pain
Migraine affects more than 3 billion people worldwide, impacting mental, social, and economic well-being. Despite a wide range of pharmacological treatments, many patients experience limited relief or adverse effects, prompting interest in integrative approaches such as homoeopathy. This scoping review aimed to systematically explore and map the existing evidence on the role of homoeopathy in the management of migraine.
A comprehensive search was conducted across major databases and search engines, including PubMed, Medscape, Science Direct, Google Scholar, CCRH Homoeopathic Archives, and the AYUSH portal, covering studies published between 1990 and 2024. The search was limited to English or translated studies from peer-reviewed sources, indexed databases, and library publications.
A total of 37 full-text studies were screened. The review focused on
- randomized controlled trials,
- prospective studies,
- and retrospective observational studies
reporting clinical outcomes using validated tools such as VAS Scale, HIT 6, 24-Hr-MQoLQ, MOS SF-36 or MIDAS scores. Case reports, case series, editorials, letters, conference proceedings, and reviews lacking original research were excluded. Study selection, data extraction, and quality verification were independently performed by the reviewers according to PRISMA-ScR guidelines.
- 6 RCTs,
- 6 observational studies,
- 1 correlational study,
- and 1 quasi-experimental study
were included, while 23 were excluded. The centesimal scale was most commonly used, with potencies of 30, 200, and 1M. Among the 14 studies, 11 showed positive results for homoeopathy in reducing migraine frequency, severity, and duration. However, 3 studies found no significant difference between the homoeopathy and placebo groups, indicating potential placebo effects. While most findings are promising, some studies question homoeopathy’s specific effectiveness over placebo.
The Indian authors who are affiliated with various homeopathic institutions concluded that this scoping review highlights the potential role of homoeopathic treatment in the management of migraine as evidenced by previous studies. However, a notable gap in high-quality, well-designed research highlights the need for generating stronger levels of evidence to validate these findings.
That’s funny!
My own assessment, based on 4 RCTs, concluded that this systematic review has not produced compelling evidence to suggest that individualized homeopathic treatment is more effective than placebo in the prevention of migraine or headache attacks. However, due to several caveats (e.g., paucity of RCTs) it seems premature to make final judgment on this matter.
How can we explain this discrepancy?
In my view, there are several options:
- The Indian reviewers included Non-randomised studies and mischaracterised some trials.
- The Indian reviewers failed to take into account the lousy quality of the positive trials.
- The Indian reviewers did not aim to test the effectiveness of homeopathy but wanted to prove it.
In fact, I fear that all of these reasons apply.
And why am I so confident that homeopathy is not useful in the management of migraine? Just think about it: The Indian authors state correctly that “migraine affects more than 3 billion people worldwide, impacting mental, social, and economic well-being”. If it worked, would homeopathy not be the long-established treatment of choice for migraine?
Chronic low back pain (CLBP) affects over half a billion people worldwide. Current pharmacologic treatments offer limited efficacy and carry substantial risks, warranting the development of safe and effective alternatives. This multicenter, randomized, placebo-controlled phase 3 trial evaluated the efficacy and safety of the herbal extract VER-01 in CLBP.
It enrolled 820 adults with CLBP (VER-01, n = 394; placebo, n = 426) and included a double-blind 12-week treatment phase (phase A), a 6-month open-label extension (phase B), followed by either a 6-month continuation (phase C) or randomized withdrawal (phase D). The primary endpoint of phase A was a change in mean numeric rating scale (NRS) pain intensity, with a change in total neuropathic pain symptom inventory (NPSI) score as a key secondary endpoint in participants with a neuropathic pain component (PainDETECT > 18). The primary endpoint for phase D was time to treatment failure.
