MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Yes, chiropractic spinal manipulation shows promise to alleviate symptoms of infant colic! At least, this is the result of an overview of systematic reviews of so-called alternative medicines (SCAMs) for infant colic. Here I focus merely on the part that deals with chiropractic spinal manipulation. The authors of the overview come to this result based mainly on the statement:

Spinal manipulation was assessed in six reviews [22, 23, 25,26,27,28]. Two multiple CAM reviews assessed manipulation but did not pool the results [22, 25]. Both found three trials to be effective [68, 69, 72, 73, or] with the exception of one [71].

And here are the references they cite (all the primary studies are on chiropractic manipulation):

22.Perry R, Hunt K, Ernst E. Nutritional supplements and other complementary medicines for infantile colic: a systematic review. Pediatrics. 2011;127:720–33.

23.Bruyas-Bertholo V, Lachaux A, Dubois J-P, Fourneret P, Letrilliart L. Quels traitements pour les coliques du nourrisson. Presse Med. 2012;41:e404–10.

24.Harb T, Matsuyama M, David M, Hill RJ. Infant colic—what works: a systematic review of interventions for breast-fed infants. J Pediatr Gastroenterol Nutr. 2016;62(5):668–86.

25.Gutiérrez-Castrellón P, Indrio F, Bolio-Galvis A, et al. Efficacy of Lactobacillus reuteri DSM 17938 for infantile colic. Systematic review with network meta-analysis. Medicine. 2017;96(51):e9375.

26.Dobson D, Lucassen PLBJ, Miller JJ, Vlieger AM, Prescott P, Lewith G. Manipulative therapies for infantile colic. Cochrane Database of Systematic Reviews. 2012;(Issue 12. Art. No.: CD004796)

27.Gleberzon BJ, Arts J, Mei A, McManus EL. The use of spinal manipulative therapy for pediatric health conditions: a systematic review of the literature. J Can Chiropr Assoc. 2012;56(2):128–41.

28.Carnes D, Plunkett A, Ellwood J, et al. Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses. BMJ Open. 2018;8:e019040.

68.Wiberg J, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled trial with a blinded observer. J Manip Physiol Ther. 1999;22(8):517–22.

69.Mercer C. A study to determine the efficacy of chiropractic spinal adjustments as a treatment protocol in the Management of Infantile Colic [thesis]. Durban: Technikon Natal,Durban University; 1999.

70.Mercer C, Nook B. The efficacy of chiropractic spinal adjustments as a treatment protocol in the management of infantile colic. In: Presented at: 5th Biennial Congress of the World Federation of Chiropractic. Auckland; 1999. p. 170-1.

71.Olafsdottir E, Forshei S, Fluge G, Markestad T. Randomized controlled trial of infantile colic treated with chiropractic spinal manipulation. Arch Dis Child. 2001;84(2):138–41.

And here is the relevant part of the overview’s conclusion:

Spinal manipulation shows promise to alleviate symptoms of colic, although concerns remain as positive effects were only demonstrated when crying was measured by unblinded parent assessors.

I have several concerns about this new overview:

  • My comments on the Canes paper are here and do not need repeating.
  • My comments on the Dobson paper (according to the overview authors, it is the best of all the reviews) are also available and need no repeating.
  • Reference 22 is a systematic review I did together with the lead author of the new overview while she was one of my co-workers at Exeter. It is not focussed on spinal manipulation, but on all SCAMs. Here is the relevant passage from our conclusions regarding spinal manipulation: The evidence for … manual therapies does not indicate an effect.

How the review authors could come to the verdict that spinal manipulation shows promise is thus more than a little mysterious. If we consider the following, it gets positively bewildering. Even the most rudimentary of searches on Medline will deliver a 2009 systematic review by myself entitled ‘Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials. It was the first systematic review on the subject but was not included in the new overview.

Why not?

I do not know.

Here are my conclusions from this paper:

Collectively these RCTs fail to demonstrate that chiropractic spinal manipulation is an effective therapy for infant colic. The largest and best reported study failed to show effectiveness (11). Numerous weaknesses of the primary data would prevent firm conclusions, even if the results of all RCTs had been unanimously positive.

And here is what my review stated about the three primary RCTs assessed in all the other review authors:

The trial by Wiberg et al. (10) did not attempt to blind the infants’ parents who acted as the evaluators of the therapeutic success. The paper provides little details about the recruitment process, but it is fair to assume that patients were asked to participate in a trial of spinal manipulation. Thus one might expect a degree of disappointment in parents of the control group whose children did not receive this treatment. This, in turn, could have impacted on the parents’ subjective judgements. In any case, there is no control for placebo effects which can be very different for a physical intervention compared with an oral placebo – dimethicone was administered as a placebo and the authors stress that it is ‘no better than placebo treatment’.

The RCT by Olafsdottir et al. (11) is by far the best-reported study of all the included RCTs. In many ways, it is a replication of Wiberg’s investigation (10) but on a larger scale with twice the sample size. It is the only study where a serious attempt was made to control for the placebo effects of spinal manipulations. For these reasons, its results seem more reliable than those of the other RCTs.

