This multicentre pragmatic randomized controlled trial evaluated the effectiveness and cost-effectiveness of physiotherapy, chiropractic care, and the combination of physiotherapy and chiropractic care compared with information and advice for the treatment of patients with nonspecific chronic low-back pain (CLBP) in Sweden.
Eighty-eight participants with nonspecific CLBP were randomly assigned to receive physiotherapy, chiropractic care, combination treatment, or information and advice. The Oswestry Disability Index (ODI), health-related quality of life (HRQoL), quality-adjusted life-years (QALYs), working status, and costs were the main outcome measures.
The study revealed no statistically significant differences in any of the outcome measures when physiotherapy, chiropractic care, and combination treatment with information and advice were compared (p > 0.05). The ODI changes between baseline and the 6-month follow-up ranged from 6.13 to 12.56 across the treatment groups, indicating reduced disability in all groups. Compared with the other treatment options, the combination treatment resulted in the greatest QALY gain (0.418) and lowest cost (SEK 3,081).
The authors concluded that, compared with alternative standalone treatment options, the combination treatment strategy resulted in greater QALY gain and lower costs from a heath care perspective. Although the study did not detect statistically significant differences in outcomes or costs among the treatment options, the combination treatment showed promising potential for cost-effectiveness. Given the small sample size and low statistical power of the study, further clinical trials with fewer treatment arms and a focus on the combination group are warranted to confirm these findings. The insights gained from this study are important for informing the design and conduct of future clinical studies investigating the effectiveness, costs and cost-effectiveness of treatments for CLBP.
I have said it countless times before – but I will say it again: we are all not very effective in curing CLBP. In terms of effectiveness, it therefore hardly matters what treatment we opt for. In this situation, our preference should be guided not by the (in)effectiveness of the therapy but by its
- safety,
- cost,
- availability.
If you apply these criteria, one thing seems very clear:
CHIROPRACTIC CANNOT BE THE TREATMENT OF CHOICE FOR CLBP.
17 Responses to Chiropractic cannot be the treatment of choice for chronic low back pain
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Chiropractic treating low back pain?
Dangerous, useless,unscientific ,risky ,silly nonsense…regardless of with part of ones body they mess with. Such a complete joke! Oh wait….they have that clicker gadjet that makes noise.
Save your money and go get a massage.
… and they very often manipulate the neck even when you only have low back pain!
“very often”?
how often?
My 30+ years in practice as a well-paid doctor-of-quackphonery allows me to say this directly and not as hearsay….
Chiropractic doesn’t work except as a placebo. It is and always was clinical theatrics masquerading as a scientific endeavor.
My experience visiting 1000’s of clinics over a 20 year time frame is absolutely honest in the assessment that a vast majority +85% manipulate (or other pointless “adjustment -techniques”) the neck and random thoracic vertebrae WHENEVER a gullible mark is laying in front of them with LBP.
Most insurers pay more for more area-manipulations.
And the absurd philosophy of course also dictates the “need” to find and “eliminate subluxations” wherever they are found.
One could look at the research rather than personal observation.
Overall, around 50% of chiropractic insurance claims are for 98941 (a little higher with geriatrics and women)
Around 25% of the population with LBP also have neck pain.
Medicare (and some other insurance companies) do not require pain in a region for an adjustment to be clinically indicated.
Of course “very often” is vague and is typically used by those who are not familiar with the research.
Dear chiro‑troll,
Consequently, information obtained from Medicare etc. will give a distorted view of chiropractic cervical spine manipulation as it is used worldwide in association with low back pain.
Your failure to provide evidence for your bald assertions is noted.
In reality, once is too often for you charlatans to be touching anyone. Any injury by any chiro is one injury too many.
One chiro is one too many. There is a level of cognitive dissonance among chiros goes beyond simple mental illness. Palmer was a conman and convicted fraudster who even stole the idea from another crackpot Still, but all of this is seemingly opaque to the feeble-minded minded lot of chiros. JFHC, how can so obvious a reality be ignored?
How often?
Every time I’ve visited a chiropractor over the decades.
You appear to know sod all about chiropractic as it’s practised outside of your business premises, however, you have a history of telling porkies on Edzard’s blog, using various pseudonyms, since 2016 or earlier.
