Chiropractic Manipulation or Medication for Low Back Pain?

What do you do when your lower back suddenly starts hurting enough to cause you to miss work and other activities? You may be tempted to try an easy fix by taking the pain medication in your medicine cabinet, but a recent study suggests you may be better off seeing a chiropractor or osteopathic physician for spinal manipulation instead.

A new study published in Spine revealed that treating acute, non-specific lower back pain with spinal manipulation therapy is more effective than the non-steroidal anti- inflammatory drug Diclofenac.1 Diclofenac 12.5 mg has been shown to be more effective than Ibuprofen 200 mg for lower back pain relief in an earlier study.2

See Lower Back Pain Symptoms, Diagnosis, and Treatment

Study design

A total of 93 patients with recent (<48 hours) acute back pain entered the study and were randomly assigned to one of three groups:

  • Spinal manipulation group. 35 patients received a standardized spinal manipulation and placebo Diclofenac.
  • Diclofenac Group. 36 patients received 50 mg Diclofenac three times per day along with sham manipulation.
  • Placebo Group. 22 patients received sham manipulation and placebo Diclofenac.
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Results point to spinal manipulation

Data were collected 12 weeks into the trial to measure self-rated disability, function, time off work, and the number of times a study participant was in enough pain to take a different medication not included in the study (rescue medication).

The main findings after 12 weeks were two-fold:

  • Spinal manipulation and Diclofenac were each more effective than placebo. In fact, the placebo group had such a large dropout rate due to high pain levels that investigators closed that arm of the study early.
  • Analysis of the results showed that the group receiving spinal manipulation fared significantly better than the group receiving Diclofenac.

The takeaway

It may be easier and less time consuming to take pain medicine to help your lower back pain, but spinal manipulation may be more effective.

Spinal manipulation is mainly provided by a chiropractor (DC) or an osteopathic physician (DO), and may be provided by other appropriately trained and accredited health professionals.

Learn more:

Understanding Spinal Manipulation

Osteopathic Medicine and Back Pain

How To Select The Best Chiropractor


  1. von Heymann, Wolfgang J. Dr. Med; Schloemer, Patrick Dipl. Math; Timm, Juergen Dr. RER, NAT, PhD; Muehlbauer, Bernd Dr. Med, "Spinal High-Velocity Low Amplitude Manipulation in Acute Nonspecific Low Back Pain: A Double-Blinded Randomized Controlled Trial in Comparison With Diclofenac and Placebo," Spine, Volume 38, Issue 7.
  2. Dreiser RL, Marty M, Ionescu E, Gold M, Liu JH, "Relief of acute low back pain with Diclofenac-K 12.5 mg tablets: a flexible dose, ibuprofen 200 mg and placebo-controlled clinical trial”, Int J Clin Pharmacol Ther., 2003 Sep;41(9):375-85.
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