back pain
This double-blind, randomized, placebo-controlled trial compared the effects of individualized homeopathic medicinal products (IHMPs) and placebo after 4 months of intervention in patients with chronic low-back pain (LBP).
- the small sample size might have the result unreliable;
- the marginal level of statistical significance;
- the fact that 5+5+8+13=31 and not 30;
- the fact that the study originated from India where hardly any negative studys of homeopathy see the light of day;
- the fact that allmost all of the many authors of this paper are affiliated with homeopathic institutions;
- the existance of a strangely similar study that has recently reported largely negative results.
This open-label, randomized, controlled trial was aimed to assess the effectiveness and safety of Vuong Hoat (VH) natural health supplement for reducing the negative impact of low back pain, improving the quality of life, and enhancing functional activities in patients with lumbar degenerative disc disease (LDD).
The study involved 60 patients suffering from low back pain caused by LDD. The participants were randomly assigned to:
- a study group (SG) comprising 30 subjects who received VH in conjunction with the same electro-acupuncture,
- a control group (CG) comprising 30 subjects who received treatment with electro-acupuncture.
These treatments lasted for 28 days.
The clinical progression and tolerability of both groups were compared based on seven objective measurements:
- visual analog scale index,
- Schober test,
- fingertip-to-floor distance,
- spinal flexion,
- spinal extension,
- spinal tilt,
- spinal rotation.
Already after 14 days of treatment, the SG showed a significant improvement in overall outcomes compared to the CG. Specifically, 43.3% of SG patients achieved very good results, 53.3% had good results, and 3.4% had moderate results, whereas corresponding figures for the CG were 6.7%, 76.7%, and 16.6%, respectively (P < .05).
After 28 days of treatment, both groups demonstrated a shift toward very good results, with the SG continuing to show better outcomes than the CG (P < .05). In the SG, the very good results increased to 76.7%, good results decreased to 20%, and moderate results were 3.3%. On the other hand, the CG had 46.7% very good results, 43.3% good results, and 10% moderate results. Notably, no side effects were reported from the VH treatments during the study.
The authors concluded that their findings of this study indicate that VH health supplement is a safe and effective approach for managing low back pain and limited spinal movement in patients with LDD.
I have several concerns and questions, some are trivial others are not:
- What does VH contain? I have no free access to the actual paper but even the abstract should mention this information.
- How do the investigators know that low back pain was caused by LDD? Lots of people have LDD without pain and vice versa.
- The A+B vs B design is known to produce false positive results due to its failure to control for placebo effects; why not use a placebo (which would have been very easy in this case)?
- Contrary to the authors statement, the outcome measures are NOT objective.
- It seems highly implausible that no side effects of VH occurred. Even placebos cause side-effects in ~6% of all cases.
- Conclusions about safety are NEVER warranted based on just 30 patients.
- Why does an allegedly respectable journal publish such rubbish?
Chronic back pain is a prevalent and debilitating condition, significantly impacting quality of life and functional independence. While conventional interventions, including physical therapy and pharmacological treatments, are commonly utilized, complementary practices like yoga are increasingly explored for their potential benefits in pain management and functional improvement.
This scoping review aimed to assess the existing evidence on the effectiveness of yoga compared to conventional interventions in reducing pain and back-related disability in older adults, highlighting key findings and identifying gaps for future research. The review followed the Arksey and O’Malley scoping review framework, systematically searching databases including PubMed, Scopus, and Web of Science. Studies were included if they:
- (1) involved older adults (aged 60 and above),
- (2) compared yoga with conventional back pain interventions,
- (3) measured outcomes related to pain intensity and back-related disability,
- (4) were published in peer reviewed journals.
A thematic analysis was performed to identify common findings, trends, and research gaps in the literature.
Twenty-four studies met the inclusion criteria, including randomized controlled trials, cohort studies, and observational research. Findings generally support the efficacy of yoga in reducing pain and disability among older adults, with many studies demonstrating comparable or superior results to conventional physical therapy interventions. Yoga was associated with additional benefits in psychological well-being, flexibility, and balance, which were less frequently addressed by conventional treatments. However, the studies varied in intervention types, duration, and measurement tools, limiting cross-study comparisons. Few studies examined long-term outcomes, highlighting a need for further longitudinal research.
