evidence
This systematic review, meta-analysis, and meta-regression investigated the effects of individualized interventions, based on exercise alone or combined with psychological treatment, on pain intensity and disability in patients with chronic non-specific low-back pain.
Databases were searched up to January 31, 2022, to retrieve respective randomized clinical trials of individualized and/or personalized and/or stratified exercise interventions with or without psychological treatment compared to any control.
The findings show:
- Fifty-eight studies (n = 10084) were included. At short-term follow-up (12 weeks), low-certainty evidence for pain intensity (SMD -0.28 [95%CI -0.42 to -0.14]) and very low-certainty evidence for disability (-0.17 [-0.31 to -0.02]) indicates superior effects of individualized versus active exercises, and very low-certainty evidence for pain intensity (-0.40; [-0.58 to -0.22])), but not (low-certainty evidence) for disability (-0.18; [-0.22 to 0.01]) compared to passive controls.
- At long-term follow-up (1 year), moderate-certainty evidence for pain intensity (-0.14 [-0.22 to -0.07]) and disability (-0.20 [-0.30 to -0.10]) indicates effects versus passive controls.
Sensitivity analyses indicate that the effects on pain, but not on disability (always short-term and versus active treatments) were robust. Pain reduction caused by individualized exercise treatments in combination with psychological interventions (in particular behavioral-cognitive therapies) (-0.28 [-0.42 to -0.14], low certainty) is of clinical importance.
The certainty of the evidence was downgraded mainly due to evidence of risk of bias, publication bias, and inconsistency that could not be explained. Individualized exercise can treat pain and disability in chronic non-specific low-back pain. The effects in the short term are of clinical importance (relative differences versus active 38% and versus passive interventions 77%), especially in regard to the little extra effort to individualize exercise. Sub-group analysis suggests a combination of individualized exercise (especially motor-control-based treatments) with behavioral therapy interventions to boost effects.
The authors concluded that the relative benefit of individualized exercise therapy on chronic low back pain compared to other active treatments is approximately 38% which is of clinical importance. Still, sustainability of effects (> 12 months) is doubtable. As individualization in exercise therapies is easy to implement, its use should be considered.
Johannes Fleckenstein, the 1st author from the Goethe-University Frankfurt, Institute of Sports Sciences, Department of Sports Medicine and Exercise Physiology, sees in the study “an urgent health policy appeal” to strengthen combined services in care and remuneration. “Compared to other countries, such as the USA, we are in a relatively good position in Germany. For example, we have a lower prescription of strong narcotics such as opiates. But the rate of unnecessary X-ray examinations, which incidentally can also contribute to the chronicity of pain, or inaccurate surgical indications is still very high.”
Personally, I find the findings of this paper rather unsurprising. As a clinician, many years ago, prescribing exercise therapy for low back pain was my daily bread. None of my team would have ever conceived the idea that exercise does not need to be individualized according to the needs and capabilities of each patient. Therefore, I suggest rephrasing the last sentence of the conclusion: As individualization in exercise therapies is easy to implement, its use should be standard procedure.
It has been reported that America’s Frontline Doctors (a right-wing organization that is associated with the ‘Tea Party’) is suing one of its founders in a battle for control over the controversial group, which gained national notoriety for spreading misinformation about COVID-19 treatments and vaccines during the pandemic.
The organization and its current board chairman have sued Simone Gold, MD, alleging that she misused the nonprofit organization’s funds to buy a $3.6 million Florida mansion, purchase a Mercedes-Benz and other luxury vehicles, and take trips on private planes.
The lawsuit, filed November 4 in federal court, comes just months after Gold was released from prison for her role in the January 6 US Capitol insurrection. Gold pleaded guilty to trespassing in the Capitol and was sentenced to 60 days in federal prison.
The group and the board chairman, Joseph Gilbert, claim that after her release from prison, Gold attempted to reassert control of the group, take over its website, and fraudulently represent herself as its director, according to the complaint. The complaint referred to Gold as a “rogue founder,” alleging that she spent almost $50,000 monthly on personal expenses using the organization’s credit cards.
Gold resigned from the group’s board in February ― before she pled guilty ― so that she could pursue her goal of opening health and wellness centers nationwide, according to the complaint. At that time, the board voted Gilbert to be its chairman and agreed to have Gilbert negotiate an agreement for Gold to serve as a consultant. Gold sought a “signing bonus” of $1.5 million, along with $50,000 to be paid monthly as a consulting fee, according to the complaint.