The study met its primary endpoint in phase A, with a mean pain reduction of -1.9 NRS points in the VER-01 group (mean difference (MD) versus placebo = -0.6, 95% confidence interval (CI) = -0.9 to -0.3; P < 0.001). Pain further decreased to -2.9 NRS points in phase B, with effects sustained through phase C. The study also met its key secondary endpoint of phase A, with a mean NPSI decrease of -14.4 (standard error, 3.3) points from baseline in the VER-01 arm (MD versus placebo = -7.3, 95% CI = -13.2 to -1.3; P = 0.017). Although phase D did not meet its primary endpoint (hazard ratio = 0.75, 95% CI = 0.44-1.27; P = 0.288), pain increased significantly more with placebo upon withdrawal (MD = 0.5, 95% CI = 0.0-1.0; P = 0.034). In phase A, the incidence of adverse events-mostly mild to moderate and transient-was higher with VER-01 than with placebo (83.3% versus 67.3%; P < 0.001). VER-01 was well-tolerated, with no signs of dependence or withdrawal.
The authors of this well-designed trial concluded that this phase 3 study provides robust evidence supporting the efficacy and safety of VER-01 in the treatment of CLBP. These findings highlight the importance of further research with VER-01 in other chronic pain conditions and suggest that VER-01 could play an important role in modern pain management.
VER-01 was developed by the German biopharmaceutical company Vertanical. It is a standardized full-spectrum extract from a specific Cannabis sativa strain (DKJ127 L). This means it contains a defined mix of the plant’s compounds, including cannabinoids (such as low levels of THC—tetrahydrocannabinol—and trace amounts of CBD and cannabigerol), terpenes, and other bioactive compounds like beta-caryophyllene and alpha-bisabolol. It is designed to harness the synergistic “entourage effect” of these compounds.
The extract has also recently been shown to be superior to opioids. An RCT concluded that VER-01 demonstrated superiority over opioids in treating CLBP, both in terms of efficacy and gastrointestinal tolerability.
PS
Given the option of either having spinal manipulation (or any other form of unproven so-called alternative medicine) or a safe and standardised cannabis extract, I certainly know what I would choose!
PPS
Vertanical has submitted marketing applications for approval in several European countries (where it is expected to be sold under the brand name Exilby if approved). The company is also preparing for a late-stage trial in the US to support a subsequent filing with the FDA. If approved, VER-01 would be the first full-spectrum cannabis extract authorized specifically for chronic low back pain and potentially a new class of medicine for chronic pain management.
Gua Sha is a form of so-called alternative medicine (SCAM) that I have reoprted about before, e.g.:
- Gua sha: who cares how it works, when it is unproven that it works?
- Gua sha, a reasonable therapy?
- Gua Sha: torture or treatment?
Chronic nonspecific low back pain (CNSLBP) is associated with thoracolumbar fascia (TLF) dysfunction. However, the structural effects of Gua Sha, a Traditional Chinese Medicine technique, remain unclear.
This study aimed to explore the acute and short-term effects of Gua Sha therapy on TLF thickness, pain intensity, and related physiological parameters in patients with CNSLBP.
Thirty-two participants with CNSLBP were randomized to receive Gua Sha or hot pack therapy, a commonly used conservative treatment for low back pain, once a week for 4 weeks. The effects of the two treatments were compared. TLF thickness, pain, and related parameters were measured at baseline and immediately after the first and fourth interventions. A 2 (group) × 3 (time) repeated measures ANOVA was used for data analysis.
With increasing intervention, both groups showed significant improvements in pain intensity and dysfunction (P < .001), significant reductions in tissue hardness and pressure pain threshold (P < .05), and significant increases in skin temperature and lumbar flexibility (P < .001). However, only the Gua Sha group significantly reduced TLF thickness immediately after the first intervention (MD = 0.388, 95% CI: 0.101-0.675; P = .01) and immediately after the fourth session (MD = 0.607, 95% CI: 0.199-1.015, P = .005). The heart rate variability-related indicators did not reach statistical significance (P > .05), but their trends were favorable.
The authors concluded that Gua Sha can effectively relieve pain, improve function, and regulate tissue mechanical properties in CNSLBP patients and its effects may be achieved through multiple pathways. Although the single and 4-session interventions were not significantly better than heat in improving fascial thickness, it performs better in pain and flexibility clinical outcomes, supporting its potential value as a complementary therapy. Future studies with larger samples and longer periods are needed to clarify its mechanism of action and optimize treatment options.
