Benefit-Harm of Chiropractic Beats Medical Care for Back Pain

Researchers looking for methods to better evaluate treatment options for health conditions have developed the "Benefit-Harm Scale," and a recent study used this scale on back pain treatments to highlight which options provide the most benefit and least harm.

Some health conditions have multiple treatment options that could be utilized to benefit a patient, but it's important to balance not just benefit, but also harm. A treatment that can be helpful but has high risk of harm is unlikely to be the best choice. That's why the Benefit-Harm Scale was developed as an easy way to assess the potential benefit and risk of a treatment, and compare it to other options.

A recent study published in The Spine Journal, reviewed research for common back treatments, including chiropractic spinal manipulation, acupuncture, medication, injections, and surgery. The graphic below illustrates the benefit and harm of these treatment options for chronic low back pain.

Evidence Lacking for Many Back Pain Treatments

The most surprising result may be the lack of evidence to appropriately evaluate many of the treatments. The researchers found a lack of quality evidence supporting medications, injections, and surgery, and were therefore unable to evaluate the benefit of these options. Evidence evaluating harm was also lacking with most of the medications studied, while serious harms have been identified for opioids and surgery.

In contrast, both spinal manipulation and acupuncture have quality evidence of benefit and low harm risk. The study authors concluded that more research is needed to further evaluate the various treatment options, but based on available evidence "acupuncture and spinal manipulation provide safer benefits than pharmacological or invasive interventions" for chronic low back pain.