Another report has more details on Gold’s alleged wrong-doing: The complaint claims that in November 2021, Gold used “AFLDS charitable funds to purchase a $3.6 million home in Naples, Florida for her personal rent-free use, and at least three vehicles and has otherwise used AFLDS funds to resource her personal lifestyle and expenses since she formed AFLDS.” Plaintiffs also allege that Gold “currently lives in this home with John Strand, rent free.” Strand is a former underwear model and boyfriend of Gold’s who was arrested with her in connection with the January 6, 2021 insurrection in the U.S. Capitol. She moved with Strand to Florida this year from Los Angeles, where she had been an emergency room physician. Strand allegedly was paid $10,000 per month as an AFLDS employee and allegedly spent $15,000 to $17,000 a month using those credit cards. He was terminated from AFLDS in summer 2022, according to the complaint. In addition to purchasing the house with AFLDS funds, the complaint said Gold purchased a Mercedes Benz Sprinter van, a Hyundai Genesis, and a GMC Denali. After taking possession of the Naples home, she used AFLDS funds to pay a personal security officer $12,000, a personal housekeeper $5,600 a month, and charged “nearly $50,000 per month” to AFLDS credit cards.
I tried to find some information on th health and wellness centers that Simone Gold wanted or did open. Alas I was unsuccessful in my endeavor. However, I found an interesting passage she once wrote:
The World Health Organization, the FDA, the NIH, and the CDC are proven liars who have lost all credibility and common-sense, while jeopardizing YOUR health and safety. What disgusts me most is how their failed prescriptions have exposed the most vulnerable: our elderly and our children. The New York Times, CNN, NPR, and hundreds of other news outlets have censored the truth in order to preserve their power. Twitter, Facebook, Google/YouTube, Apple, and dozens of other Tech companies are throttling down content, suppressing information, and de-platforming those with whom they disagree.
I find it hard to find words for a comment – except perhaps this: maybe it is not such a bad thing when anti-vaxxers fight each other; it means they have less time, energy, and money to confuse the public with their lies.
A review conducted in 2015 reported community pharmacists are willing to adopt a professional role in counselling consumers about the appropriate and safe use of so-called alternative medicine (SCAM) but faced multiple barriers in doing so. This current review aimed to update and extend these findings, by identifying studies published since 2015 that reported on pharmacists across any setting.
Eligible studies published between January 01, 2016, and December 31, 2021, were identified across 6 databases (PubMed, Scopus, Web of Science, EMBASE, ScienceDirect and MEDLINE). A grounded theory approach was used to thematically synthesize the data extracted.
A total of 64studies representing pharmacists across 30 countries were included for review. The study designs varied and included:
- cross-sectional surveys (n = 36),
- qualitative studies (n = 14),
- pseudo-patient studies (n = 3).
Eight studies reported on practice and/or bioethical responsibilities and 19 studies documented factors that would enable pharmacists to fulfill these responsibilities, while 37 studies reported on both.
The authors concluded that these findings indicate research about pharmacists’ responsibilities associated with SCAM is evolving from gap analysis towards research that is proactive in advocating for change in multiple areas. These findings can be used to inform a consensus discussion among pharmacists and key stakeholders regarding a set of professional responsibilities that would serve in the development of: a clearly defined role and associated practice standards, and competency requirements that inform educational learning objectives for inclusion in undergraduate, post-graduate and continuing professional pharmacy education.
I am puzzled why so many researchers in this specific area seem to avoid clearer language plainly stating the essential, simple, and undeniable facts. I am equally puzzled why so few pharmacists speak out.
It is obvious that community pharmacists are firstly healthcare professionals and only secondly shopkeepers. As such, they have important professional and ethical duties. Foremost, they are obliged to inform their customers responsibly – and responsible means telling them about the evidence for or against the SCAM product they are about to purchase. This duty also entails that pharmacists must inform themselves about the best current evidence. In turn, this means they must stop tolerating the current plethora of under- or post-graduate SCAM courses that are not evidence-based.
As we have discussed ad nauseam on this blog, none of this is actually happening (except in very few laudable cases)!
