Back pain, neck pain, and headache are common office visits I see in primary care. Today, I read an article put out by the American Chiropractic Association:
A new survey showing that nearly half of all Americans are concerned about the safety of the medical care they receive should send a strong signal to the health and insurance industries that safer non-drug, non-surgical treatments should be considered whenever possible, according to the American Chiropractic Association (ACA).Chiropractic care is one of the safest health care options available today, boasts high patient satisfaction ratings and has been shown to be more effective than medication at treating conditions ranging from back pain to headaches, according to the ACA.
Let’s look at the data and see if they’re right.
Chiropractic care in back pain
A meta-analysis of 26 randomized controlled studies (RCTs) evaluating spinal manipulation for acute and chronic back pain reported that spinal manipulation was superior to sham therapies and therapies judged to have no evidence of a benefit but was not superior to effective conventional treatments.
Another meta-analysis of 39 RCTs evaluated spinal manipulation in the treatment of low back pain. Again, the results were similar:
For patients with acute low back pain, spinal manipulative therapy was superior only to sham therapy or therapies judged to be ineffective or even harmful. Spinal manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school. Results for patients with chronic low back pain were similar. Radiation of pain, study quality, profession of manipulator, and use of manipulation alone or in combination with other therapies did not affect these results.
Thus, chiropractic care is certainly better than nothing for low back pain, but definitely not better than conventional medication. It certainly is more expensive. I would consider it in those where medication is not appropriate.
Chiropractic care in neck pain
The efficacy of manipulation in neck pain is more limited. A RCT comparing intensive training, physiotherapy, or manipulation for patients with chronic neck pain showed no difference between the modalities.
Another review of 33 clinical trials found the following:
Mobilization and/or manipulation when used with exercise are beneficial for persistent mechanical neck disorders with or without headache. Done alone, manipulation and/or mobilization were not beneficial; when compared to one another, neither was superior.
In other words, chiropractic care used in conjunction with mobilization (i.e. neck exercises) was useful, but not by itself.
The data remains inconclusive to draw firm conclusions about the use of chiropractic care for neck pain.
Chiropractic care in headache
Again, there is very limited, if any, data supporting the efficacy of chiropractic care for headaches. One study showed no benefit of chiropractic care for migraine headaches. Another showed no additional benefit when spinal manipulation was added to the medication amitriptyline when treating migraine headaches. Another systematic review of 8 trials showed no benefit of spinal manipulation for treating four different types of headache (tension, migraine, “cervicogenic” and “spondylogenic”).
So, before you send “a strong signal to the health and insurance industries that safer non-drug, non-surgical treatments should be considered whenever possible”, be familiar with the evidence behind these treatments first. Chiropractic care certainly has its place, and I have many patients who swear by it. However, it will should not replace conventional therapy just yet.
