As mentioned before, the US ‘Agency for Healthcare Research and Quality (AHRQ) have published a most comprehensive review update entitled ‘Noninvasive Nonpharmacological Treatment for Chronic Pain‘. It followed the AHRQ Methods Guide for Effectiveness and Comparative Effectiveness. The conditions included were:
- Chronic low back pain
- Chronic neck pain
- Osteoarthritis (knee, hip, hand)
- Chronic tension headache
Here are the main findings related to spinal manipulation:
LOW BACK PAIN
- Spinal manipulation was associated with small improvements compared with sham manipulation, usual care, an attention control, or a placebo intervention in short-term (3 trials) and intermediate-term (3 trials) function (strength of evidence SOE: low). There was no difference between spinal manipulation versus sham manipulation, usual care, an attention control, or a placebo intervention in short-term pain (3 trials), but manipulation was associated with a small improvement compared with controls on intermediate-term pain (3 trials) (SOE: low for short term, moderate for intermediate term).
CHRONIC TENSION HEADACHE
- Spinal manipulation therapy was associated with small improvements in function and moderate improvements in pain compared with usual care over the short term in one trial (SOE: low). Approximately a quarter of the patients had comorbid migraine.
It was noted that many trails failed to report on adverse effects (AEs). Non- serious AEs reported included mild to moderate increase in pain, local discomfort and tiredness (2 RCTs).
Hardly impressive, is it?
Yet, some chiropractors treating chronic pain claim they practice Evidence-based medicine. This review seems to disclose this claim as bogus. What chiropractors do practice on virtually all patients is spinal manipulation which generates more harm than it produces benefit.
Please note yet again that:
- many chiro trials fail to mention AEs (thus violating research ethics),
- clinical trials are always too small to give a reliable impression about safety,
- no post-marketing surveillance exists in chiropractic,
- we thus have to rely mostly on case reports and similar articles,
- and the collective evidence from such reports shows quite clearly that spinal manipulations are not safe,
- chiropractors tend to deny all of the above,
- this is because they have a monumental conflict of interest.