By and large, pharmacists continue to go along with the double standards of a) evidence for conventional drugs and b) fairy tales for SCAM. In the interest of progress, patient safety, and public health, it is time that pharmacists wake up and remind themselves that they are not commercially orientated shopkeepers but ethical healthcare professionals.
In recent weeks, I have been thinking a lot about ‘INTEGRATIVE MEDICINE‘. Skeptics mostly see it as a way of smuggling quackery into conventional healthcare. This is undoubtedly true and important. But it occurred to me that there also is a somewhat different perspective that has so far been neglected. Let me try to explain by recounting a story. It is fictive, of course, but the fiction is based on the observation of many cases during previous decades.
The story is about a doctor – let’s call him George – who, to be frank, is not the most gifted of his colleagues. Already at medical school, he was not as dedicated as his teachers would have hoped. In fact, medicine had not been his first choice at all. Yet he ended up as a general practitioner and eventually became a partner in a practice with 5 GPs.
Over the years, it became clear that George lacked something to be a good doctor. He knew his stuff, alright, got most of the diagnoses correct, and made not too many mistakes. But something was not quite right. One could say that, relative to his colleagues, he lacked kindness, dedication, compassion, and empathy. He often found it unnecessary to respect his patients. Sometimes, he even joked about them and about what he perceived as their stupidity.
If we view medicine as being both a science and an art, one might conclude that George was just about alright with the science but notably deficient in the art of healthcare. Most of his patients were aware that something was amiss; many even avoided him and tried to consult one of his colleagues instead. On more than one occasion, patients had told George that they were disappointed with his attitude. Some had even told him to the face that he lacked kindness. Such conversations made George think. He had to admit to himself that his colleagues were better at building good relationships with their patients. Eventually, George decided that something ought to change.
As it happened, George’s wife had a friend who was a Reiki healer. One day, he asked the healer – let’s call her Liz – whether she would like to try working alongside the GPs in his practice. Liz was delighted and accepted. George did not believe for a minute that Reiki was more than hocus-pocus, but he knew that Liz was kind and had loads of the compassion that he was so obviously lacking.
Hence force George and Liz formed a team: George looked after his patients the best he could and whenever he felt that more empathy and compassion were required, he would send the patient to Liz. This partnership changed everything. The patients were content, George was happy, and Liz was beaming.
As some patients frowned at the idea of Reiki, George soon recruited an aromatherapist as well. After that, a lay homeopath and a reflexologist were employed. George’s GP partners (who made little use of the alternative practitioners) were sure that none of these therapies had any specific effects (incidentally, a belief not shared by the practitioners in question who felt they were doing wonders). But for George, the therapists clearly did supplement his limited interpersonal skills. Patients were delighted and the GP practice began to thrive. As for George, he became an increasingly outspoken and prominent advocate of INTEGRATED MEDICINE. The fact that there was no evidence to support it did hardly matter to him; what counted was that it rendered his own incompetence less visible.
About a year later, George convinced his slightly bewildered partners to rename their practice ‘THE INTEGRATIVE HEALTH CENTRE’.
End of story
In case you did not get my point, let me make it more bluntly: INTEGRATIVE MEDICINE can be a way for some doctors to delegate the art of medicine to quacks. Good doctors don’t need to do this because they are able to show compassion and treat their patients as whole human beings. Less gifted doctors, however, find INTEGRATIVE MEDICINE a practical solution to their own incompetence.
So, is INTEGRATIVE MEDICINE a good compromise then?
No, certainly not!
The last thing we need in healthcare is for doctors to start delegating the art of medicine to others. It would be a serious mistake, nothing less than abandoning the core values of medicine to charlatans.
But what is the solution?
Obviously, it is to make sure all doctors are competent. We need to select medical students adequately, tell them much more about the importance of kindness, compassion, empathy, holism, etc., and teach them how to show and use these qualities. We need to train doctors to be competent in both the science and the art of medicine. This has to begin in medical school and must continue throughout their professional career. We need to make sure that doctors like George understand the message; if they prove to be unable to do so, we should direct them to professions where compassion is not essential.
The worst solution we can possibly envisage is to allow charlatans to cover up the incompetence of people like George and call it INTEGRATED MEDICINE.
I just got this email with sad news: Ken Frazier “died peacefully this morning, three weeks after being diagnosed with acute myeloid leukemia. Judy and I were fortunate to spend time with Ken and Ruth last week and tell Ken personally how much he has meant to us over our entire lives.”
