Kevin, M.D. - Medical Weblog

this article is about chiropractice,a new way and view in medicine,that needs less money and has less side effects.anc gives some evidences about it that proves this kind of treatment is'nt clear and we can't trust it.but I think for that claim we need more evidences and researches and we can't give a fact with some limited results.I think it will be better if yuo give more examples about treatment like that and explain it more.
 

Good links - there is also evidence that with cervical spinal manipulation there is an increased risk of carotid artery aneurysm and fatal stroke, even in young patients at low risk. These studies are available through medline or even a google search. How much money does the american chiropractic association spend in lobbying washington each year?
 

WHere are the statistics regarding the number of patients who have sustained serious neurological damage as a result of chiropractic "manipulation?"
 

You really need to distinguish between "chiropractic care" which may employ spinal manipulation and a hodge podge of psuedo-science with spinal manipulation which can be performed by a variety of non-chiropractic practitioners. The results from the new UK-BEAM study lend some insights into the appropriateness of spinal manipulation in the community-based primary care setting:

: BMJ. 2004 Nov 19

United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care.

[No authors listed]

OBJECTIVE: To estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain. DESIGN: Pragmatic randomised trial with factorial design. SETTING: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom. PARTICIPANTS: 1334 patients consulting their general practices about low back pain. MAIN OUTCOME MEASURES: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores. RESULTS: All groups improved over time. Exercise improved mean disability questionnaire scores at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than "best care." For manipulation the additional improvement was 1.6 (0.8 to 2.3) at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at three months and 1.3 (0.5 to 2.1) at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred. CONCLUSIONS: Relative to "best care" in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months.

BMJ. 2004 Nov 19

United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care.

[No authors listed]

OBJECTIVE: To assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise ("combined treatment") to "best care" in general practice for patients consulting with low back pain. DESIGN: Stochastic cost utility analysis alongside pragmatic randomised trial with factorial design. SETTING: 181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom. PARTICIPANTS: 1287 (96%) of 1334 trial participants. MAIN OUTCOME MEASURES: Healthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months. RESULTS: Over one year, mean treatment costs relative to "best care" were pound195 ($360; 279 euro; 95% credibility interval pound85 to pound308) for manipulation, pound140 ( pound3 to pound278) for exercise, and pound125 ( pound21 to pound228) for combined treatment. All three active treatments increased participants' average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost pound3800; in economic terms it had an "incremental cost effectiveness ratio" of pound3800. Manipulation alone had a ratio of pound8700 relative to combined treatment. If the NHS was prepared to pay at least pound10 000 for each extra QALY (lower than previous recommendations in the United Kingdom), manipulation alone would probably be the best strategy. If manipulation was not available, exercise would have an incremental cost effectiveness ratio of pound8300 relative to best care. CONCLUSIONS: Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.
 

I don't see how people could think that conventional medicine is better suited to handle back pain, neck pain or headaches. Will conventional medicine relieve symtoms i.e. back pain, neck pain etc... yes but will convention medicine actually fix the problem? This would be an overwhelming NO. Conventional medicine masks the problem that is causing pain but does not actually fix anything. Have you ever figured out why drug companies never use the word Health in their ads. They Can't. They can't sell it because thay can't do it. Oh and if you think surgery is better. Studies show that 50% of all back surgeries fail. So I can't see where conventional medicine has its place.
 

Drug companies and physicians would lose a lot of cash if they admitted that chiropractic and other similar treatments actually work. Think about people who used Vioxx for joint pain; the pain is still there, and now they have learned that the drug they've taken for years is dangerous, and recalled. Every drug has a side effect and I'll pay $8 for an adjustment any day rather than let these drug companies become anymore powerful than they already are. Chiropractic care cured my neck and shoulder pain and now I live medicine free. No one can tell you that is not a healthy choice.
 

I would like to note that while perhaps not effective for migraines, I have found it to be extremely effective for sinus headaches. I went in very skeptical (at the behest of my mom), but after several weeks it became clear that the sudden relief I got immediately after a chiropractor visit was not coincidental. I've gotten to the point where I can stretch/crack my neck so that I don't need constant care, but spinal misalignment defitely contributes to allergy-caused sinus headaches
 

Wow! What is your point of this post. Studies show that both chiropractic care and "traditional medicine" my help patients with symptoms ranging from back pain to headache. I am a pharmacist so I feel my opinion on medicine carries some validity. There are two large categories of back pain; acute and chronic. I have seen thousands of patients treated short term for acute back pain and the results are great. Hoewever, the medical communities resistance and inability to admit that they may not be be the best answer for chronic pain is shortsided and arogant. Longterm use of NSAID's, muscle relaxants and even narcotic pain relievers is out of control in this country. These medications are a cover, not a cure for patient problems. It is time for all medical doctors to swallow your ego and do what is best for your patients, not what is best for your pocket book. And in your future posts, please don't talk about the expense of chiropractic care. I found this beyond laughable. Try posting the monthly cost of Celebrex (well over $80/month in most cases). Couple that with a office visit so your doc can hand you your prescription (well over $100). And 7 years from now when you back pain is still there we can discuss the cost of back surgery. I am quite sure that my take most of a patients $1000 deductible, assuming they have insurance.
Dr. Tyson
 

