"For the millions of Americans with chronic low back pain a silver bullet to alleviate the condition has yet to be identified a new study suggests.    Reviewing  studies comparing spinal manipulative therapy SMT to other treatments such as medication exercise or physical therapy researchers from the Netherlands found that SMT appears to be no better or worse than other options at relieving back pain longterm.    The analyses indicated that SMT  which involves manual manipulation of the spine and surrounding muscles  has only a shortterm impact on pain relief although it eases pain faster than other treatments.    In short no single therapy is better than another although some individuals are likely to have more success with one therapy than another said study author Sidney Rubinstein a research fellow at VU University Medical Center in Amsterdam.    Current studies are focusing on which subjects are more likely to benefit from spinal manipulation exercise or other therapies he added. Spinal manipulation should be considered a viable treatment option for those with nonspecific chronic low back pain.    The study was recently published in the journal Spine.    More than  patients were included in the compilation of results which the study authors said were sparse in data indicating participants overall recovery quality of life and ability to return to work. The studies also varied in quality with only nine of  considered low in bias according to background information accompanying the study.    In all evaluations patients were randomly assigned to SMT or another comparison treatment including active treatments such as exercise or inactive placebo treatments.    About twothirds of the studies were not included in a previous review published in  and all patients had suffered from lower back pain for  weeks or longer.    While chiropractors often perform SMT on patients it is also administered by physical therapists and osteopaths. But which treatment is right for any patient depends not only on their specific pain but their doctors recommendations and their own comfort level with various options said Stephen Perle a spokesman for the American Chiropractic Association.    The cost of SMT sessions varies widely depending on the region Perle said.    Nobody has the answer at this time Perle said. I guess people in almost every profession like to say We have a compelling treatment and it will work almost every time but thats just not the case.    With low back pain there are many reasons people dont get better added Perle also a professor of clinical sciences in the College of Chiropractic at the University of Bridgeport in Connecticut. So the finding was not unexpected.    An unrelated study of  patients with low back pain published July  in Annals of Internal Medicine suggested that massage may be better than medication or exercise for shortterm pain relief.    Seattle researchers found that those who received either relaxation massage or structural massage which involved manipulation of muscles and ligaments had less pain and better functioning for up to a year compared to those getting usual medical care which included medication and physical therapy.    More information  The U.S. National Institute of Neurological Disorders and Stroke has more information about low back pain.  SOURCES Sidney Rubinstein D.C. Ph.D. research fellow Institute for Research in Extramural Medicine VU University Medical Center Amsterdam the Netherlands Stephen M. Perle D.C. spokesman American Chiropractic Association and professor clinical sciences College of Chiropractic University of Bridgeport Conn. June   Spine"