What the hell is the established “the benefit is worth the risk” of chiropractic cervical spine manipulation applied during maintenance treatment for chronic low back pain (rhetorical question). Let me think… Oh, it’s the signature theatrics: to elicit the cracking noises that are supposed to maintain the client’s belief that this Doctor of Cosplay is in fact a real doctor who knows more about the spine than do non-chiropractic doctors.
I thank you again for your pathetic attempts to whitewash your ‘profession’; behaviour that enabled me to see it for the crock of …. that it truly is.
DC wrote: “how often?”
It is on record that many chiropractic patients have their necks manipulated for problems unrelated to head and neck pain, such as low-back pain and general health problems or for “maintenance care” on asymptomatic patients. In fact, one paper found that around 89% of cervical manipulations are inappropriate and overlooking serious adverse events arising from them will lower incidence rates, probably quite dramatically, resulting in a false impression of the procedure’s safety profile. Bearing in mind that chiropractic ‘subluxations’ are fictitious lesions, here’s what Professor Ernst had to say in his 2009 paper ‘Spinal manipulation for the early management of persistent non-specific low back pain — a critique of the recent NICE guidelines’ which was published in the International Journal of Clinical Practice:
QUOTE
“It is true that serious complications occur mostly (not exclusively) after upper spinal manipulation. So the guideline authors felt that they could be excluded. This assumes that a patient with lower back pain will not receive manipulations of the upper spine. This is clearly not always the case. Chiropractors view the spine as an entity. Where they diagnose ‘subluxations’, they will normally manipulate and ‘adjust’ them (11). And ‘subluxations’ will be diagnosed in the upper spine, even if the patient suffers from back pain. Thus many, if not most back pain patients receive upper spinal manipulations. It follows that the risks of this treatment should be included in any adequate risk assessment.”
Ref. http://tinyurl.com/6b6nkzg
Reference (11) is Ernst E. Chiropractic: a critical evaluation. J Pain Sympt Man 2008; 35: 544–62. Page 6 of that paper mentions a report that indicates that only 11% of all cervical manipulations are “appropriate” and references Coulter I, Hurwitz E, Adams A, et al. The appropriateness of manipulation and mobilization of the cervical spine. Santa Monica, CA: RAND, 1996:18e43.
BW: it comes down to how one determines if manipulation is considered clinically appropriate.
DC wrote: “BW: it comes down to how one determines if manipulation is considered clinically appropriate.”
@ DC
Cervical spine manipulations should never be deemed appropriate given that the procedure’s risk/benefit profile is unfavourable (and you’ve been on this blog long enough to know it).
As you should know the majority of the risk is performing cSMT in the presence of contraindications or improper technique. That’s practitioner error.
Regardless, the question was the claim of “very often”. It appears to be less than 50% file 98941 and a fair share have both neck and low back pain. Others without neck pain can fulfill Medicare requirements.
Thus I question the “very often” claim and probably few have cervical manipulation without any clinical findings.
But I am open to review evidence that suggests otherwise.
DC wrote: “the majority of the risk is performing cSMT in the presence of contraindications…”
@DC
You do know that there are no reliable screening methods available to eliminate those who might predisposed to being seriously harmed, don’t you? Ergo, why isn’t the intervention being discarded?
There are absolute contraindications to cSMT. Of course if they are missed upon a history and exam it increases the probability of a serious adverse event. It appears with most published cases they fall under that category.
But we’ve been thru all of this before.
“It appears to be less than 50% file 98941”
When chiro‑troll omits evidence to support its anonymous assertions, there’s invariably a reason; such as lying by omission.
Group 1 Codes [my emphasis]
98940 CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 1-2 REGIONS
98941 CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 3-4 REGIONS
98942 CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 5 REGIONS
Sigh
98940 may or may not include the cervical spine
98941 most likely includes the cervical spine
98942 must include the cervical spine.
Your tripe response adds nothing to the discussion, as usual.
“may or may not” “most likely”
You cannot extract cervical spine manipulation information from that coding, bluffer.
And you still haven’t backed any of your anonymous bald assertions with evidence. Perhaps the wording of the red banner is too complicated for you.
Your promotion of chiropractic cervical spine manipulation, on a thread started by David Nette, is disgusting. You really are a vile creature.