chiropractic
- (1) SMT,
- (2) ambulatory ibuprofen prescription,
using propensity matching for OUD risk factors. The primary outcome was the risk ratio (RR) of OUD. The RR for long-term opioid use, and opioid prescription RR and mean count were also explored. Primary analyses conducted in TriNetX and R used logistic regression for matching, standardized mean difference to assess between-cohort balance (threshold of ≤ 0.1), and contingency tables for RRs, using a significance threshold of p < 0.05.
Chiropractors and homeopaths are trusted sources of health information for many Canadians, including around vaccination. However, within Ontario, Canada, the College of Chiropractors of Ontario and the College of Homeopaths of Ontario regulations state that vaccines are not within their scope of practice and providers should not express views, treat, or advise patients with respect to vaccination.
The aims of the present study were to:
- (1) describe the attitudes and beliefs regarding vaccination held among participating chiropractors and homeopaths;
- (2) identify the sources of information about vaccination they trust and use to guide their personal vaccination decisions;
- (3) describe how they navigate patient requests for guidance on vaccine decision-making within the current regulatory landscape.
Semi-structured interviews (N = 16) were conducted between February 2020-March 2021 and explored participants’ opinions on vaccination, sources of information they trust and recommend to their patients, and how they navigate vaccine conversations with patients.
Providers’ personal beliefs regarding vaccination were described as reinforced by social and professional networks, through their personal experiences, and in consultation with clients. Various strategies were used to support patients while abiding by regulations (e.g. referring patients to providers for whom vaccination is within their scope of practice); however, other strategies described (e.g., stating personal beliefs) could be interpreted as a breach of regulation.
The authors conclused that this research reinforces existing literature suggesting that patients using chiropractors and homeopaths have questions about vaccination and are looking for trusted information. Public health services should consider engaging with chiropractors and homeopaths to facilitate communication between patients and immunization providers.
I ask myself whether any reliable evidence can come out of an interview study of 16 practitioners conducted almost 5 years ago. In the discussion section, the authors state this:
Various strategies were used by chiropractors and homeopaths to support patients while abiding by their professional scope of practice guidelines, limiting their capacity to provide recommendations for vaccination. Despite incidences of breaches in regulation, there may be opportunities for these providers to play a role in vaccine promotion. Many chiropractors and homeopaths report an interest from their clients for information about vaccination to guide their decision-making. Regulatory frameworks might be revised to permit them to refer to resources promoting vaccine uptake (i.e., NACI, government websites, etc.). There will no doubt remain challenges to such pathways, as hurdles remain related to persistent distrust in public health interventions and vaccination, and providers who continue to breach regulation. However, it is possible that in partnering with chiropractors and homeopaths, and though beyond our data, perhaps other CAM providers, public health providers might grow trust in their patients as a means for vaccine promotion.
I would have thought that the main issue regarding informing patients about vaccination – or any other health-relaated matter – is reliability: the public needs information based on sound evidence. We know from many studies that homeopaths and chiropractors often do believe in lots of things other than or contrary to evidence. Therefore, I feel that partnering with chiropractors and homeopaths would require first of all that these practitioners alter their stance on evidence. As both chiropractors and homeopaths work in anti-science professions and environments, this seems to be an insurmountable task. The last thing we need is a bunch of charlatans increasing the already huge amount of misinformation consumers are exposed to currently.
The United States spends more money on the care of back and neck pain than any other health condition. Despite this, the cost-effectiveness for many recommended treatments is unclear. Our primary objective for this project was to estimate the cost-effectiveness of spinal manipulative therapy (SMT), supervised exercise therapy (ET), and home exercise and advice (HEA) for spinal pain in the U.S.
The researchers analyzed cost and clinical outcome data from eight randomized trials conducted in the U.S. using an individual participant data meta-analysis approach. They calculated cost-effectiveness from the societal and healthcare perspective of various comparisons between SMT, ET, and HEA. Incremental cost-effectiveness ratios (ICERs) were calculated using quality-adjusted life years as the main outcome.
The 8 trials included a total of 1803 participants and 1488 (83%) provided complete data. Incremental cost-effectiveness ratios and probabilities of cost-effectiveness varied substantially between studies; thus, the reseaarchers did not conduct meta-analysis and report findings from individual trials.
Cost-effectiveness findings were favorable for SMT compared to HEA for acute neck pain (ICERs below $50k/QALY) and when added to HEA for chronic back-related leg pain and chronic neck pain in older adults (better outcomes and lower costs). However, SMT was not likely cost-effective compared to HEA for chronic back pain in adults or when added to HEA for older adults (higher costs and worse outcomes).