The RCT by Browning and Miller (12) is a comparison of two manual techniques both of which are assumed by the authors to be effective. Thus it is essentially a non-inferiority trial. Yet, it is woefully underpowered for such a design. Even if it had the necessary power, its results would be difficult to interpret because none of the two interventions have been proven to be effective. Thus, one would still be uncertain whether both interventions are similarly ineffective or effective. As it stands, the result simply seems to demonstrate that symptoms of infant colic lessen over time possibly as a result of non-specific therapeutic effects, the natural history of the disease, concomitant treatments, social desirability or a combination of these factors.

So, what should we conclude from all this? I am not sure – except for one thing, of course: I would not call the evidence for chiropractic spinal manipulation promising.

14 Responses to Chiropractic spinal manipulation shows promise to alleviate symptoms of infant colic? Surely not!

  • Entrepreneurial-theatrics-masquerading as healthcare.

  • one has to wonder if parental blinding is that big of an issue?

    “The findings showed that knowledge of treatment by the parent did not appear to contribute to the observed treatment effects in this study. Thus, it is unlikely that observed treatment effect is due to bias on the part of the reporting parent.”

    https://www.jmptonline.org/article/S0161-4754(12)00161-3/fulltext

  • I suffered from severe soreness in my right knee and swollen joints which eventually developed into such a painful condition, I could not lift my leg or put weight on it to walk. After trying several treatments, I finally went to a care clinic where x-rays showed advanced Arthritis/OA. My condition worsened with severe pains and stiffness, so a friend introduced me to Herbal Health Point (ww w. herbalhealthpoint. c om) and their Arthritis Formula treatment protocol, I immediately started on the treatment, few weeks into the treatment the pain and stifness were completely gone and I had regained complete use of my leg. The treatment totally reversed my Arthritis condition, since I completed the treatment 11 months ago I have not had any symptom or pain

    • this post is about infant colic
      this blog is about evidence – yours is an anecdote

      • EE

        C’mon Professor

        The purpose of this blog is to create doubt about CAM and Homeopathy so you can sell more books…. and you know it.

        Patients turn away from SBM for good reasons, and they will come back when and if they choose in their own time. .
        In the meantime, your blog, and your arguments will serve little to deter anyone searching for other beneficial therapies outside SBM.

        If you really want to serve the community, create a blog that focuses on the shortcomings and pitfalls of SBM, therein lies the potential to really help the sickened public.

        • @ RG on Saturday 23 November 2019 at 15:09

          The post is by Cosgrove is obviously an advertisement. It also appears on other websites but it doesn’t surprise me that you did not notice.

          The Prof doesn’t need to sell books; it is a labour of love dedicated to trying to scrape carbuncles, like you, off the weary feet of humanity. Does not the acronym SBM not register in your head as to its derivation. The same science that allows you to post on this blog. Why believe one and not another? (Sorry, I know that question is above you.)

  • @RG: you are a genius…of sorts. Perhaps you might point your “argument” towards Hahnemann and Palmer, 2 reprobates who certainly intended to “create doubt” about the competing theories of their day to sell more “books”. Perhaps in your imbecile-logic you could point to ONE scientific advance, one morsel of substantive NEW knowledge “Chiroquackery-science” or “homeopathetic-science” has contributed to the world stage….let’s say from 1960 to present.
    It appears D(umb) C(onfused) and the cast of chiroquackery and homeopathetic miscreants trying to defend their indefensible pecuniary reward systems can only delve deeper into TU Quoque and Strawman argumentation. Perhaps you as a self anointed know-it-all could help us poor slobs finally get to the truth.
    I await your pithy reply.

    • Michael Kenny

      Even though I use a couple of CAM therapies myself, I make no claims to be an advocate for CAM. You won’t find any of my post here making any claims about acupuncture or chiropractic…. or many of the other therapies mentioned here. Even the CAM therapies I have found beneficial for myself, I don’t push here. Neither am I here to prove anything scientific…. you can keep that for yourself and your buddies.

      I only acknowledge that the failures of SBM have turned millions to search out other solutions to their illnesses, including me and my family. When SBM fails or doesn’t have good solutions, can you blame anybody for looking elsewhere ?
      SBM needs to end the charade.

      Perhaps if SBM got it’s shit together, and started actually healing people, rather than making them worse. At that point perhaps sick patients would stick with SBM, and end the controversy.

      • “Perhaps if SBM got it’s shit together, and started actually healing people, rather than making them worse. At that point perhaps sick patients would stick with SBM, and end the controversy.”

        Perhaps a bout of bowel cancer might change your mind. or would you refuse SBM treatment out of principle? My cancer riddled brother-in-law was given 12 months with no chemo and two years with. Four years later, he doesn’t like the effects of chemo but he prefers that to being under the grass looking up.

        At this point, you are nothing more than another dopey troll with nothing useful to contribute except nonsense.

  • Although the situation had never come up I would never consent to letting my infant have a spinal manipulation where I was not present. In fact I would want to be present for any medical treatment except where it’s directly contradicted (e.g. surgery in a sterile operating theater).

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