Spinal manipulation 'has no benefit for back pain'

[Ian David]

Spinal manipulation 'has no benefit for back pain'
21 Sep 09
By Nigel Praities

Controversy over the inclusion of spinal manipulation in NICE guidelines on back pain intensified this week after a study showed no benefit when it was added to standard care with painkillers.

The study in patients with acute low back pain presenting in primary care found no difference in the pain scores of those treated with spinal manipulation and analgesics, compared with those receiving analgesics alone.

It casts doubt on NICE advice that GPs consider a course of spinal manipulation in patients with low back pain after prescribing paracetamol, NSAIDs or weak opiods.

<snip>

Professor Peter Juni, lead investigator and head of the division of clinical epidemiology and biostatistics at the University of Bern, Switzerland, said: ‘Spinal manipulation is unlikely to result in relevant early back pain reduction in primary care patients with acute back pain.’

The study adds to mounting criticism over NICE guidelines on back pain. The controversy has already led to the British Pain Society ousting their president, Professor Paul Watson, a member of the guideline development group.

More:
http://www.pulsetoday.co.uk/story.asp?sectioncode=35&storycode=4123702&c=2

[mdmc]

1. that has not been my experience

I found much relief with mobic and "adjustments". I also found massage and acupuncture to help with the pain..

[Ian David]

2. Masturbating helps too. Seriously. And it's free. n/t

[mdmc]

6. sex has been proven effective re: pain management

An orgasm tends to "over rule" all pain messages sent to the brain. I read about it when studying up on rheumatoid arthritis..

[TreasonousBastard]

10. Except for headaches--- orgasm and...

blood pressure spikes can make a mild one pretty bad.

[stopbush]

3. I see a chiro around once a month.

It works for me, and I'm not taking pills. Why take pills if one doesn't have to?

While I wouldn't say I have acute back pain, when I have back pain, it is no party. It's not the type of pain one can imagine one has, or the type of ill that can be relieved by placebo.

My chiro mixes in strength training and stretching with her adjustments, and I think that helps a lot. She works with a lot of athletes doing rehabilitation. Chiro is only one facet of what she does when I see her. In fact, it's about 20-25% of the therapy session, tops.

I'm a firm believer in science, and I don't believe in so-called alternative medicine. Medicine means that something has been proven to work through unbiased testing. Last I looked, adjusting the spine to relieve back pain is the one area of chiro that does some good according to "standard" medicine.

[Christa]

5. It is called the Placebo effect.

A placebo is a sham medical intervention intended to lead the recipient to believe that the intervention may improve his/her condition. In one common placebo treatment, a patient is given an inert "sugar pill" and told that the pill may improve his/her condition. The fact that the pill is inert is withheld from the patient. The intervention may cause the patient to believe that the treatment will change his/her condition; this belief sometimes causes the patient's condition to change, a phenomenon known as the placebo effect.

Placebos are widely used in medicine, and the placebo effect is a pervasive phenomenon; in fact, it is part of the response to any active medication. However, the deceptive nature of the placebo creates tension between the Hippocratic Oath and the honesty of the doctor-patient relationship. The placebo effect points to the importance of perception and the brain's role in physical health.

Placebos have greater effect in some countries than others, and this varies with condition treated. Placebo effects in treating gastric ulcers is low in Brazil, higher in northern Europe (Denmark, Netherlands) and extremely high in Germany. But the placebo effect for hypertension is lower in Germany than elsewhere.

http://en.wikipedia.org/wiki/Placebo

[Ian David]

9. That was even the consensus of Quackwatch.

This is from a site that debunks bogus alt-med claims. Their position is pretty much that spinal manipulations of the LOWER back, when done BY HAND, ON ADULTS, can be an effective treatment for back pain.

Chiropractic: Does the Bad Outweigh the Good?
Samuel Homola, D.C.