The authors concluded that this evidence suggests that yoga is a viable alternative or adjunct to conventional back pain interventions in older adults, offering potential benefits for pain reduction, functional mobility, and quality of life. Despite these promising findings, the heterogeneity of studies and lack of long-term data indicate a need for further high-quality research to establish standardized protocols and evaluate sustained effects. Future studies should focus on randomized controlled designs with consistent measures to better inform clinical guidelines on integrating yoga into back pain management for older adults.
“Yoga is a viable alternative or adjunct to conventional back pain interventions”?
Really?
Based on what precisely?
We cannot know, because the paper does not even reference the primary studies. Nor does it provide essential details about them. Nor does it reveal what the ‘conventional interventions’ were. Nor does it address the problem of bias or methodological quality of the primary studies.
What we do know is that some (but not how many) uncontrolled studies were included. This means that the evidence is likely to be flimsy indeed.
It is, of course, possible that some form of yoga is an effective therapy for back pain but the above paper does not come anywhere near proving this hypothesis. Personally, I suspect that most treatments that include an element of exercise might be marginally helpful, but somehow doubt that one is dramatically better than the next.
The Internet is increasingly used as a primary source of information for patients. Many private physiotherapy practices provide informative content on low back pain (LBP) and neck pain (NP) on their websites, but the extent to which this information is biopsychosocial, guidelines-consistent, and fear-inducing is unknown. The aim of this study was to analyse the information on websites of private physiotherapy practices in the Netherlands about LBP and NP regarding consistency with the guidelines and the biopsychosocial model and to explore the use of fear-inducing language.
The content of all existing Dutch private physiotherapy practice websites was examined in a cross sectional study design. Content analysis was based on predetermined criteria of the biopsychosocial model and evidence-based guidelines. Descriptive statistics were applied.
After removing duplicates and sites without information, 834 (10%) of 8707 websites remained. Information about LBP was found on 449 (54%) websites and 295 (35%) websites informed about NP. A majority of websites (LBP: n = 287, 64%; NP: n = 174, 59%) were biomedically oriented. Treatment advice was given 1855 times on n = 560 (67%) websites. Most of the recommended interventions were inconsistent with or not mentioned in the guidelines. Fear-inducing language was provided n = 1624 (69%) times.
The interventions that were inconsistent with the guidelines included several so-called alternative medicine (SCAM) options, including:
- dry needling (for LBP),
- medical tape (for LBP),
- trigger point therapy (for LBP),
- dry needling (for NP),
- trigger point therapy (for NP).
The authors concluded that their study shows that most Dutch private physiotherapy practice website are not a reliable source of information for patients with LPB and NP. The Dutch physiotherapy community needs to take action to comprehensively review and update the information on their websites to align with high‐quality best practice recommendations and guidelines for LBP and NP. It is important to strive for better information for patients to reduce fear, to support them in making better recovery choices, to achieve less disability, and to improve their quality of life.
To be honest, I would never have expected Dutch private physiotherapy practice website to be a reliable source of information for patients with LPB and NP. In general, private websites from healthcare practitioners are not reliable sources for anything, as we have so often seen on this blog. They are promotional by nature and have the purpose of boosting business.
I fear that the only thing positive I can say about the private physiotherapy practice websites is that they are not nearly as bad as those of:
- acupuncturists,
- aromatherapists,
- chiropractors,
- energy healers,
- herbalists,
- homeopaths,
- naturopaths,
- osteopath,
- reflexologists,
- etc, etc.
(If you need evidence for these bold statements, please look through the last 3 000 posts of this blog.)
As misinformation can cause untold harm, we need to ask: what is the solution to this problem? I think it’s disarmingly simple: for health-related information, stay away from websites that are evidently promotional by nature!
Do Chiropractors Break Necks? This is an interesting question. “Dr.” Greg Malakoff (Chiropractor/Neurologist, Board Certified) provided the following answer (never mind that he seems to mean ‘do chiros cause strokes?’):
… The total disinformation that seems to be republished monthly on the news concerning chiropractors and strokes is based on a study performed in the 1950’s, that has been totally discredited. However, students these days are rather lazy and every time a meta analysis is performed on this old study it reaches all the news stations because their main sponsors are drug companies and they don’t want you having the opportunity to get well without their products. A meta analysis is simply someone reading the old study, and writing a book report on it.