Gua sha, sometimes referred to as “scraping”, “spooning” or “coining”, is a traditional Chinese treatment that has
spread to several other Asian countries. It has long been popular in Vietnam and is now also becoming well-known in the West. The treatment consists of scraping the skin with a smooth edge placed against the pre-oiled skin surface, pressed down firmly, and then moved downwards along muscles or meridians. According to its proponents, gua sha stimulates the flow of the vital energy ‘chi’ and releases unhealthy bodily matter from blood stasis within sore, tired, stiff or injured muscle areas.
It is easy to imagine that Gua Sha is associated with sizable placebo effects. This means one needs to think carefully about how to control for tham in clinical trials, if we want to know whether the treatment works beyond placebo. I am not sure how to achieve this, but I am quite certain that the current study failed to do it. Thus its results merely showed that Gua Sha is just as useless as another therapy thay is unproven for CNSLBP.
And what about the thoracolumbar fascia thickness? I think that its significance is entirely speculative. Moreover, the reliability of its measurement seems questionable. Most likely, it is yet another red herring in a paper already more than full of fishy stuff.
PS
I stated it many times before, but I must say it again: almost any odd SCAM (e.g. chiropractic!) works a little for back pain – particularly if you test it in lousy studies and don’t control for placebo effects.
This study analyzed the prevalence and characteristics of misinformation in YouTube videos about chiropractic treatment for otitis media (OM).
YouTube was searched in January 2023 (Incognito mode, US region) using the terms “chiropractic treatment for otitis media”, “chiropractic ear infection”, and “chiropractic ear problems”. The first 50 English-language videos ranked by relevance were evaluated. Two independent reviewers extracted metadata (views, duration, likes, comments, upload source) and coded for references to evidence-based therapies, chiropractic techniques, and misinformation themes (“fixing” nerves or the Eustachian tube); a third reviewer resolved discrepancies. Descriptive statistics summarized video characteristics and engagement. A parallel PubMed search identified published literature on the most commonly mentioned techniques.
Fifty videos accrued 2,600,209 views, with a mean of 192 seconds, and generated 21,102 likes and 1,766 comments. Chiropractors produced 42 videos (84% of the content); hospital or academic channels contributed two videos (4%).
The findings are both revealing and frightening:
- Only three videos (6%) cited scientific sources.
- Twenty-five (50%) videos claimed that chiropractic manipulation could “fix” the Eustachian tube.
- Forteen videos (28%) asserted nerve correction.
- None of the videos mentioned antibiotics or tympanostomy tubes.
- Upper‑cervical adjustments (32 videos, 64%) and ear‑massage maneuvers (25 videos, 50%) were the most frequently promoted techniques, despite limited or low‑quality supporting evidence in the published literature.
The authors concluded that misinformation about chiropractic treatment for OM is widespread and highly viewed on YouTube. The omission of proven therapies and promotion of unverified claims pose risks for delayed care
and preventable harm. Efforts from clinicians, professional societies, educators, and platforms are needed to
elevate accurate content, promote media literacy, and reduce exposure to misleading medical information.
I suppose most of us have seen such videos. They are surprisingly popular, are by no means confined to relatively benign conditions like otits media, and reach vast audiences. Therefore, I often was tempted to conduct a proper study of them. I praise the US authors for having me beaten to it!
After reading this paper and after watching some of the videos, I foremost have one question:
HOW CAN ANYONE STILL BELIEVE THAT CHIROPRACTORS ARE SERIOUS HEALTHCARE PROFESSIONALS?
- (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.
Robert F. Kennedy Jr. has stated that circumcised boys have double the rate of autism. He thus suggested this is “highly likely” because they are given Tylenol for pain after the procedure. His claim references this 2015 study published in the Journal of the Royal Society of Medicine:
Objective: Based on converging observations in animal, clinical and ecological studies, we hypothesised a possible impact of ritual circumcision on the subsequent risk of autism spectrum disorder (ASD) in young boys.
Design: National, register-based cohort study.
Setting: Denmark.