Ken was a part of CFI history quite literally from Day One. In May 1976, writing for Science News, Ken reported on the formation of the Committee for the Scientific Investigation of Claims of the Paranormal (CSICOP). In 1977, Ken joined CSICOP to serve as editor of The Zetetic, which became Skeptical Inquirer in 1978. He held that position ever since, spending the better part of five decades defining and steering the work of the skeptical community in combatting disinformation and pseudoscience. Ken has also published numerous papers and books, e.g.:
Ken’s book Science Under Siege: Defending Science, Exposing Pseudoscience was featured by Science News for its “engaging, insightful, and often surprising essays by researchers and journalists” about “what science is and is not, and what happens when the facts get twisted.” And he was working on yet another book; only a few months ago he wrote to me taking me for help with it:
… I am completing [ a book] on science and pseudoscience, titled Shadows of Science. It was just accepted by Prometheus Books for publication in Fall 2023. I am now working on a final chapter on “Pseudomedicine,” pseudoscience in medicine. This is not my area of expertise so I am relying on many medical professionals who have investigated and written about medical pseudoscience, most prominently you.
My chapter is mainly concerned with broad points and principles in identifying and describing pseudoscience in medicine — SCAM.
I merely ask if you mind if I quote from and paraphrase from a number of your writings—all with full credit to you in the text itself in addition to in the bibliography
I have always been particularly impressed with the Introduction to your So-Called Alternative Medicine (SCAM) for Cancer as well as parts of your earlier book SCAM: So-Called Alternative Medicine (which carries my testimonial to you on the back cover!). This includes your definition of SCAM and your list of popular therapies and perhaps some of your common assumptions about SCAM. I also would love to draw upon some of the information in your boxes in the opening parts of SCAM…
Ken has on many occasions been most helpful and kind to me, and it goes without saying that I was delighted to assist.
He was a giant amongst the US skeptics, and we will all miss him badly.
This study described osteopathic practise activity, scope of practice and the osteopathic patient profile in order to understand the role osteopathy plays within the United Kingdom’s (UK) health system a decade after the authors’ previous survey.
The researchers used a retrospective questionnaire survey design to ask about osteopathic practice and audit patient case notes. All UK-registered osteopaths were invited to participate in the survey. The survey was conducted using a web-based system. Each participating osteopath was asked about themselves, and their practice and asked to randomly select and extract data from up to 8 random new patient health records during 2018. All patient-related data were anonymized.
The survey response rate was 500 osteopaths (9.4% of the profession) who provided information about 395 patients and 2,215 consultations. Most osteopaths were:
- self-employed (81.1%; 344/424 responses),
- working alone either exclusively or often (63.9%; 237/371),
- able to offer 48.6% of patients an appointment within 3 days (184/379).
Patient ages ranged from 1 month to 96 years (mean 44.7 years, Std Dev. 21.5), of these 58.4% (227/389) were female. Infants <1 years old represented 4.8% (18/379) of patients. The majority of patients presented with musculoskeletal complaints (81.0%; 306/378) followed by pediatric conditions (5%). Persistent complaints (present for more than 12 weeks before the appointment) were the most common (67.9%; 256/377) and 41.7% (156/374) of patients had co-existing medical conditions.
The most common treatment approaches used at the first appointment were:
- soft-tissue techniques (73.9%; 292/395),
- articulatory techniques (69.4%; 274/395),
- high-velocity low-amplitude thrust (34.4%; 136/395),
- cranial techniques (23%).
The mean number of treatments per patient was 7 (mode 4). Osteopaths’ referral to other healthcare practitioners amounted to:
- GPs 29%
- Other complementary therapists 21%
- Other osteopaths 18%
The authors concluded that osteopaths predominantly provide care of musculoskeletal conditions, typically in private practice. To better understand the role of osteopathy in UK health service delivery, the profession needs to do more research with patients in order to understand their needs and their expected outcomes of care, and for this to inform osteopathic practice and education.
What can we conclude from a survey that has a 9% response rate?
Nothing!
If I ignore this fact, do I find anything of interest here?
Not a lot!
Perhaps just three points:
- Osteopaths use high-velocity low-amplitude thrusts, the type of manipulation that has most frequently been associated with serious complications, too frequently.
- They also employ cranial osteopathy, which is probably the least plausible technique in their repertoire, too often.
