The average number of hours of pain suffered by the patients was reduced from nearly 19 hours a day to less than 5 hours. The number of analgesics was also reduced from over 6 tablets per day to half a tablet. Not surprisingly, all of the patients were satisfied with the treatment they received. DR Aswani concluded: " Our study demonstrates the considerable benefit of having an osteopath service available on the NHS."

The first systematic review to suggest that manipulation offers an effective approach for chronic low back pain is reported in Spine (vol. 22, Number 18, September 1997, pp2128-2156). The report covers a systematic review of 150 randomised controlled trials for the treatment of acute and chronic low back pain. Less than 35% of the trials for acute pain and less than 25% for chronic pain were considered valid under the criteria applied by the report's authors. However, valid trials demonstrated strong evidence for the effectiveness of manipulation, back schools and exercise therapy for chronic presentations, especially for short-term effects.

The new trial has shown that spinal manipulation is more effective than ultrasound in the treatment of chronic low back pain."The purpose of the study was to compare the effects of short-and long-term spinal manipulation therapy to ultrasound and to investigate the effect of spinal manipulation on the lumbar muscle endurance," said DR Mohammed Mohseni-Bandpei, visiting fellow at the University of East Anglia in Norwich.

At six months, functional disability was reduced from 30% to 12% among experimental subjects and decreased from 32 to 22% among controls. "At the end of the treatment, we found both groups improved on all outcome measures, but the experimental subjects saw greater improvements," DR Mohseni-Bandpei said. "At six months follow-up, the results remained the same."

A review of studies into the osteopathic treatment of headaches has found that spinal manipulation can be an effective way of treating certain types of headache pain. The researchers reviewed the results of nine trials involving a total of 683 patients with chronic headache, they noted that spinal manipulation had a short-term pain-relieving effect similar to the tricyclic anti-depressant amitriptyline on both chronic tension-type and migraine headaches. Spinal manipulation was also more effective than massage for neck-related headaches. The results suggest, said the researchers, that spinal manipulative therapy (SMT) appeared to provide an effective alternative to drug treatments (J Manip Physiol Ther, 2001: 24: 457-66).

A trial in Canada has found that patients with low back pain might do better to stay on the move instead of taking bed rest and physiotherapy. Doctors have found during clinical trials of common treatments for acute back pain that they could be doing more harm than good. The trial found that patients who were put on bed rest spent an average of three days longer in bed than other patients but took 42 per cent longer to get back to normal activities. The trial also found on a long-term follow-up that physiotherapy combined with an education progamme had a harmful effect.

One of the authors of the paper published in the BMJ, Professor J Gilbert at the department of family medicine at McMaster University in Ontario said, "There is little reason to prescribe either bed rest or isometric exercises to patients in family practice who suffer from low back pain. Assessment favoured early mobilisation over bed rest and suggested that physiotherapy and an education programme was doing more harm than good".

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