BACKGROUND CONTEXT: Acute back pain and sciatica are major sources of disability. Many medical interventions are available, including manipulations, with conflicting results.

PURPOSE: To assess the short- and long-term effects of spinal manipulations on acute back pain and sciatica with disc protrusion.

STUDY DESIGN/SETTING: Randomized double-blind trial comparing active and simulated manipulations in rehabilitation medical centers in Rome and suburbs.

PATIENT SAMPLE: 102 ambulatory patients with at least moderate pain on a visual analog scale for local pain (VAS1) and/or radiating pain (VAS2).

OUTCOME MEASURES: Pain-free patients at end of treatment; treatment failure (proportion of patients stopping the assigned treatment for lack of effect on pain); number of days with no, mild, moderate, or severe pain; quality of life; number of days on nonsteroidal anti-inflammatory drugs; number of drug prescriptions; VAS1 and VAS2 scores; quality of life and psychosocial findings; and reduction of disc protrusion on magnetic resonance imaging.

METHODS: Manipulations or simulated manipulations were done 5 days per week by experienced chiropractors, with a number of sessions which depended on pain relief or up to a maximum of 20, using a rapid thrust technique. Patients were assessed at admission and at 15, 30, 45, 90, and 180 days. At each visit, all indicators of pain relief were used.

RESULTS: A total of 64 men and 38 women aged 19-63 years were randomized to manipulations (53) or simulated manipulations (49). Manipulations appeared more effective on the basis of the percentage of pain-free cases (local pain 28 vs. 6%; p<.005; radiating pain 55 vs. 20%; p<.0001), number of days with pain (23.6 vs. 27.4; p<.005), and number of days with moderate or severe pain (13.9 vs. 17.9; p<.05). Patients receiving manipulations had lower mean VAS1 (p<.0001) and VAS2 scores (p<.001). A significant interaction was found between therapeutic arm and time. There were no significant differences in quality of life and psychosocial scores. There were only two treatment failures (manipulation 1; simulated manipulation 1) and no adverse events.

CONCLUSIONS: Active manipulations have more effect than simulated manipulations on pain relief for acute back pain and sciatica with disc protrusion.

OBJECTIVE:The purpose of this study was to compare the clinical efficacy of spinal manipulation against microdiskectomy in patients with sciatica secondary to lumbar disk herniation (LDH).

METHODS:One hundred twenty patients presenting through elective referral by primary care physicians to neurosurgical spine surgeons were consecutively screened for symptoms of unilateral lumbar radiculopathy secondary to LDH at L3-4, L4-5, or L5-S1. Forty consecutive consenting patients who met inclusion criteria (patients must have failed at least 3 months of nonoperative management including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy, and/or acupuncture) were randomized to either surgical microdiskectomy or standardized chiropractic spinal manipulation. Crossover to the alternate treatment was allowed after 3 months.

RESULTS:Significant improvement in both treatment groups compared to baseline scores over time was observed in all outcome measures. After 1 year, follow-up intent-to-treat analysis did not reveal a difference in outcome based on the original treatment received. However, 3 patients crossed over from surgery to spinal manipulation and failed to gain further improvement. Eight patients crossed from spinal manipulation to surgery and improved to the same degree as their primary surgical counterparts.

CONCLUSIONS:Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.

OBJECTIVE: This study evaluated the effectiveness of massage therapy as a component in increasing range of motion (ROM), decreasing pain and assisting in healing of a client with low back pain (LBP) and sciatica symptoms. METHODS: The client presented with an insidious onset of LBP and pain that radiated into the right lower extremity (sciatica). The client had been experiencing this pain daily for the past 9 months. Frequency, duration, and intensity of symptoms were recorded in a daily diary beginning the day after the client's first visit with the massage therapist. Manual therapy was administered once a week; each session lasted 45 min and consisted of a structured protocol directed mainly toward muscles of the lumbar spine, pelvis, thigh, and leg regions. RESULTS: The results of this study suggest that massage therapy was effective at reducing LBP intensity and increasing ROM for this particular client. LBP intensity was assessed at level one the first three assessment periods. The reduction in post-massage LBP intensity was maintained from week six until week 10 with the exception of week six (no change) and week seven (pain increase due to intense trigger point treatment). The client's activities of daily living (ADLs) steadily increased throughout the 10-week study. CONCLUSION: The distinct techniques and stretches used during the course of this study have the possibility of becoming useful, non-pharmacological interventions for reducing or eliminating pain and sciatica symptoms associated with low back pain.

Background. Sciatica is one of the most frequently reported complaints; it affects quality of life and reduces social and economic efficacy. Clinical studies on the efficacy of acupuncture therapy in sciatica are increasing, while systematic reviews assessing the efficacy of acupuncture therapy are still lacking. Objective. This study aims to assess the effectiveness of acupuncture therapy for sciatica. Methods. Comprehensive searches of 8 databases were conducted up until April 2015. Outcomes included effectiveness (proportion of patients who improved totally or partly in clinical symptoms), pain intensity, and pain threshold. Effect sizes were presented as risk ratio (RR) and mean difference (MD). Pooled effect sizes were calculated by fixed effects or random effects model. Results. A total of 12 studies (involving 1842 participants) were included. Results showed that acupuncture was more effective than conventional Western medicine (CWM) in outcomes effectiveness (RR 1.21, 95% CI: 1.16-1.25), pain intensity (MD -1.25, 95% CI: -1.63 to -0.86), and pain threshold (MD: 1.08, 95% CI: 0.98-1.17). Subgroup and sensitivity analysis found that the results did not change in different treatment method and drug categories substantially. The reported adverse effects were acceptable. Conclusions. Acupuncture may be effective in treating the pain associated with sciatica.

OBJECTIVE: To observe the relation between the pain threshold and the therapeutic effects of acupuncture for sciatica. METHODS: 90 sciatica patients were equally divided at random into the following 3 groups: a warming acupuncture group treated with the needles warmed by burning moxa, a western medicine group administered Nimesulide tablets and a point-injection group with Anisodamine injected. The pain threshold was tested before treatment and after the first, second and third treatment courses. RESULTS: The warming acupuncture therapy showed better therapeutic effects than the other two groups with significant differences in the change of pain threshold and the improvement of clinical symptoms and signs (P<0.01). CONCLUSION: Acupuncture can relieve the symptoms of sciatica with the increase of pain threshold.

OBJECTIVE: To observe the relation between the pain threshold and the therapeutic effects of acupuncture for sciatica. METHODS: 90 sciatica patients were equally divided at random into the following 3 groups: a warming acupuncture group treated with the needles warmed by burning moxa, a western medicine group administered Nimesulide tablets and a point-injection group with Anisodamine injected. The pain threshold was tested before treatment and after the first, second and third treatment courses. RESULTS: The warming acupuncture therapy showed better therapeutic effects than the other two groups with significant differences in the change of pain threshold and the improvement of clinical symptoms and signs (P<0.01). CONCLUSION: Acupuncture can relieve the symptoms of sciatica with the increase of pain threshold.