Findings for SMT were favorable when compared to ET in adults with chronic back pain and when added to ET for chronic neck pain in adults (better outcomes and lower costs) and chronic back pain in adolescents (ICERs below $50k/QALY). However, SMT is not likely cost-effective when compared to ET for chronic neck pain in adults (ICERs below $70k/QALY for exercise) and findings were inconsistent across outcomes in older adults with chronic back pain.
Finally, ET may be cost-effective compared to HEA for adults with chronic neck pain (ICERs largely between $100-$200k/QALY), but not for chronic back pain or when added to HEA for older adults with chronic neck or back pain (higher costs and worse outcomes).
The authors concluded that overall based on willingness to pay thresholds of $50-$200k/QALY, there was moderate to high probability that spinal manipulation is cost-effective relative to HEA for neck pain and back-related leg pain, but not for chronic back pain. There was also moderate to high probability spinal manipulation was cost-effective relative to exercise therapy for chronic back pain but findings were mixed for neck pain and more favorable in older adults. Cost-effectiveness findings for exercise therapy were mostly not favorable relative to less intensive home exercise programs as costs were higher, and outcomes were often worse.
The authors admit that their analyses have several limitations: Randomized clinical trials are often designed to detect important differences in disease-specific clinical outcomes that are most likely to be impacted by the treatments assessed (e.g., pain severity, disability). Important measures for assessing cost-effectiveness include general health outcomes like changes in QALYs, healthcare use, and missed work. These measures were collected alongside disease-specific measures, but the trials were not powered to detect important differences in cost-effectiveness outcomes. Participants self-reported their use of healthcare and medications along with number of missed workdays. We did not have access to administrative data for healthcare use or costs. While access to administrative data would have reduced potential measurement error for these variables, it is not without limitations due to the high variability in coverage and re-imbursement policies for healthcare procedures across insurance products in the U.S. Costs for reduced productivity due to spinal pain included missed work in and outside of the home, but costs due to reduced productivity while still at work (i.e., presenteeism) were not included. This is an important limitation as costs due to reduced productivity while at work consistently account for a large proportion of total costs in spinal pain burden of illness studies. Finally, all studies were conducted in the U.S. with resources valued using U.S. prices and findings are not likely generalizable to populations or healthcare systems in other countries.
The authors stress that additional studies are needed to assess the cost-effectiveness of these approaches relative to medical care, the most common treatment approach in the US , as well as other guideline recommended treatments such as massage, acupuncture, mindfulness-based stress reduction, tai chi, yoga, and cognitive behavioral therapy
In view of these limitations and the fact that just 8 trials could be included, the relatively firm comclusions are surprising, in my view. To me, much of the data look unconvincing, somewhat random, inconsistent and implausible. could it be that the authors were trying to generate and emphacize positive results? After all, most of them are affiliated to the “Integrative Health and Wellbeing Research Program Earl E. Bakken Center for Spirituality & Healing, University of Minnesota”!
This systematic review was aimed at evaluating if musculoskeletal manipulations (MMs), including osteopathic manipulation and chiropractic care, are effective to improve quality of life, pain intensity and function in older adults with musculoskeletal disorders.
Randomised controlled trials, controlled non-randomised trials and open label trials evaluating the efficacy and safety of MM such as osteopathic manipulation, chiropractic manipulation, myofascial release, craniosacral therapy, as monotherapy or adjunctive therapies in older people (age ≥65 years) with musculoskeletal disorders. The main outcomes included pain intensity, functionality and quality of life. Additionally, other related outcomes were considered, such as medical use duration, mood, mobility, motion, strength and endurance. Finally, we considered any adverse events.
Selection and data extraction were performed independently by two authors. The effect estimates for each study were performed using Review Manager V.5.14. Continuous outcomes were analysed using the mean difference (95% CI). The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool 2 (RoB 2). No meta-analysis was performed.
Five parallel randomised controlled trials were included, with a total sample size of 676 participants (41.6% women with a mean age of 77.3 years): 34 with chronic pain, 265 with neck pain and 377 with low back pain. MMs were not effective in patients with chronic pain, neither in pain intensity nor in functionality.
For neck pain, considering the main outcomes, only in one of the two studies was there a statistically significant improvement in neck pain intensity only at week 12 for spinal manipulative treatment (SMT)+home exercise (HE) compared with HE alone (ES=-0.90 (95% CI -1.46 to -0.34); p=0.002).
