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Interpretation: "Patients with acute low back pain receiving recommended first-line care do not recover more quickly with the addition of diclofenac or spinal manipulative therapy….These results are important because both diclofenac and spinal manipulative therapy have potential risks and additional cost for patients. If patients have high rates of recovery with baseline care and no clinically worthwhile benefit from the addition of diclofenac or spinal manipulative therapy, then GPs can manage patients confidently without exposing them to increased risks and costs associated with NSAIDs or spinal manipulative therapy." Hancock MJ, Maher CG, Latimer J, McLachlan AJ, Cooper CW, O Day R, et al., The Lancet 2007; 370:1638-1643 (November 2007) [pdf] [An accompanying editorial noted: (1) Systematic reviews had concluded that NSAIDS and spinal manipulation were more effective than placebos. However, the patients in the reviewed studies did not have optimum first-line care, and the apparent benefit was not large, and (2) Advice to remain active and prescription of paracetamol will be sufficient for most patients with acute low back pain. (Koes BW. Evidence-based management of acute low back pain. Lancet 370:1595-1596 2007)]