- They refer patients too frequently to other SCAM practitioners and too rarely to GPs.
To come back to the question asked in the title of this post: What do UK osteopaths do? My answer is
ALMOST NOTHING THAT MIGHT BE USEFUL.
Shiatsu is a Japanese form of so-called alternative medicine (SCAM) derived from Traditional Chinese Medicine using deep pressure on the paths of the postulated acupuncture meridians. Clinical observations on this topic are said to be encouraging, especially for the treatment of sleep and conduct disorders, but there is a lack of empirical data.
The objective of this study was to examine the possible therapeutic effects of shiatsu in a clinical population of children treated in child and adolescent psychiatry. It was designed as a qualitative descriptive and non-interventional study, conducted on children treated in day-care hospital units and outpatient clinical settings. Shiatsu was administered, at least during 3 sessions, to children with an autism spectrum disorder or other disorders according to ICD-11 criteria (such as conduct disorders with impulsivity or attention deficit).
The evaluation was performed by two independent researchers (a child psychiatrist and a psychologist who were not the caregivers) based on direct observation of children during the shiatsu sessions, combined with semi-structured non-inductive interviews with their parents, and data collected from focus groups conducted with the children’s caregivers. A phenomenological interpretive analysis (IPA) approach with Nvivo coding software was used to analyze the data.
Based on semi-structured interviews with 13 parents cross-referenced with data from 2 focus groups and direct observations of 7 children during 2 full shiatsu sessions for each observation, the results show that shiatsu has positive effects on
- internal tension (a relief effect, notably on aggressive behaviors directed against others or self),
- sleep (including improvement of sleep quality),
- social interaction,
- attention,
- verbalization of affects and traumatic memories of early childhood,
- perception of bodily limits.
As these children had several other treatments as well, it cannot be proved that the positive effects observed in this study are related specifically to shiatsu practice. Shiatsu may participate and facilitate the effects of other treatments. It is noteworthy that most of the children came willingly to the shiatsu sessions, ask their parents to repeat the shiatsu sessions at home, and indicate to the practitioner, from one session to the next, their elective body points where they wish to receive the application of shiatsu.
The authors concluded that the findings suggest therapeutic benefits of shiatsu, especially on externalize violence with a relief of aggressive behavior directed against others or self (knowing, moreover, that internal tension, sleep disorders and non-verbalization of affects or traumatic memories, all improved by shiatsu, are also all risk factors for externalize violence). These results highlight, therefore, the need to develop a daily practice of shiatsu in child and adolescent psychiatry. Further research is required to clarify the effects of shiatsu and ascertain better its underlying mechanisms based on this exploratory pilot study.
I do appreciate that, with a treatment that has not been submitted to many controlled clinical trials, researchers feel that they have to start from scratch, e.g. simple observations. However, they also must realize that their observations do not lend themselves to firm conclusions about the effects of the treatment. In the present case, the researchers do seem to be aware of this caveat but nevertheless make statements that go way beyond of what is warranted:
- the results show that shiatsu has positive effects on …
- Shiatsu may participate and facilitate the effects of other treatments
- the findings suggest therapeutic benefits of shiatsu, especially on externalize violence
- These results highlight, therefore, the need to develop a daily practice of shiatsu in child and adolescent psychiatry
I fear that these statements are not merely exaggerated but suspect they are also untrue. Testing them in properly controlled clinical trials would show whether my suspicion is correct. Meanwhile, I would like to remind
- researchers,
- reviewers,
- and journal editors
of their duty to be truthful and not mislead the public.
I was fascinated to find a chiropractor who proudly listed ‘the most common conditions chiropractors help kids with‘:
- Vision problems
- Skin conditions
- Bedwetting
- Sinus problems
- ADD/ADHD
- Stomachaches
- Asthma
- Allergies
- Loss of hearing
- Ear Infections
- Hip, leg, or foot pain
- Constipation
- Poor coordination
- Breastfeeding difficulties
- Arm, hand, or shoulder pain
- Anxiety and nervousness
- Colic
- Scoliosis
The birth process, even under normal conditions, is frequently the first cause of spinal stress. After the head of the child appears, the physician grabs the baby’s head and twists it around in a figure eight motion, lifting it up to receive the lower shoulder and then down to receive the upper shoulder. This creates significant stress on the spine of the baby.