If they were to actually study what has been discovered since the 1950’s, which is a tremendous amount of valid scientific research, not one done on a cadaver and deliberately making false conclusions, they would discover a few things, that I feel you should know.
The typical stroke victim if they survive has stroke posture, which consists of the arm being flexed and a lower leg extended. That would be a whole lot of brain damage, but we don’t see the entire motor strip damaged on brain scans. We typically see just a small area with an infarct. That area is the internal capsule. Picture a vase with all it’s stems entering into the narrow portion of it. All the neurons in the brain that leave it from different areas of the motor cortex with long nerves that go to innervate the muscles that you want to move are exiting through this narrow opening called the internal capsule.
Why is that important to know if you ever want a chance at being healthy? The arteries in the back of your neck, called the vertebral arteries do not go there, they do not go to the internal capsule where we see the stroke damage. That part of the brain is being fed by the carotid arteries that are in the front of your neck. That means the chiropractor is not the problem, we are not affecting those arteries. Case closed.
However, there is a type of more severe stroke related to the back of the neck arteries called vertebral artery dissection. These arteries feed the brain stem and the vital centers in there. The vital centers are what keep you breathing and your heart beating. That means, that I have never been sued by a victim of this because they are going to be dead before they get off of the table. That doesn’t happen, well it hasn’t happened to me or just about any other chiropractor. People can get this type of artery damage, but it is proven to be practically impossible to tear those arteries by a chiropractic adjustment. It would require hundreds of pounds of force to tear those arteries with a chiropractic adjustment. So unless your chiropractor is the size of a Polar Bear, there is a good chance you are remaining sick or in pain for no reason at all.
I know, what about that playboy model who died from the chiropractor that she went to? The incompetent medical examiner said that was the cause, but apparently he and all the media don’t read well. She had fallen and hurt the arteries in her neck a month earlier. The E.R. didn’t bother to do an ultrasound Doppler study of her arteries and if they had, they might have realized that she was injured more severely. Instead, she sought help for her neck pain a month later from a chiropractor. Most chiropractors do not have ultrasound Doppler equipment in their office. Neither do most urgent medical care centers. In this case, the adjustment aggravated the severe insult that she had sustained a month earlier. Perhaps he is guilty of taking for granted that the E.R. had done it’s job properly. She should never have been released from the E.R.
While it was all over the news everyday, every hour of every day for weeks, just how often does something like this occur? You are more likely to get blown up out of the sky by a terrorist, and as you are falling to earth still in your seat, get struck by lightning and shot and stabbed by terrorists that have parachuted out of another plane to make sure they had finished their job. However, they too get struck by lightning and you fall to the ground safely where you are now eaten by a land shark.
With that in mind, millions of people are suffering daily for decades because they are afraid of a chiropractic adjustment. This is the safest and most powerful form of treatment known to modern medical science. The number 3 leading cause of death in America is from medicine. Compare that to the one woman that died from a chiropractor in Canada. The case is kind of famous because that was the case that had Chiropractic outlawed in a province. The patient was obese, smoked, was diabetic, and took birth control pills. She had died of a stroke a month after going to the chiropractor. She was the perfect storm of walking disease and as I stated earlier, if the chiropractor was to have caused the stroke, she was not walking out of his office.
There are millions of dollars to be made off of your medical misery. You being sick helps fuel our economy. However, if you want the opportunity to be healthy it can’t be achieved with a lifestyle of drugs. Chiropractors have been labeled back pain doctors, but we are really brain doctors. Our treatment affects your brain and your brain is responsible for creating good health. If you are a drug company, then you would want people to be sick and miserable enough to buy your product. If you are sick and tired of being sick and tired your best chance of not staying that way is to visit a chiropractor. Don’t let all the disinformation keep you miserable and unhealthy.
___________________
I find Malakoff’s answer relevant nnot least because it demonstrates a few points that are important:
- Some chiros call themselves doctors and manage to fool consumers in assuming that they are medically competent.
- Some even call themselves neurologists, it seems.
- They are the exact opposite of competent.
- They understand neither science, nor medicine, nor the methodologies used.
- They have misunderstood so much about [patho)physiology that it’s frightening to think they treat ill people.
- Despite all this they love to use pseudo-scientific language.
- They use it to impress and to white-wash their quackery and the chiropractic profession.
- They have an unrealistic view about the value of chiropractic.
- They are in denial about the risks of spinal manipulation.