<snip>

Limitations of Chiropractic

Since chiropractors work on the back, most people think of the chiropractor as a back specialist. But when back-pain victims visit a chiropractic office, they may be given pamphlets suggesting that chiropractic treatment is also beneficial for asthma, infantile colic, ear infection, digestive disturbances, and a host of other organic or visceral problems. There are many good chiropractors who do a good job treating back pain, but few voluntarily limit their treatment to the care of back pain. Chiropractic colleges are still teaching the theory that using spinal adjustments to correct vertebral subluxations will restore and maintain health. Unless you see a chiropractor who has been recommended by an orthopedic specialist or who works with physicians in a back-pain clinic, your chances of finding a properly limited chiropractor are slim. Poorly informed consumers may not know where to draw the line when they visit a chiropractor.

"That spinal manipulation is somewhat effective symptomatic therapy for some patients with acute low back pain is, I believe, no longer in dispute," said the editorial in the New England Journal of Medicine <10>. But "there appears to be little evidence to support the value of spinal manipulation for non-musculoskeletal conditions. For this reason, I think it is currently inappropriate to consider chiropractic as a broad-based alternative to traditional medical care."

<snip>

2. Seek Appropriate Manipulation

Properly performed spinal manipulation is always done by hand. Chiropractors who believe that slightly misaligned vertebrae can cause disease often use machines or small hand-held spring-loaded mallets to tap misaligned vertebrae back into place. A 1998 survey by the National Board of Chiropractic Examiners found that 62.8% of survey respondents said they used an Activator mallet to adjust subluxations <11>. Such chiropractors might also use instruments to measure heat and electrical activity over skin surfaces in a search for subluxations. The only treatment they may offer is a spinal adjustment for whatever ails you.

A good chiropractor who specializes in the care of neuromusculoskeletal problems does not use instruments and machines to diagnose and treat subluxations. And his treatment is not limited to the spinal adjustment. Physical therapy, massage, exercise, rest, home treatment with hot or cold packs -or no treatment at all-are sometimes more appropriate than spinal manipulation.

More:
http://www.quackwatch.com/01QuackeryRelatedTopics/chiroeval.html

[ayeshahaqqiqa]

12. Ah yes, quackwatch

which has an axe to grind about anything alternative. I don't consider it a credible source.

[Orrex]

35. That's an ad hominem

You need to show that Quackwatch is actually wrong, if indeed it is, rather than simply objectionable to you.

[HuckleB]

41. So you don't consider evidence-based discussion valid?

[stopbush]

19. As I said, I see my chiro for lower back pain and that's it.

It's an effective treatment. The final bolded paragraph you quoted above (ie: "A good chiropractor who specializes...") pretty much sums up what my chiro/physical therapist does with me.

[ayeshahaqqiqa]

11. Chiropractors do so much more than just spinal manipulation

Mine gave me back exercises that have really worked. I sit at a desk all day, and those exercises have been a boon when the back starts aching. And the pillow I got from him has helped me from getting the neck pain back.

I could go on and on about what chiropractors do, but to those who only believe in "cut and drug" MDs, there is no use. I just tell them to not see chiropractors. I promise I will never ban them from seeing their doctors--just don't ban me from seeing mine.

[Christa]

4. I 100% agree

I have had excruciating back for many years and most, if not all of the treatment I have received had zero effect on my pain. It is all about the money. Chiropractors are snake oil salesmen and why we actually give them credibility in this day and age is way beyond me.

Don't even get me started on homeopathy and acupuncture which are nothing more than modern day witchcraft.

[stopbush]

20. Agreed that homeopathy and acupuncture are bogus.

Though my wife did acupuncture for a sore arm and she swears it helped (placebo?).

Chrio for the lower back is recognized as a legitimate and effective therapy by the medical community.