Participants: A total of 342,877 boys born between 1994 and 2003 and followed in the age span 0-9 years between 1994 and 2013.
Main outcome measures: Information about cohort members’ ritual circumcisions, confounders and ASD outcomes, as well as two supplementary outcomes, hyperkinetic disorder and asthma, was obtained from national registers. Hazard ratios (HRs) with 95% confidence intervals (CIs) associated with foreskin status were obtained using Cox proportional hazards regression analyses.
Results: With a total of 4986 ASD cases, our study showed that regardless of cultural background circumcised boys were more likely than intact boys to develop ASD before age 10 years (HR = 1.46; 95% CI: 1.11-1.93). Risk was particularly high for infantile autism before age five years (HR = 2.06; 95% CI: 1.36-3.13). Circumcised boys in non-Muslim families were also more likely to develop hyperkinetic disorder (HR = 1.81; 95% CI: 1.11-2.96). Associations with asthma were consistently inconspicuous (HR = 0.96; 95% CI: 0.84-1.10).
Conclusions: We confirmed our hypothesis that boys who undergo ritual circumcision may run a greater risk of developing ASD. This finding, and the unexpected observation of an increased risk of hyperactivity disorder among circumcised boys in non-Muslim families, need attention, particularly because data limitations most likely rendered our HR estimates conservative. Considering the widespread practice of non-therapeutic circumcision in infancy and childhood around the world, confirmatory studies should be given priority.
In other words, the study found that circumcised boys were more likely to be diagnosed with autism compared to others in the group. Kennedy asserts that the post-circumcision use of Tylenol is the causal factor, relating it to his broader, unproven theory that acetaminophen use in early childhood is linked to autism.
Yet, every 1st-year medical student would point out that the study demonstrated only a correlation, not a causation, between circumcision and autism. Critically, the researchers involved in the original Denmark study stated that they had no data on the use of painkillers or anesthetics during the procedure, meaning they could not address whether Tylenol was involved in the observed correlation.
Other subsequent, more rigorous studies have found no evidence to support a link between either circumcision or Tylenol use and autism. Numerous health organizations, including the Autism Society of America, have criticized Kennedy’s theorie as being unproven, misleading, and not based on scientific evidence.
PS
Mr Kennedy, if you are reading this (which would surprise me), here are a few further, well-documented correlations that you might find worthy of your pseudo-research interest:
- The per capita consumption of margarine is highly correlated with the divorce rate in Maine.
- There’s a strong correlation between the number of people who drowned by falling into a pool and the number of films in which Nicolas Cage has appeared.
- The number of doctoral degrees awarded in civil engineering correlates with the per capita consumption of mozzarella cheese.
- The amount of cheese consumed strongly correlates with the number of people who have died by becoming tangled in their bedsheets.
- The revenue generated by arcades is correlated with the number of computer science doctorates awarded.
- The per capita consumption of sour cream correlates with the number of motorcycle deaths in the U.S.
THANK YOU FOR YOUR ATTENTION IN THIS MATTER.
Shingles or herpes zoster (HZ) is a neurotropic virus that causes a painful and hard to treat illness. Evidence is accumulating that HZ vaccinations might lower the risk of dementia. This effect is surprising but well-documented; here are 3 recent meta-analyses:
An international team of scientists aimed to evaluate the association of HZ infection, protective effects of antiviral treatment or vaccination on dementia. Systematic searches of PubMed, MEDLINE, EMBASE, Scopus, Web of Science, CINAHL, and Cochrane CENTRAL was performed from January 1, 1996, to October 31, 2024. Observational studies evaluating HZ infection, antivirals, or vaccination and dementia risk were selected. Risk of bias was examined with the Newcastle-Ottawa scale. A random-effects meta-analysis was performed, with the rate ratio (RR) and corresponding 95% confidence intervals (CIs) being pooled for dementia. Presence of heterogeneity was assessed with I2, and differences by study-level characteristics were estimated using subgroup meta-analysis and meta-regression.