“Spinal cord and brain stem traumas often occur during the process of birth but frequently escape diagnosis. Infants often experience lasting neurological defects. Spinal trauma at birth is essentially attributed to longitudinal traction, especially when this force is combined with flexion and torsion of the spinal axis during delivery.” ~Abraham Towbin, MD
Growth patterns suggest the potential for neurological disorders is most critical from birth to two years of age, as this time is the most dynamic and important phase of postnatal brain development. Over sixty percent of all neurological development occurs after birth in the child’s first year of life. This is why it is so important to bring your child to a local pediatric chiropractor to have them checked and for your child to get a chiropractic adjustment during the first year of their life. Lee Hadley MD states “Subluxation alone is a rational reason for Pediatric Chiropractic care throughout a lifetime from birth.”
As our children continue to grow, the daily stresses can have a negative impact on an ever growing body. During the first few years of life, an infant often falls while learning to walk or can fall while tumbling off a bed or other piece of furniture. Even the seemingly innocent act of playfully tossing babies up in the air and catching them often results in a whiplash-like trauma to the spine, making it essential to get your baby checked by a pediatric chiropractor every stage of his/her development as minor injuries can present as major health concerns down the road if gone uncorrected.
______________________________
On the Internet, similar texts can be found by the hundreds. I am sure that many new parents are sufficiently impressed by them to take their kids to a chiropractor. I have yet to hear of a single case where the chiropractor then checked out the child and concluded: “there is nothing wrong; your baby does not need any therapy.” Chiropractors always find something – not something truly pathological, but something to mislead the parent and to earn some money.
Often the treatment that follows turns out to be a prolonged and thus expensive series of sessions that almost invariably involve manipulating the infant’s fragile and developing spine. There is no compelling evidence that this approach is effective for anything. In addition, there is evidence that it can do harm, sometimes even serious harm.
And that’s the reason why I have mentioned this topic before and intend to continue doing so in the future:
- There is hardly a good reason for adults to consult a chiropractor.
- There is no reason to take a child to a chiropractor.
- There are good reasons for chiropractors to stop treating children.
But let’s be a bit more specific. Let’s deal with the above list of indications on the basis of the reliable evidence:
- Vision problems – no sound evidence that chiropractic manipulations are effective.
- Skin conditions – no sound evidence that chiropractic manipulations are effective.
- Bedwetting – some evidence that chiropractic manipulations are ineffective.
- Sinus problems – no sound evidence that chiropractic manipulations are effective.
- ADD/ADHD – some evidence that chiropractic manipulations are ineffective.
- Stomachaches – no sound evidence that chiropractic manipulations are effective.
- Asthma – some evidence that chiropractic manipulations are ineffective.
- Allergies – no sound evidence that chiropractic manipulations are effective.
- Loss of hearing – no sound evidence that chiropractic manipulations are effective.
- Ear Infections – some evidence that chiropractic manipulations are ineffective.
- Hip, leg, or foot pain – no sound evidence that chiropractic manipulations are effective.
- Constipation – no sound evidence that chiropractic manipulations are effective.
- Poor coordination – no sound evidence that chiropractic manipulations are effective.
- Breastfeeding difficulties – no good evidence that chiropractic manipulations are effective.
- Arm, hand, or shoulder pain – no sound evidence that chiropractic manipulations are effective.
- Anxiety and nervousness – no sound evidence that chiropractic manipulations are effective.
- Colic – some evidence that chiropractic manipulations are ineffective.
- Scoliosis – no sound evidence that chiropractic manipulations are effective.
I rest my case.
One of the numerous conditions chiropractors, osteopaths, and other manual therapists claim to treat effectively is tension-type headache (TTH). For this purpose, they (in particular, chiropractors) often use high-velocity, low-amplitude manipulations of the neck. They do so despite the fact that the evidence for these techniques is less than convincing.
This systematic review evaluated the evidence about the effectiveness of manual therapy (MT) on pain intensity, frequency, and impact of pain in individuals with tension-type headache (TTH).
Medline, Embase, Scopus, Web of Science, CENTRAL, and PEDro were searched in June 2020. Randomized clinical trials that applied MT not associated with other interventions for TTH were selected. The level of evidence was synthesized using GRADE, and Standardized Mean Differences (SMD) were calculated for meta-analysis.