You say you've had back pain for years. Have you tried chiro? I've had back pain for years as well, and I refuse to believe it's all in my mind, especially as I have no other illnesses worth mentioning. I've had back pain in good times and bad, when under pressure and when life was relatively carefree. I've been free of back pain after seeing a chiro for months and even years at a time. At other times, it takes more visits to get me "fixed."

Also, I have the x-rays taken from when I started chiro and where I am now. To me, it looks like my body is better aligned. It's not just the chiro, it's the strengthening exercises I do for the lower back that help tremendously. The stretches also help.

I find that if I see a chiro once a month, I stay in a good place. If I stop going, it catches up with me in 5-6 months and I end up doing more sessions than I would have if I had gone once a month. It's physical therapy and exercise.

[Christa]

21. I have been to a chiro

recommended by my doctor and after about 6 treatments I stopped going as I felt it was a waste of time. There was no improvement at all.

[stopbush]

22. If there was no improvement, then I wouldn't go either.

It works for me.

[bananas]

27. Study Shows Acupuncture Trumps Standard Care for Back Pain Relief

Acupuncture May Ease Chronic Back Pain
Study Shows Acupuncture Trumps Standard Care for Back Pain Relief
By Kathleen Doheny
WebMD Health News
Reviewed by Louise Chang, MD

May 11, 2009 -- The ancient technique of acupuncture helps relieve chronic back pain better than standard care such as medications or physical therapy, according to a new study.

Even more surprising, all three acupuncture techniques tested -- including a "sham" technique with toothpicks and no skin puncturing -- worked better than the usual care given for the problem.

<snip>

"The individualized acupuncture did not provide any benefit over the standardized acupuncture," Cherkin tells WebMD. "The simulated acupuncture, which did stimulate the standardized points, also had the same effect. All three did better than usual care."

Those who got any of the acupuncture treatments were more likely than those getting usual care to have a "meaningful" improvement in the dysfunction scale, which reflects the ability to engage in activities of daily living. Overall, 60% of the acupuncture-treated patients, but just 39% of the usual-care group patients, had meaningful improvements in dysfunction, the researchers found.

<snip>

[ayeshahaqqiqa]

34. Acupuncture has been used in China for centuries

in place of anesthetic for operations. I know of a case here in Arkansas where it was used in eye surgery because the patient could not tolerate anesthetic. I don't have time now (got to get to work), but I believe there have been double-blind studies that show acupuncture does work in some instances.

I think the problem here is that people have the quaint notion that a medical procedure they like will always work for every person. I've found this not to be the case. The human body is a complex mechanism, and is very individualized. For me, taking certain antibiotics actually makes me sicker: I nearly died when an MD insisted that I keep taking the same one over and over for recurring tonsilitis--I went into a coma and was so ill I couldn't even be moved to the hospital. And yet homeopathic remedies have worked for me in clearing up bladder infections where antibiotics only made them worse and also gave me yeast infections. Does this mean I want to ban antibiotics? Of course not, because I know that they really do work for some people. I'm just not one of those people.

[laconicsax]

37. The argument 'used in ' for centuries amounts to squat.

In Europe, Africa, and the Americas, drowning someone was used for centuries as a diagnostic tool to see if they were a witch.

[ayeshahaqqiqa]

42. But the difference is that acupuncture works

to stop pain. Your analogy is faulty.

But it is obvious there is no reason to talk with you--your mind is closed on the issue.

[laconicsax]

48. My analogy isn't faulty, your case is.

I've read of acupuncture's merits, and those merits are far more persuasive than the 'used for centuries' argument. For the simple reason that saying that something has been used for a long time says nothing of its worth--only of its longevity.

[ayeshahaqqiqa]

7. If chiropractic doesn't work for you,

don't go to a chiropractor. If it does, don't let anyone stop you from going to see them.

My MD SENT me to a chiropractor because of a neck problem, and it was solved. No more pain. And no drugs to have to take continually, either.