- They are consumed by conspiracy theories without even attempting to provide evidence in their support.
Guest post by Catherine de Jong
Academic circles have reacted with surprise to the announcement on 12 November of the appointment of chiropractor Sidney Rubinstein as endowed professor at the Vrije Universiteit Amsterdam. The website of the Dutch Chiropractors Association (NCA) states:
“On 1 August 2024, Mr. Sidney Rubinstein was appointed professor by special appointment at the chair “Optimizing Management of Musculoskeletal Health” at the Vrije Universiteit in Amsterdam. In addition to his work as a chiropractor in his own practice, Rubinstein has been working at the Vrije Universiteit for a long time. In addition to treating patients, he has always focused on research and development within chiropractic and musculoskeletal (MSK) disorders.”
Chiropractic is an alternative method of treatment. There is no scientific evidence for clinically relevant positive treatment outcomes. For that reason, chiropractic is not mentioned as a treatment option in the guidelines of general practitioners and medical specialists in the Netherlands. Both the profession and the education are not recognized in the Netherlands. On the website of the NVAO (Dutch-Flemish Academic Organization, www.nvao.net), chiropractic does not appear as an accredited program. There is now plenty of research, especially case reports, on the damage that treatment by a chiropractor can cause, such as cerebral infarctions due to arterial dissection of carotid arteries due to cracking of the neck by chiropractors.
On June 20, 2008, the website of Medisch Contact (magazine of KNMG, Dutch Society of Medical Doctors) stated: “First Dutch chiropractor gets his PhD: Sidney Rubinstein will be the first chiropractor in the Netherlands to obtain a PhD today. Rubinstein states that most of the side effects of chiropractic are harmless and temporary.”
This dissertation, for which Sidney Rubinstein obtained his doctorate at VU Amsterdam, was substandard and was criticized in a letter sent to the same journal. The subsequent correspondence with, among others, the supervisor can be read here. In short, a dissertation that VU Amsterdam cannot be proud of.
The Cochrane database contains two reviews published by Rubinstein on chiropractic, or Spinal Manipulative Therapy (SMT) for acute and chronic back pain, respectively. The conclusion was the same in both cases: In summary, SMT appears to be no better or worse than other existing therapies for patients with acute/chronic low‐back pain. In a 2013 update (Spinal manipulative therapy for acute low back pain: an update of the Cochrane review. Spine 2013; 38(3): E158-77), Rubinstein comes to the same conclusion: SMT is no more effective for acute low back pain than inert interventions, sham SMT or as adjunct therapy. SMT also seems to be no better than other recommended therapies. Rubinstein himself has concluded years ago that chiropractic or SMT has no greater effect than other treatments (like standard physiotherapy), but still it needs to be researched again and again?
At the end of the news item on the NCA’s website, the truth is revealed: the NCA subsidizes half of the chair! The members of this organization (there are now more than 500 chiropractors in the Netherlands) have diligently raised the money for this chair. Since its foundation in 1896 by the grocer/magnetizer D.D. Palmer, chiropractic has had every chance to prove its usefulness, but it has not succeeded. That Rubinstein can change that situation is, of course, extremely unlikely.
This appointment is therefore in fact a political publicity stunt for a still pointless alternative treatment. It will do both the practice of Sidney Rubinstein and that of other chiropractors a lot of good that there is now a professor of chiropractic in the Netherlands.
The other half of the chair is paid for by the university. This means that public money that could have been better spent is now going to be wasted on research into an alternative treatment that we already know is useless, by a researcher who has already shown that there is no added value of treatment by a chiropractor.
A substandard dissertation and a purchased chair, but Sidney Rubinstein can call himself a professor. With the appointment of chiropractor Sidney Rubinstein as endowed professor at VU Amsterdam, the university is jeopardizing its good name and contributing to the unjustified elevation of Sidney Rubenstein’s status and his pointless method of treatment, chiropractic.
Can this appointment really be reconciled with the scientific norms and values that VU Amsterdam wants to uphold?
This study evaluated the real-world impact of acupuncture on analgesics and healthcare resource utilization among breast cancer survivors.
The authors selected from a United States (US) commercial claims database (25% random sample of IQVIA PharMetrics® Plus for Academics) 18–63 years old malignant breast cancer survivors who were experiencing pain and were ≥ 1 year removed from cancer diagnosis. Using the difference-in-difference technique, annualized changes in analgesics [prevalence, rates of short-term (< 30-day supply) and long-term (≥ 30-day supply) prescription fills] and healthcare resource utilization (healthcare costs, hospitalizations, and emergency department visits) were compared between acupuncture-treated and non-treated patients.