For low back pain, SMT+HE showed a statistically significant reduction in pain at 12 weeks compared with HE (ES=-0.79 (95% CI -1.39 to -0.19) p=0.010.
For neck pain and low back pain, no statistically significant improvement in functional status and quality of life was observed with MM compared with any control group.
RoB 2 showed a high risk of bias in three studies and some concerns in the others. At the domain level, the lowest risk was observed in the randomisation process (80% with some concerns). All five studies reported adverse events, none of which were serious.
The authors concluded that this systematic review highlights the need for further investigation into complementary therapies, particularly osteopathy, for chronic pain management and prevention in elderly individuals. The results of the current work emphasise that there is a need to further investigate this topic and move the focus more on the promotion of healthy and management behaviours (eg, more physical activity, self-efficacy and adaptive coping, less healthcare utilisation, medication use) and less on the pain symptoms. The fundamental need for complementary medicine, and in particular MM such as chiropractic care and osteopathic manipulative treatment, is the development of clinical trials and RCTs to assess efficacy on quality of life, pain, functionality and general health of the elderly patient. These will help us to determine where MM can be significant.
This, it seems to me, is merely a polite way of stating that neither chiropractic nor osteopathy are supported by sound evidence, and that therapeutic claims by chiropractors and osteopaths are usually hugely exaggerated. Therefore, the prudent thing to do, if you are suffering from back or neck pain, is to use treatments that are less expensive and less likely to cause severe, sometimes life-threatening adverse effects.
On Aug. 15, 2023, the defendant is said to have failed to elicit a proper medical history from the plaintiff, including current medications used. The chiropractor also is claimed to have failed to provide him with a sufficient pre-treatment screening and assessment. Thirdly, the plaintiff claimed that the chiropractor gave him a manipulation that was contraindicated for him, which caused bleeding into the epidural space, progressive spinal compression, and need for emergency decompression surgery.
Immediately after the chiropractic manipulation, the plaintiff felt nauseous and started vomitting. He went home and began to feel right-sided weakness in his leg. Subsequently, he went to his local emergency department. The patient was immediately transferred to another hospital for an urgent laminectomy. There he remained hospitalized for a week and received physical therapy. The patient made a satisfactory recovery and was able to return to work eight weeks later.
Florence A. Carey of Crowe & Harris, Boston, the plaintiff’s expert, was of the opinion that, if the defendant had appropriately elicited information from the patient, in accordance with the accepted standard of medical care and treatment, he would have learned that the plaintiff was on anticoagulation therapy and, more likely than not, the defendant would not have performed a high velocity, low amplitude manipulation on him.
The case was settled for an amount of US $ 700,000.
This seems a fairly typical example of a serious injury caused by chiropractic spinal manipulation combined with insufficient informed consent. Such incidents do often not show up in the medical literature – instead, they are settled via legal actions which often precludes the publication of the case in a medical journal. As these cases remain undocumented in medical terms, and as chiropractors have managed to avoid creating a comprehensive monitoting system of such events, the chiropractic profession uses this situation as an opportunity to (falsely) claim that the risks of chiropractic are negligibly small or even non-existent.
And what might be the solution?
Simple!
Avoid consulting a chiropractor or any other healthcare professional who wants to manipulate your neck. Such treatments do no good and can cause serious harm.
We have often discussed the fact that chiropractic does not offer an effective option of healthcare. This begs the question, if it’s not healthcare, what is it? DD Palmer, the inventor of chiropractic, was tempted by the idea of turning it into a religion. In a way, this makes sense. As we all know, religions are not based on evidence, they are based on powerful beliefs – and so is chiropractic! Thus the concept of chiropractic as a religion might be less far-fetched as it seems at first glance.
Here is an excerpt of a letter by DD Palmer of May 1911, the period where he was very much into the religious idea:
…I occupy in chiropractic a similar position as did Mrs. Eddy in Christian Science. Mrs. Eddy claimed to receive her ideas from the other world and so do I. She founded theron a religion, so may I. I am THE ONLY ONE IN CHIROPRACTIC WHO CAN DO SO…
You ask, what I think will be the final outcome of our law getting. It will be that we will have to build a boat similar to Christian Science and hoist a religious flag. I have received chiropractic from the other world, similar as did Mrs. Eddy. No other one has laid claim to that, NOT EVEN B.J.