[JuniperLea]

14. Yep...

My sports injury doc (orthopedic surgeon) sent me to the chiro, and he has before and after x-rays showing the marked improvement. I guess my vertebrae know a good placebo when they see it! LOL!

My insurance pays for it, and it covers homeopathy and acupuncture too.

I had to laugh when I read here that those things are "modern day witchcraft" because some of "those things" are practices that are thousands of years old.

I'll try just about anything to keep from taking drugs and making Big Pharma bigger.

[laconicsax]

15. Umm...

Homeopathy is nonsense. The principles upon which it stands are false. Water doesn't have a memory and diluting something doesn't make it stronger. These are easily testable. The guy who came up with the homeopathy based it on the notion that diseases are caused by bodily imbalances, not invading organisms.

Here's a thread you may have missed: http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=222x67808
Here's a video you may enjoy: http://www.youtube.com/watch?v=HMGIbOGu8q0

[ayeshahaqqiqa]

17. Funny, if it doesn't work,

how come the FDA will not allow folks to buy Herpes Zoster remedy without a doctor's prescription? Just askin'....

[laconicsax]

25. Because any claims about its potency aren't supported?

Laconicspouse used to work for an alternative medicine company that got in trouble with the FDA for advertising that their product could cure ailments without any evidence. If the FDA just let anyone market and sell unsubstantiated cures OTC, there'd be a lot more snake oil on the market.

[ayeshahaqqiqa]

33. But the FDA requires a scrip for it!

In other words, the FDA not only thinks it works, but that its distribution needs to be controlled. IF it were bogus, they would shut down Washington Homeopathics, the manufacturer.

And in case you don't think the FDA shuts down drug manufacturers, the makers of Armour Thyroid,a prescription thyroid medicine, was shut down by the FDA because they changed their formula without FDA approval, thereby resulting in a nation-wide thyroid medicine shortage. Armour is NOT homeopathic, btw--it is a prescription drug--I'm just showing by this example that if a manufacturer of a prescription drug doesn't follow FDA guidelines they can be shut down.

[laconicsax]

36. Could you provide a link to what you're talking about?

I'm not up on every vial of water marketed as a cure to whatever ailment someone with money has and Google reveals lots of evil conspiracies meant to keep those vials of water from being sold as actual medicine. A link would simplify things greatly.

[JuniperLea]

18. Ummm....

Did I say anything other than it has a benefit amount in my insurance.

No.

But thanks... I think...

[laconicsax]

26. There's no reason why it should be a 'perk.'

If homeopathy works, simple tap water should be an amazingly potent cure for pretty much any ailment or disease. Health insurance shouldn't pay someone else's water bill.

[Christa]

23. The voice of reason!

There is absolutely no scientific proof that homeopathy or acupuncture works at all. It is all in the mind.

[ayeshahaqqiqa]

16. If we're forced to buy health insurance,

I need to know what company you are with.

[HuckleB]

47. Well, there's one way to begin to reduce wasteful health care expenses.

Homeopathy should not be covered.

[TreasonousBastard]

8. Hmmmm... no mention of the different kinds of back pain, and...

kinda downplays that the pills aren't that great, either. And there are always risks with pills and surgery. Often more risks than spinal manipulation or other alternative therapies.

So, since medical experts aren't guaranteeing to solve the problems yet, it looks like whatever works for you and your back pain is the answer.

[ayeshahaqqiqa]

13. Bingo!

I agree with your sentiments wholeheartedly!

[nickinSTL]

24. you know, I don't much care if it's a placebo effect

with chiropractic or anything else.

As long as you don't have a serious physical issue that's being masked by a placebo effect, it seems to me that with pain management, if it works, then pursue it.

The issue is with the pain, and if chiropractic limits the pain, the issue of whether it's a placebo effect or not is irrelevant.

If it doesn't work for you, don't do it.

I have a friend who believes it works for her, and as long as that's the case, I would never tell her not to go. If she feels better after treatment, that's all that matters, IMO.