Eighteen studies (N = 9.4 million) were included. Infection was associated with elevated risk of dementia (RR 1.14; 95% CI: 1.04, 1.25, I2 = 98%); this remained significant in the sensitivity analysis when the two case-control studies were removed (RR 1.17; 95% CI: 1.06, 1.30, I2 = 98%). Subgroup analysis based on sex, age, study population, bias scores, type of dementia or HZO did not show statistically significant differences in risk. Treatment with antivirals showed a small effect (RR 0.84; 95% CI: 0.71, 0.99, I2 = 73%), but prophylaxis with HZ vaccination was associated with a significantly lower risk (RR 0.68; 95% CI: 0.56, 0.83, I2 = 99%).
The authors concluded that there is a slightly raised dementia risk after HZ infection and reduced risks after antiviral treatment and prevention with vaccination. However, results should be interpreted with caution due to significant heterogeneity in pooled analyses.
Previous studies have reported a decreased risk of dementia with herpes zoster vaccination. Given this background, this systematic review and meta-analysis aimed to investigate the association between herpes zoster vaccination and the risk of dementia. An Indian/American team searched five databases until November 2023 for case-control, cross-sectional, or cohort studies investigating the association of herpes zoster vaccination and dementia. Odds ratios and 95% confidence intervals (95% CIs) were pooled in the meta-analysis. Meta-regression, subgroup, and sensitivity analysis were also conducted. The researchers evaluated a total of five studies (one cross-sectional, one case-control, and four cohort studies) that included a total number of 103,615 patients who were vaccinated with herpes zoster vaccine. All the studies were of high quality, ranging from 7 to 9. Due to the high heterogeneity (I2 = 100%, p < .00001) observed in our study, a random effect model was used for the analysis. The pooled odds ratio was 0.84 (95% CI: 0.50, 1.43), p (overall effect) = .53), indicating that herpes zoster vaccination reduces the risk of dementia.
The authors concluded that herpes zoster vaccination is associated with a reduction of the risk of dementia. More epidemiological studies are needed to confirm the association.
Herpes zoster (HZ) infection may increase the risk of dementia, that causes a heavy socioeconomic burden. However, the epidemiological evidence between HZ vaccination and the risk of dementia remains inconclusive. This meta-analysis was conducted to investigate the effect of HZ vaccination on the onset of dementia. The researchers searched PubMed, EMBASE, Web of Science, Science Direct, and Scopus for cohort studies assessing the association between HZ vaccination and dementia risk up to 20th January 2025. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled adopting a random-effect model. Four eligible studies were included in the systematic review and five retrospective cohort studies in the meta-analysis. Among 14,493,383 dementia-free participants at baseline, 427,309 dementia cases occurred during 36-95 months of follow-up. All studies were of high quality. Pooled analysis of adjusted HRs indicated that HZ vaccination could reduce dementia risk by 29% (HR = 0.71, 95% CI: 0.66-0.76, I2 = 97.15%). Subgroup analyses revealed heterogeneity linked to definitions of dementia, exposure measurements, vaccination doses, deprivation index, and region. The results were stable in the sensitivity analyses, and no publication bias was found.
The authors concluded that HZ vaccination was notably related to a reduced risk of dementia. More mechanistic studies and epidemiological studies are warranted.
_______________
The effect seems powerful and faily consistent across different studies. But how can this be? Australian neuroscientists have suggested that subclinical zooster virus reactivation might act as a renewable peripheral immune stressor, amplifying microglial priming in aging brains. Shingles vaccination may suppress this viral reservoir, reducing cumulative inflammatory tone.
Whatever the mechanism, the news that zoster vaccination might strongly reduce the dementia risk is hugely encouraging. It could also, I hope, have the effect that the dangerous anti-vaccination attitude currently fuelled by the incompetent US govenment will be getting a little less popular.
PS
Needless to say that these vaccinations also reliably prevent shingles!
So please, do consider getting vaccinated.