Exemption clauses instead of chiro laws by all means, and LET THAT EXEMPTION BE THE RIGHT TO PRACTICE OUR RELIGION. But we must have a religious head, one who is the founder, as did Christ, Mohamed, Jo. Smith, Mrs. Eddy, Martin Luther and other who have founded religions. I am the fountain head. I am the founder of chiropractic in its science, in its art, in its philosophy and in its religious phase. Now, if chiropractors desire to claim me as their head, their leader, the way is clear. My writings have been gradually steering in that direction until now it is time to assume that we have the same right to as has Christian Scientists.
Oregon is free to Chiropractors. California gives Chiropractors only one chance, that of practicing our religion.
The protective policy of the U.C.A. is O.K., but that of religion is far better. The latter can only be assumed by having a leader, a head, a person who has received chiropractic as a science, as an art, as a philosophy and as a religion. Do you catch on?
The policy of the U.C.A. is the best that B.J. can be at the head of, BUT THE RELIGIOUS MOVE IS FAR BETTER, but we must incorporate under the man who received the principles of chiropractic from the other world, who wrote the book of all chiropractic books, who today has much new matter, valuable, which is not contained in that book.
If you will watch my book closely as you read, you will find it has a religion contained in it, altho I do not so name it.
If either of the Davenport schools would take advantage of practicing our religion founded by D.D. Palmer, it will make the way of chiropractic as easy as it was for the S.C.’s…
I feel that, of the many daft and dangerous ideas of Palmer, this one is more plausible and viable than the rest (had he not died several months later, he might have succeeded with his plan). The concept of chiropractic as a religion explains the chiropractors’ stubborn rejection of science, evidence, rationality, etc. as well as their often fanatic belief in their actions. And, of course, it makes the many weird comments of chiropractors on my blog appear in an entirely different light.
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.
No, the article I am referring to is NOT entitled ‘ANIMAL CHIROPRACTIC (AC) IS NONSENSE’ – quite to the contrary, it is entitled ‘Animal Chiropractic. A Basic Description and Its Importance in Veterinary Practice’. Yet, I feel that the former title would be more suitable.
Judge for yourself. Here is the abstract:
Properly applied AC can be safe and effective. Only licensed health care professionals who have completed extensive postgraduate training should offer AC. As we initially described, AC’s goal is to improve afferent and efferent homeostasis, stability of joints through better sensitivity, and efferent motoric response to improve joint stability. By providing AC, veterinarians can help their patients achieve the highest level of function, independence, and quality of life possible. In this article, we have described AC as a valuable modality that, by improving afferent input and positive modulation of the ventral horn cells and their efferent motor neurons, can positively affect patient strength, stability, and mobility. Therefore, improved conditioning, performance, and postoperative recoveries can enhance patient outcomes by including AC in veterinary practice.
“Any evidence?”, I hear you ask.
Yes, there is an entire paragraph entitled ‘Efficacy and safety’; here it is in full:
There have been several articles published showing the efficacy of AC. Most articles published discussing effectiveness and safety have been from human research, reporting a very low incidence of injuries when provided by licensed and trained professionals. Other national agencies have published information showing the statistical significance of SMT in humans over other treatment therapies.
Surely, this cannot be all!
But it is!
So, let me help out and provide a full summary of the evidence:
THERE IS NO RELIABLE EVIDENCE THAT ANIMAL CHIROPRACTIC DOES MORE GOOD THAN HARM.
And that’s why I think the article should best be entitled:
ANIMAL CHIROPRACTIC IS NONSENSE.
PS
And on reflection, I even think that ‘nonsense’ might be too polite a term for describing it correctly
I came across an interesting article that is most relevant to the subject of so-called alternative medicine (SCAM). Here is its abstract:
The dream of a universal cure has persisted throughout history, evolving from ancient myths to modern pseudoscience. This essay explores the cultural and cognitive resilience of the panacea archetype, tracing its transformation from ancient elixirs and patent medicines to contemporary pseudotreatments, including homeopathy, Radithor, MMS, and ivermectin. These so-called cures endure not merely due to misinformation but because they are embedded within emotionally and cognitively compelling narratives. Drawing from mythology, literature, cognitive psychology, and historical analysis, we examine how panaceas offer more than promises of healing: they provide meaning, control, and hope, especially during times of crisis and uncertainty. Key narrative patterns—heroic discoverers, persecuted truths, villainous establishments, and testimonial-driven validation—align with cognitive biases such as confirmation bias, illusion of causality, and need for cognitive closure. These dynamics are further amplified by digital echo chambers, institutional distrust, and the politicization of medical beliefs. The persistence of panaceas is not merely a failure of science communication but a reflection of deep human vulnerabilities—emotional, epistemological, and social. Understanding the structure and appeal of these narratives is essential not only for combating medical misinformation but also for restoring public trust in scientific and medical institutions.