[Fire_Medic_Dave]

28. Hydrocodone and Flexeril washed down with moonshine works very well.

[conscious evolution]

50. Hydrocodone and flexiril did not help my back pain.

Chiropractic manipulation,on the other hand,did.
The adjustment took the pressure of dislocated vertabrae off of my sciatic nerve.

[xchrom]

29. indeed. nt

[HamdenRice]

30. Ludicrous study design -- this study proves nothing and never could

It's reasonable to complain sometimes about alt med claims, but what's more amazing is some of the nonsense that gets funded and published as traditional science.

This study tries to measure the effectiveness of manipulation by comparing manipulation plus analgesics to analgesics alone.

Didn't anyone point out that if both are effective (in ways that are not additive or reinforcing of each other) that there could be no observable positive effect of manipulation even if there was one?

A properly designed study would be to compare manipulation to a placebo.

[Celebration]

31. I would settle

For analgesics alone vs. adjustments alone

OR, how about

Analgesics alone vs. Adjustjments plus analgesics?

Now, suppose the latter one showed no difference between the two groups. The headline would be.

"Analgesics Do Not Benefit Back Pain"

LOL, completely laughable study, I agree. It's almost as if it is a setup. Nooooo...............

[HamdenRice]

32. "Analgesics alone vs. Adjustjments plus analgesics?"

"Analgesics Do Not Benefit Back Pain"

Exactly!

[Celebration]

38. corrected

Adjustments alone vs. Adjustments plus analgesics

I guess if those were the same then that would prove analgesics don't work, right?

So why didn't they include adjustments alone as one arm of the study?

Fear of the result?

[HamdenRice]

39. Right! I didn't catch that. nt

[Orrex]

40. Perhaps chiropractors could conduct such a study.

Nothing would validate their profession more soundly than an unambiguous study showing that the competition doesn't work.


A major problem facing chiropractors is that they still--to this day--make baseless and absurd claims about what chiropractic can do and what ailments it can treat. The quacks who claim that spinal adjustments can cure hayfever seriously damage the credibility of chiropractors who claim that such manipulations can mitigate lower back pain.

I must disclaim that I'm happy to accept the possibility that chiropractic treatment can be helpful for back pain, but when the practice veers into the unsubstantiated realm of mystical subluxations, my BS detector starts clanging.

[Celebration]

43. actually

That study would be about as bogus as the one here.

I have a sneaky suspicion that some people do better with chiropractors, some people do better with analgesics, and a significant percentage of both would get better anyway.

Ya know, if one thing doesn't work, try another. Averages and median scores on studies are not the be all and end all. We are all actually, uh, a bit different from each other.

[Orrex]

44. That's an interesting suggestion

If I'm reading you correctly, you're proposing that some people might respond better to analgesics, while others might respond better to chiropractic. Is that right?

Interesting. I'll need to think about that.

[Celebration]

45. Yes, of course n/t

[Dorian Gray]

46. That's how I feel, too

I had one chiropractor practically try to convince me that he could get me pregnant. Ummmm.... not unless you were going to have sex with me, fool. And he was too much of an asshole to even consider that!

Seriously, though, I think that there is a definite place for chiropractic treatments. I've been to two that I've loved. They manipulated my spine, helped me in two sessions with some lower back pain, gave me exercises and sent me on my way.

There was one who pretty much made me never want to go back to a chiropractor again. (The one above.) He was so full of shit and tried to sell me SIXTY FREAKING SESSIONS the first time I met him. Bullshit. Definite snakeoil salesman.

[OllieLotte]

49. I have had way too much experience that has proven to

me that you are wrong. I have probably been "adjusted" over 100 times in my life and it helped tremendously (usually). I have since had a spinal fusion and probably get adjusted once a year now when I somehow do something that messes up my back, which is pretty rare.

I can tell you that exercise makes everything work better and I try to take care of back.