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

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)
  • Fibromyalgia
  • 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 : 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 (: low). Approximately a quarter of the patients had comorbid migraine.

HARMS

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.

18 Responses to Spinal manipulation for chronic pain: an important update

  • All of the usual culprits will pop up with the same unsubstantiated nonsense in support of chiro, without realising their stupidity is on full display.

    In Victoria (Australia), a former health minister is a chiro so the insidious incursion occurs everywhere. I roll my eyes every time the moron is on a media report, as I do when chiros and supporters post complete crap here. Perhaps an untreated personal dose of polio might change their mind about medicine but I would not hold my breath.

  • “Our report focuses on single interventions. It is unclear to what extent our findings represent conditions under which the various interventions are currently delivered.”

  • SMT for Chronic LBP is certainly not a stand alone treatment.

    • surgery for appendectomy is also not a stand alone treatment – and yet we have to assess the surgery when we want to know whether surgeons do any good for pts with an inflamed appendix.

      • If it was only that simple.

        • luckily, we have some chiros who are able to understand even the most complex matters!

          • Maybe someday some skeptics will catch up.

          • chiropractic = the art of being confident about the worst BS?
            Dunning and Kruger send their regards.

          • Right.

            Not So Golden After All: The Complexities of Chronic Low Back Pain in Older Adulthood. Gerontologist 2018 Sep 14;58(5):923-931.

            Chronic Low Back Pain Is Highly Individualised: Patterns of Classification Across Three Unidimensional Subgrouping Analyses. Scand J Pain. 2019 Jun 29

            Unraveling the Complexity of Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy
            November 1, 2016 Volume 46 Issue 11 Pages 932-937.

            Rehabilitation for Low Back Pain: A Narrative Review for Managing Pain and Improving Function in Acute and Chronic Conditions. Pain and Therapy volume 9, pages 83–96(2020)

          • so?
            only chiros who understand this?

  • True

    Also looking for a treatment for chronic LBP is like looking for a treatment for persistant abdominal pain… This is not a diagnosis

    • Nor is it just a low back problem and the outcome measures may need to be expanded to grasp “success”.

      Example.

      Nevertheless, we conclude from the evidence thus far that chronic low back pain and sciatica resulting from LDH can induce structural and functional alterations of the cerebral cortex that are potentially reversible after successful treatment.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590233/#!po=0.00000

      • @DC
        Oh my. I ventured to read this Luchtmann and Fiersching paper. I shouldn’t have. It is a cavalcade in speculation and conjecture. The methodology is tricky and trecherous, resulting in very inconsistent findings. Reminds strongly of the dead salmon experiment. They admit in so any words that they have no idea what they really are observing with their advanced tehnology but nonetheless try to draw conclusions from extremely inconsistent findings using what definitely is no more than wishful thinking.

        • I thought they were clear…

          “Despite all of these remarkable findings, the results nevertheless have to be interpreted with caution. The underlying cytoarchitectonic cause of these morphological alterations is still unknown.”

  • Before rushing to condemn chiropractic, consider the evidence of the effectiveness of sham surgery for back pain. There are many studies showing that sham is often as effective as real surgery, due to the placebo effect. https://www.advisory.com/daily-briefing/2017/08/03/sham-surgery

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