May, 2023.  Researchers saw there were many studies related to treatments for the management of chronic low back pain.  These studies compared the safety and effectiveness of various nonpharmacological treatments. Other studies compared various pharmacological treatments.  And still more studies that compared more invasive treatments.  However, there was a lack of research that compared these categories of treatments against the other categories.  Therefore, researchers performed a systematic review and meta-analysis to create a more direct comparison.

Researchers collected over 17,000 records associated with randomized controlled trials through May, 2022.  These included trials for nonpharmacological, pharmacological and invasive treatments compared to placebo.  Subjects were adults with chronic, nonspecific low back pain and were evaluated at immediate term (≤2 weeks), and short-term (>2 weeks to ≤12 weeks).  Additionally, information for any serious adverse events was collected. Nonpharmacological treatments evaluated included acupuncture and spinal manipulation (commonly known as a chiropractic adjustment).  Pharmacological treatments included NSAIDs and opioid medications.  Invasive treatments included surgery and epidural corticosteroid injections.

After analysis, both acupuncture and spinal manipulation were found to be effective in reducing pain intensity compared to sham treatment.  Other treatments were scored as “uncertain” due to their not being proven effective, too much variation in the results to make a definitive conclusion or a lack of data to evaluate.

Acupuncture and spinal manipulation were also listed under the lowest harms level warnings (“indicating rarer risk of events”).  Among pharmacological and invasive treatments, NSAIDs, combination ingredient opioids, and steroid injections, also had lower harms level warnings compared to the higher ratings assigned to single ingredient opioid analgesics and surgery.

These findings led the researchers to conclude: “From the limited trials conducted, nonpharmacological interventions of acupuncture and spinal manipulation provide safer benefits than pharmacological or invasive interventions.”  They suggest additional studies of this type be conducted to confirm results and explore the areas where more data would be beneficial.

If you or a loved one is experiencing low back pain, or other musculoskeletal pain, talk to your chiropractor about how safe, natural chiropractic care may help.  Doctors of Chiropractic are trained to not only evaluate and make treatment recommendations, but also to work with other health care providers to provide the best possible outcome, while minimizing the risks associated with many medications and surgical procedures.  If you do not have a chiropractor, you can find a TCA member doctor near you at



Feise RJ, Mathieson S, Kessler RS, Witenko C, Zaina F, Brown BT. Benefits and harms of treatments for chronic nonspecific low back pain without radiculopathy: systematic review and meta-analysis. Spine J. 2023 May;23(5):629-641. doi: 10.1016/j.spinee.2022.11.003. Epub 2022 Nov 17. PMID: 36400393.