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No evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain. Annals of Internal Medicine (June 2003) The definitive meta-analysis of spinal manipulation for back pain. "This is the most thorough and thoughtful analysis of this subject ever published…. According to a recent cost evaluation chiropractic care for back pain is about twice as expensive as medical care and we also know of serious and rare complications associated with spinal manipulation. Thus, spinal manipulation is an unlikely candidate for the treatment of choice for back pain….. Among other things, (this meta-analysis) should prompt those experts that are responsible for writing guidelines on therapy for back pain to check carefully whether their recommendations regarding spinal manipulation are truly evidence-based." E. Ernst, Focus on Alternative and Complementary Therapies (FACT), December 2003]