Among 495 (3%) acupuncture-treated patients (median age: 55 years, stage 4: 12%, average 2.5 years post cancer diagnosis), most had commercial health insurance (92%) and experiencing musculoskeletal pain (98%). Twenty-seven percent were receiving antidepressants and 3% completed ≥ 2 long-term prescription fills of opioids. Prevalence of opioid usage reduced from 29 to 19% (P < 0.001) and NSAID usage reduced from 21 to 14% (P = 0.001) post-acupuncture. The relative prevalence of opioid and NSAID use decreased by 20% (P < 0.05) and 19% (P = 0.07), respectively, in the acupuncture-treated group compared to non-treated patients (n = 16,129). However, the reductions were not statistically significant after adjustment for confounding. Patients receiving acupuncture for pain (n = 264, 53%) were found with a relative decrease by 47% and 49% (both P < 0.05) in short-term opioid and NSAID fills compared to those treated for other conditions. High-utilization patients (≥ 10 acupuncture sessions, n = 178, 36%) were observed with a significant reduction in total healthcare costs (P < 0.001) unlike low-utilization patients.
The authors concluded that, although adjusted results did not show that patients receiving acupuncture had better outcomes than non-treated patients, exploratory analyses revealed that patients treated specifically for pain used fewer analgesics and those with high acupuncture utilization incurred lower healthcare costs. Further studies are required to examine acupuncture effectiveness in real-world settings.
Oh, dear!
Which institutions support such nonsense?
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, 802 W Peltason Dr, Irvine, CA, 92697-4625, USA.
- School of Pharmacy, Chapman University, RK 94-206, 9401 Jeronimo Road, Irvine, CA, 92618, USA.
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea.
- Integrative Medicine Program, Departments of Supportive Care Medicine and Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
- School of Pharmacy, Chapman University, RK 94-206, 9401 Jeronimo Road, Irvine, CA, 92618, USA. [email protected].
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, 802 W Peltason Dr, Irvine, CA, 92697-4625, USA. [email protected].
And which journal is not ashamed to publish it?
It’s the BMC Med!
The conclusion is, of course, quite wrong.
Please let me try to formulate one that comes closer to what the study actually shows:
This study failed to show that a ‘real world impact’ of acupuncture exists. Since the authors were dissatisfied with a negative result, subsequent data dredging was undertaken until some findings emerged that were in line with their expectations. Sadly, no responsible scienctist will take this paper seriously.
Two years ago, I reported about an acupuncture review that was, in my view, a fairly clear case of scientific misconduct. To remind you, here is my from 22/11/22 about it:
Acupuncture is emerging as a potential therapy for relieving pain, but the effectiveness of acupuncture for relieving low back and/or pelvic pain (LBPP) during pregnancy remains controversial. This meta-analysis aimed to investigate the effects of acupuncture on pain, functional status, and quality of life for women with LBPP pain during pregnancy.
The authors included all RCTs evaluating the effects of acupuncture on LBPP during pregnancy. Data extraction and study quality assessments were independently performed by three reviewers. The mean differences (MDs) with 95% CIs for pooled data were calculated. The primary outcomes were pain, functional status, and quality of life. The secondary outcomes were overall effects (a questionnaire at a post-treatment visit within a week after the last treatment to determine the number of people who received good or excellent help), analgesic consumption, Apgar scores >7 at 5 min, adverse events, gestational age at birth, induction of labor and mode of birth.
Ten studies, reporting on a total of 1040 women, were included. Overall, acupuncture
- relieved pain during pregnancy (MD=1.70, 95% CI: (0.95 to 2.45), p<0.00001, I2=90%),
- improved functional status (MD=12.44, 95% CI: (3.32 to 21.55), p=0.007, I2=94%),
- improved quality of life (MD=−8.89, 95% CI: (−11.90 to –5.88), p<0.00001, I2 = 57%).