Fifteen studies were included with a total sample of 1131 individuals. The analyses show that high-velocity, low-amplitude techniques were not superior to no treatment in reducing pain intensity (SMD = 0.01, low evidence) and frequency (SMD = -0.27, moderate evidence). Soft tissue interventions were superior to no treatment in reducing pain intensity (SMD = -0.86, low evidence) and frequency of pain (SMD = -1.45, low evidence). Dry needling was superior to no treatment in reducing pain intensity (SMD = -5.16, moderate evidence) and frequency (SMD = -2.14, moderate evidence). Soft tissue interventions were not superior to no treatment and other treatments on the impact of headache.
The authors concluded that manual therapy may have positive effects on pain intensity and frequency, but more studies are necessary to strengthen the evidence of the effects of manual therapy on subjects with tension-type headache. Implications for rehabilitation soft tissue interventions and dry needling can be used to improve pain intensity and frequency in patients with tension type headache. High velocity and low amplitude thrust manipulations were not effective for improving pain intensity and frequency in patients with tension type headache. Manual therapy was not effective for improving the impact of headache in patients with tension type headache.
So, this review shows that:
- soft tissue interventions are better than no treatment,
- dry needling is better than no treatment.
These two results fail to impress me. Due to a placebo effect, almost any treatment should be better than no therapy at all.
ALMOST, because high-velocity, low-amplitude techniques were not superior to no treatment in reducing the intensity and frequency of pain. This, I feel, is an important finding that needs an explanation.
As it is only logical that high-velocity, low-amplitude techniques must also produce a positive placebo effect, the finding can only mean that these manipulations also generate a negative effect that is strong enough to cancel the positive response to placebo. (In addition, they can also cause severe complications via arterial dissections, as discussed often on this blog.)
Too complicated?
Perhaps; let me, therefore, put it simply and use the blunt words of a neurologist who once was quoted saying this:
DON’T LET THE BUGGARS TOUCH YOUR NECK!
The authors of this article searched 37 online sources, as well as print libraries, for homeopathy (HOM) and related terms in eight languages (1980 to March 2021). They included studies that compared a homeopathic medicine or intervention with a control regarding the therapeutic or preventive outcome of a disease (classified according to International Classification of Diseases-10). Subsequently, the data were extracted independently by two reviewers and analyzed descriptively.
A total of 636 investigations met the inclusion criteria, of which 541 had a therapeutic and 95 a preventive purpose. Seventy-three percent were randomized controlled trials (n = 463), whereas the rest were non-randomized studies (n = 173). The most frequently employed comparator was placebo (n = 400).
The type of homeopathic intervention was classified as:
- multi-constituent or complex (n = 272),
- classical or individualized (n = 176),
- routine or clinical (n = 161),
- isopathic (n = 19),
- various (n = 8).
The potencies ranged from 1X (dilution of -10,000) to 10 M (100–10.000). The included studies explored the effect of HOM in 223 different medical indications. The authors also present the evidence in an online database.
The authors concluded that this bibliography maps the status quo of clinical research in HOM. The data will serve for future targeted reviews, which may focus on the most studied conditions and/or homeopathic medicines, clinical impact, and the risk of bias of the included studies.
There are still skeptics who claim that no evidence exists for homeopathy. This paper proves them wrong. The number of studies may seem sizable to homeopaths, but compared to most other so-called alternative medicines (SCAMs), it is low. And compared to any conventional field of healthcare, it is truly tiny.
There are also those who claim that no rigorous trials of homeopathy with a positive results have ever emerged. This assumption is also erroneous. There are several such studies, but this paper was not aimed at identifying them. Obviously, the more important question is this: what does the totality of the methodologically sound evidence show? It fails to convincingly demonstrate that homeopathy has effects beyond placebo.
The present review was unquestionably a lot of tedious work, but it does not address these latter questions. It was published by known believers in homeopathy and sponsored by the Tiedemann Foundation for Classical Homeopathy, the Homeopathy Foundation of the Association of Homeopathic Doctors (DZVhÄ), both in Germany, and the Foundation of Homeopathy Pierre Schmidt and the Förderverein komplementärmedizinische Forschung, both in Switzerland.
The dataset established by this article will now almost certainly be used for numerous further analyses. I hope that this work will not be left to enthusiasts of homeopathy who have often demonstrated to be blinded by their own biases and are thus no longer taken seriously outside the realm of homeopathy. It would be much more productive, I feel, if independent scientists could tackle this task.
