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

The current Cochrane review of clinical trials testing the effectiveness of manipulation/mobilisation for neck pain concluded as follows:

Although support can be found for use of thoracic manipulation versus control for neck pain, function and QoL, results for cervical manipulation and mobilisation versus control are few and diverse. Publication bias cannot be ruled out. Research designed to protect against various biases is needed. Findings suggest that manipulation and mobilisation present similar results for every outcome at immediate/short/intermediate-term follow-up. Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate/intermediate/long-term follow-up. Since the risk of rare but serious adverse events for manipulation exists, further high-quality research focusing on mobilisation and comparing mobilisation or manipulation versus other treatment options is needed to guide clinicians in their optimal treatment choices.

Such a critical assessment must be tough for chiropractors who gain a substantial part of their income from treating such patients. What is the solution? Simple, convene a panel of chiros and issue recommendations that are more prone to stimulate their cash flow!

Exactly that seems to have just happened.

The purpose of the researchers was to develop best-practice recommendations for chiropractic management of adults with neck pain.

A steering committee of experts in chiropractic practice, education, and research drafted a set of recommendations based on the most current relevant clinical practice guidelines. Additional supportive literature was identified through targeted searches conducted by a health sciences librarian. A national panel of chiropractors representing expertise in practice, research, and teaching rated the recommendations using a modified Delphi process. The consensus process was conducted from August to November 2018. Fifty-six panelists rated the 50 statements and concepts and reached consensus on all statements within 3 rounds.

The statements and concepts covered aspects of the clinical encounter, ranging from informed consent through diagnosis, assessment, treatment planning and implementation, and concurrent management and referral for patients presenting with neck pain.

The authors concluded that these best-practice recommendations for chiropractic management of adults with neck pain are based on the best available scientific evidence. For uncomplicated neck pain, including neck pain with headache or radicular symptoms, chiropractic manipulation and multimodal care are recommended.

Let’s be clear what this amounts to: a panel of highly selected chiropractors (sponsored by a chiropractic organisation) has reached a consensus (and published it in a chiropractic) which allows them to continue to treat patients with neck pain.

Isn’t that just great?

Now let’s think ahead – what next?

I suggest the following:

  1. A panel of homeopaths recommending homeopathy.
  2. A panel of faith healers recommending faith healing.
  3. A panel of crystal healers recommending crystal healing.
  4. A panel of colon therapists recommending colonic irrigation.
  5. A panel of supplement manufacturers recommending to buy supplements.

I am sure you get the gist.

 

 

5 Responses to Surprise, surprise! Chiropractors recommend chiropractic management of neck pain

  • Note what this paper did not consider: “Best-Practice Recommendations for Management of Patients With Neck Pain.”

    Instead, the paper considered “ chiropractic management” – perversely and uncritically accepting the premises behind ‘chiropractic’. Such an approach lacks professional integrity.

    ‘Chiropractic’ is a system of healthcare devised by its originator as “different from medicine”. D. D. Palmer held séances to contact a dead physician named Jim Atkinson and stated that those séances helped him develop chiropractic – as he wrote in his 1914 book The Chiropractor:
    “The knowledge and philosophy given me by Dr. Jim Atkinson, an intelligent spiritual being, together with explanations of phenomena, principles resolved from causes, effects, powers, laws and utility, appealed to my reason. The method by which I obtained an explanation of certain physical phenomena, from an intelligence in the spiritual world, is known in biblical language as inspiration. In a great measure The Chiropractor’s Adjuster was written under such spiritual promptings.”

    I appreciate some chiropractors have ‘moved on’ from these beliefs, but then they can hardly be said to be chiropractors any more, can they? Just as MD’s are not witch doctors, shamans or leeches which once they were.

    Chiropractors who have ‘moved on’ are physical therapists – which is what they could have trained and qualified to be in the first place, without wasting time and trouble studying an anachronistic system
    Or, if they were keen on the appellation ‘Dr’ they could have qualified in medicine, and then specialised in musculo-skeletal work if they so wished.

    There is no plausible ‘scientific evidence’ that managing adults with neck pain by using the (very short) lever arms of cervical spinous or transverse processes to ‘adjust subluxations’ has any benefit over treatment by physical therapists.

    The only reason I can think of for any person wishing to be a ‘chiropractor’ is the desire to be associated with an effective system for marketing of an alternative healthcare system, and securing financial advantage from patients who do not understand the history, philosophy and implications of ‘chiropractic’ (which are usually rendered covert, thus obviating the chiropractor’s obligation to obtain informed consent before treatment).

    What other reasons are there?

    This paper represents an excellent example of circular reasoning – and an enormous logical fallacy.

  • Silly criticism.

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