There was a significant difference in overall effects (OR=0.13, 95% CI: (0.07 to 0.23), p<0.00001, I2 = 7%). However, there was no significant difference in analgesic consumption during the study period (OR=2.49, 95% CI: (0.08 to 80.25), p=0.61, I2=61%) and Apgar scores of newborns (OR=1.02, 95% CI: (0.37 to 2.83), p=0.97, I2 = 0%). Preterm birth from acupuncture during the study period was reported in two studies. Although preterm contractions were reported in two studies, all infants were in good health at birth. In terms of gestational age at birth, induction of labor, and mode of birth, only one study reported the gestational age at birth (mean gestation 40 weeks).
The authors concluded that acupuncture significantly improved pain, functional status and quality of life in women with LBPP during the pregnancy. Additionally, acupuncture had no observable severe adverse influences on the newborns. More large-scale and well-designed RCTs are still needed to further confirm these results.
What should we make of this paper?
In case you are in a hurry: NOT A LOT!
In case you need more, here are a few points:
- many trials were of poor quality;
- there was evidence of publication bias;
- there was considerable heterogeneity within the studies.
The most important issue is one studiously avoided in the paper: the treatment of the control groups. One has to dig deep into this paper to find that the control groups could be treated with “other treatments, no intervention, and placebo acupuncture”. Trials comparing acupuncture combined plus other treatments with other treatments were also considered to be eligible. In other words, the analyses included studies that compared acupuncture to no treatment at all as well as studies that followed the infamous ‘A+Bversus B’ design. Seven studies used no intervention or standard of care in the control group thus not controlling for placebo effects.
Nobody can thus be in the slightest surprised that the overall result of the meta-analysis was positive – false positive, that is! And the worst is that this glaring limitation was not discussed as a feature that prevents firm conclusions.
Dishonest researchers?
Biased reviewers?
Incompetent editors?
Truly unbelievable!!!
In consideration of these points, let me rephrase the conclusions:
The well-documented placebo (and other non-specific) effects of acupuncture improved pain, functional status and quality of life in women with LBPP during the pregnancy. Unsurprisingly, acupuncture had no observable severe adverse influences on the newborns. More large-scale and well-designed RCTs are not needed to further confirm these results.
PS
I find it exasperating to see that more and more (formerly) reputable journals are misleading us with such rubbish!!!
_________________________
Now – 2 years later! – the journal (BMJ-Open) has retracted the article and posted the following notice about the decision:
BMJ Open has retracted this article.1 After publication, multiple issues were raised with the journal concerning the design and reporting of the study. The editors and integrity team investigated the issues with the authors. There were fundamental flaws with the research, including the control group selection and data extraction, not amenable to correction.
I am delighted that this misleading paper is now officially discredited. Yet, I do have some concerns:
WHY DOES IT TAKE 2 YEARS TO IDENTIFY SOMETHING AS FRAUDULENT RUBBISH, WHEN IT TOOK ME ALL OF ~30 MINUTES?
Instead of just insisting on a triumphant ‘I TOLD YOU SO’, let me provide some constructive advice to reviewers and journal editors.
- Many journal editors are to lazy to find reviewers themselves and ask the submitting author to name a few. Having myself published in the BMJ Open (the journal that published the paper in question) I fear that this might have been the case in the present instance. This habit invites poor reviews, e.g. reviews from colleagues who owe a favour to the submitting authors. It does not promote objective reviews and should be abandonned.
- Papers on acupuncture originating from China (as the one in question) are very likely to be biased (or worse), as we have so often discussed on this blog. Editors should be extra careful with such submissions.
- Reviewers who have in the past overlooked obvious flaws in a paper should be banned from further reviewing in future.
- Editors should understand the reviewers’ comments only as guidelines and still have an obligation to check the actual submissions themselves. the responsibility for publishing an article lies with them alone.
- Editors who repeatedly make such mistakes should be dismissed.
I think that adhering to these suggestions might improve the quality of published research … and, by Jove, this would be badly needed in the realm of so-called alternative medicine!!!