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 study investigated the efficacy of cognitive functional therapy (CFT) versus a sham procedure for pain intensity and disability for patients with non-specific chronic low back pain (CLBP). It is a randomised sham-controlled trial conducted in a primary care public health service. A total of 152 participants were randomly assigned to the CFT group (n=76) and the sham group (n=76). The CFT group received six 1 hour individualised sessions; the sham procedure group received six individual sessions of neutral talking+detuned photobiomodulation (low-level laser therapy) equipment. Both groups received an education booklet with information on strategies for CLBP self-management. Primary outcomes were pain intensity and disability at 6 weeks. Participants were assessed preintervention, postintervention (at 6 weeks), and 3 and 6 months after randomisation.
The researchers obtained primary outcome data from 97.4% (n=74) of participants in the CFT group and 98.7% (n=75) from the sham group. The CFT group showed greater effects in pain intensity (mean difference (MD)=-1.8; 95% CI -2.5 to -1.1) and disability (MD=-9.9; 95% CI -13.2 to -6.5) postintervention compared with the sham group. The effect remained at the 3-month and 6-month follow-ups.
The authors concluded that CFT showed sustained clinical efficacy compared with a sham procedure for treating pain intensity and disability in patients with CLBP.
In recent months, there have been many studies of CFT showing promise for LBP, e.g.:
- In people with lifting-related LBP undergoing CFT, increased trunk velocity during lifting showed potentially large correlations with reductions in disability and improvements in pain self-efficacy.
- Within-person changes in lifting technique varied among individuals. Greater trunk ROM and velocity, lower knee ROM and velocity, and faster lifting movements often co-occurred with lower levels of pain and functional limitation. This reflects a transition along a continuum from squat-like towards semi-squat-like and stoop-like lifting techniques.
- Following eight weeks of intervention, both ET and ET + CFT improved functional disability, pain, lumbar pelvic motor control, and biopsychosocial indicators in individuals with CNLBP. Notably, while the combined intervention group (ET + CFT) showed greater improvements across most outcomes, it was significantly different from the exercise-only group only on the Kinesiophobia scale. These findings suggest that cognitive functional therapy may enhance the effectiveness of exercise therapy by addressing psychological factors, such as fear of movement, that contribute to pain and disability in CNLBP.
- Improvements in pain catastrophizing (PC) and pain self-efficacy (PSE) were strongly correlated with increased trunk velocity-but not trunk or lumbar ROM-in people with CLBP who were undergoing CFT. These findings are consistent with CFT that explicitly trains “nonprotective” spinal movement in conjunction with positively reframing pain cognitions
- Cognitive functional therapy intervention had a greater effect on the vertical ground reaction force parameters. The reason for the greater effect of cognitive functional therapy intervention on vertical ground reaction force parameters can be partially explained due to the multimodal therapy used through cognitive exercises and motor control.
So, what exactly is this new wonder therapy? CFT is an approach invented and promoted by physiotherapists to analyse the behavioural psychology, beliefs and patterns of movement of LBP patients. Subsequently, the therapist would assist patients in understanding their pain and determine strategies to manage it within their goals of activities, participation, and lifestyle. CFT employs a multifaceted clinical reasoning framework to identify modifiable factors of an individuals presentation based on their personal characteristics and lifestyle and assessing their response to pain. CFT is supposed to help patients become autonomous, and self-manage their pain with their own personalised treatment.
A CFT intervention would usually involve, over several sessions:
- Making sense of the patient’s pain, and helping them to understand the pain.
- Exposure with Control (show and train the patient their movement with alterations in movement pattern and control)
- Training postural control
- Training their movement with or without gradual exposure
- Providing visual feedback with mirror or video
- Integrating these patterns in functional tasks
- Providing reassurance of safe movement of the body
- Making the patient feel more comfortable and accustomed to the movement
- Lifestyle changes, such as sleeping patterns, and breathing techniques
- Outcome (leading to a positive outcome, where the patient would behave normally, and feel rejuvenated).
It seems to me that CFT condenses and formalizes much of what good clinicians have been doing intuitively all along – simply because it is common sense and physiologically plausible. It also seems to me that it is not the huge breakthrough that it is currently hyped to be. It probably is a step in the right direction but not a magic wand for getting rid of back pain.
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.