The term “panacea” comes from ancient Greek mythology where it was the name of the goddess of universal remedy, a daughter of Asclepius, the god of medicine and healing. The name is a compound of the words “pan” meaning “all” and “akeia” meaning “cure”. A panacea is thus a cure all.
SCAM is littered with panaceas:
- Homeopathy is supposed to cure all diseases according to its inventor.
- Chiropractic is supposed to cure all diseases according to its inventor.
- Osteopathy is supposed to cure all diseases according to its inventor.
- Acupuncture is supposed to cure all diseases according to TCM philosophy.
- Bach flower remedies are supposed to cure all diseases according to its inventor.
- Schuessler Salts are supposed to cure all diseases according to its inventor.
- Etc., etc.
The reason for all these assumption lies in a misunderstanding of the origin of disease:
- Hahnemann was convinced that all illness originates from a weakness of the life forces.
- Palmer was convinced that all illness originates from subluxations of the spine.
- Still was convinced that all illness originates from a malalignment of joints.
- TCM proponents are convinced that all illness originates from an imbalance of the two life forces.
- Bach was convinced that all illness originates from emotional states.
- Schuessler was convinced that all illness originates from mineral imbalances.
The allure of such concepts is understandable: they are so much simpler than reality! When the naive enthusiasm wears off, it is time for some rational and critical thinking. The causes of disease are manifold, and (sadly) there is no (and never will be) a panacea. If then, faced with the evidence, the enthusiasm does not give way to reason, it amouunts no longer to allure but to stupidity.
Back pain has become a widespread issue that significantly affects many aspects of the lives of those afflicted. Hydrotherapy has gained attention in the medical and sports communities and has been recognized as a valuable treatment method. The aim of the current research was to determine the effect of hydrotherapy on pain intensity and balance in people with non-specific chronic back pain.
For this systematic review, Persian and English articles were searched for between 2014 and 2024 in Google Scholar, Scopus, PubMed, SID, ISC, and Magiran databases. Finally, 21 relevant articles were selected based on the inclusion and exclusion criteria. The effect of hydrotherapy on pain intensity and balance in people with chronic non-specific low back pain was investigated.
The results of 2 studies showed that hydrotherapy and the Williams flexion model significantly reduced pain and increased dynamic balance. Three studies suggested that hydrotherapy exercises have positive effects on reducing pain and improving balance in people with chronic non-specific low back pain. One study indicated that hydrotherapy does not affect the electrical activity of the back muscles and that the improvement of pain depends on other factors. In addition, the results of 4 studies showed that hydrotherapy exercises and massage therapy help reduce pain, where 6 studies showed that specific movements in water and strengthening the core muscles are also beneficial.
The authors concluded that, based on the studies reviewed in the present research on hydrotherapy, this method can be considered one of the effective approaches for reducing pain intensity and improving balance in individuals with non-specific chronic back pain.
Great, yet another method that is effective for back pain!
The evidence is as good as for many other approaches.
Hold on, there are many caveats!!!
- Due to the nature of the treatment, most primary studies do not control for placebo effects (JUST LIKE STUDIES OF CHIROPRACTIC, FOR INSTANCE).
- The treatment is not a uniform modality but includes several different therapies which makes it impossible to say what actually works and what not (JUST LIKE STUDIES OF CHIROPRACTIC, FOR INSTANCE).
- The primary studies are burdened with many more methodological flaws (JUST LIKE STUDIES OF CHIROPRACTIC, FOR INSTANCE).
- The research is done mostly by investigators who want to show that their treatment works (JUST LIKE STUDIES OF CHIROPRACTIC, FOR INSTANCE).
- The effect sizes tend to be small (JUST LIKE STUDIES OF CHIROPRACTIC, FOR INSTANCE).
I could continue, but you probably get the drift.
So, if you have back pain, should you see a chiropractor (osteopath, acupuncturist, homeopath, other SCAM practitioner who claims his/her therapy works for sore backs) or a practitioner of hydrotherapy?
A difficult choice?
Let me help you:
- the evidence is flimsy for all;
- the costs for chiro etc. tend to be high;
- the risks of chiro etc. can be considerable;
Best to choose a treatment that is inexpensive and low-risk … which means?
Yes, you got it: you might as well choose hydrotherapy!