Spanish colleagues and I just published an article entitled “Is Osteopathic Manipulative Treatment Clinically Superior to Sham or Placebo for Patients with Neck or Low-Back Pain? A Systematic Review with Meta-Analysis”. Here is its abstract:
The aim of this systematic review and meta-analysis was to compare whether osteopathic manipulative treatment (OMT) for somatic dysfunctions was more effective than sham or placebo interventions in improving pain intensity, disability, and quality of life for patients with neck pain (NP) or low-back pain (LBP). Methods: A systematic review and meta-analysis was carried out. Searches were conducted in PubMed, Physiotherapy Evidence Database, Cochrane Library, and Web of Science from inception to September 2024. Studies applying a pragmatic intervention based on the diagnosis of somatic dysfunctions in patients with NP or LBP were included. The methodological quality was assessed with the PEDro scale. The quantitative synthesis was performed using random-effect meta-analysis calculating the standardized mean difference (SMD) with RevMan 5.4. The certainty of evidence was evaluated using GRADEPro. Results: Nine studies were included in the qualitative synthesis, and most of them showed no superior effect of OMTs compared to sham or placebo in any clinical outcome. The quantitative synthesis reported no statistically significant differences for pain intensity (SMD = −0.15; −0.38, 0.08; seven studies; 1173 patients) or disability (SMD = −0.09; −0.25, 0.08; six studies; 1153 patients). The certainty of evidence was downgraded to moderate, low, or very low. Conclusions: The findings of this study reveal that OMT is not superior to sham or placebo for improving pain, disability, and quality of life in patients with NP or LBP.
As always, it seems important to stress that our review has several limitations. Firstly, the searches were conducted in the most relevant databases; however, some studies not indexed in these sources may have been missed. Secondly, the diverse NP and LBP diagnosis, as well as the lack of data reported by some studies, complicates the interpretation of the results and may weaken our conclusion. Thirdly, the primary studies pragmatically applied interventions based on diagnoses of various somatic dysfunctions, resulting in a high degree of heterogeneity among the treatments applied.
Despite these limitations, it is fair to say, I think, that OMT is not nearlly as solidly supported by reliable evidence as most osteopaths try to make us believe. In essence, this means that, if you suffer from NP or LBP, you best concult a proper doctor or physiotherapist.
Chiropractic is a complementary medicine that has been growing increasingly in different countries over recent decades. It addresses the prevention, diagnosis and treatment of the neuromusculoskeletal system disorders and their effects on the whole body health.
This review aimed to evaluate the effectiveness of chiropractic in the treatment of different diseases. To gather data, scientific electronic databases, such as Cochrane, Medline, Google Scholar, and Scirus were searched and all systematic reviews in the field of chiropractic were obtained. Reviews were included if they were specifically concerned with the effectiveness of chiropractic treatment, included evidence from at least one clinical trial, included randomized studies and focused on a specific disease. The articles were excluded if:
- – they were concerned with a combination of chiropractic and other treatments (not specifically chiropractic treatment);
- – they lacked at least one clinical trial;
- – they lacked at least one randomized study;
- – and they studied chiropractic in the treatment of multiple diseases.
The research data including the article’s first author’s name, type of disease, intervention type, number and types of research used, meta-analysis, number of participants, and overall results of the study, were extracted, studied and analyzed.
Totally, 23 chiropractic systematic reviews were found, and 11 articles met the defined criteria. The results showed the influence of chiropractic on improvement of neck pain, shoulder and neck trigger points, and sport injuries. In the cases of asthma, infant colic, autism spectrum disorder, gastrointestinal problems, fibromyalgia, back pain and carpal tunnel syndrome, there was no conclusive scientific evidence. There is heterogeneity in some of the studies and also limited number of clinical trials in the assessed systematic reviews. Thus, conducting comprehensive studies based on more reliable study designs are highly recommended.
The authors stressed that three points should be emphasized. Firstly, there is a discrepancy between the development of chiropractic in different countries of the world and the quality and quantity of studies regarding the effectiveness and safety of chiropractic in treatment of diseases. Secondly, some of the systematic reviews regarding the effectiveness of chiropractic in treatment of diseases had a minimum quality of research methodology and were not useful for evaluation. Some of the excluded articles are examples of this problem. Finally, a limited number of studies (11 systematic review articles and 10 diseases) had the required criteria and were assessed in the study.
Assessment and analysis of the studies showed the impact of chiropractic on improvement of some upper extremity conditions including shoulder and neck trigger points, neck pain and sport injuries. In the case of asthma, infant colic and other studied diseases, further clinical trials with larger sample sizes and high quality research methodology are recommended.
So, is chiroprctic of proven effectiveness for any disease?
The conditions for which there is tentatively positive evidence (btw: most rely on my research!!!) are arguably not diseases but symptoms of undelying conditions. Therefore, the answer to my question above is:
NO.