Dr Charles, you can't be serious. How much money does the american chiropractic assosiaction spend in washington? Not even close to what the "medical" association does. All the medical doctors do is push drugs for the drug companies. They pay for your vacations and give you huge perks. It's a sham. Unless you need surgery, no need to go to the doctor.
 

Dr. Kevin, you really need to look at more studies than the ones you currently have listed. There are over a 100 studies showing chiropractic care to be effective for neck and back pain. You cannot discount all the studies that were done in the 80's and 90's showing the superioty of chiropractic care. Are you familiar with the study done in the Chicago are where chiropractors acted as PCP's the results were astounding. Look up AMI and the studies with it
 

I love it when my friends suggest their chiropractor has really helped them with (whatever). They explain they go see him every week for a manipulation and it just works wonders.

Hint: If he was helping you, you wouldn't have to go back every week, now would you?
 

Mr.Small -
Your reply shows a lack of understanding relative to chiropractic. You are looking at it from your allopathic conditioning.
You state, "Hint: If he was helping you, you wouldn't have to go back every week, now would you?"

Would you apply the same thinking to nutrition? "If eating healthy food really helps you to be healthy, why do you have to keep eating that way?"

When someone is prescribed medication, do you squawk at the fact that they have to take it the rest of their life? "If those little purple pills were really helping you, you wouldn't have to take them everyday, now would you?"

Gregory
 

I am a board certified emergency pysician and have authored and publshed about a half dozen articles on back pain. I have reviewed most of the articles discussed here. A lot, if not all, of the data supporting chiropractic care is flawed but not worthless, but the meta-analyses were well done and I think are helpful to get a big picture.

I also have an extensive history of personal back pain, have receved chiropractic manipulation, and treat many pts with it.

My professional opinion is that chiropracters provide a valuable service. They hold pts, touch pts, and tell them that hey are getting better. They encourage them, give lots of positive feedback, and sell it.

But, and here is the rub, what they do, and what they theorize, is not really valid, from a scientific standpoint. Their knowledge of anatomy, physiology, and pathology is really rudimentary. The theory (as I have interpreted it and been told) is that spinal subluxations cause disease, that manipulations correct the subluxations, and that correcting the subluxations cures the disease. I mean, lets be serious, sublxations are likely irrelevant. The pts back pain has nothing to do with some minor subluxations, which are likely normal varients.

That being said, i still refer some pts to chiropracters. Especially the ones with personality issues who need a "hug" from their provider. I do not refer pts who have acute pain who are normal and not too neeedy, because no matter what we do to them, they will get better just as fast, as the data shows.

And, by the way, I recently took care of a 32 year old mother of 2 who had a cervical manipulation done. She dies four days later from complications of her vertebral artery dissection. Risk/benefit...
 

A recent conversation with Jim, a male client in a physical therapy setting:

Jim: “The muscle strain in my leg is doing much better.”

RT: “You should be able to return to playing racquetball this weekend. But take it easy. Ease back into the game so we don’t re-injure that muscle.”

Jim: “I can’t wait to play again. Incidentally, do you have anything I could do for soreness in my neck?”

RT: “Yeah, I could show you a few stretches. It’s easy stuff. Try them over the weekend. And if they don’t help make an appointment with your doctor, get a prescription and we’ll evaluate and treat your neck pain.”

Jim: “Hey, I can feel these stretches pulling on the sore areas. I’ll try them over the weekend. How often?”

RT: Try once or twice each day until your next visit on Monday. Say, you said you work at a computer all day, didn’t you?”

Jim: “Yeah, as a programmer.

RT: ”How many hours per week?”

Jim: “About forty-five to fifty.”

RT: “Anyone else complaining about neck soreness where you work?”

Jim: “Yes, all of them.”

RT: “And how many people is that?”

Jim: “About sixty.”

RT: “My, my, my. Somebody needs to look into this.”

I came to this conclusion after similar conversations with teachers, lawyers, administrative assistants and customer service representatives, just to name a few. Happily, on Monday Jim reported that the soreness had gone, and that he was going to use these stretches as a preventative measure during his work day.

Looking into research on the matter I found that between 15% and 30% of those working in an office setting had neck injury requiring medical intervention. My own inquiries revealed higher numbers of people battling with intermittent neck pain, soreness and stiffness from extended time at a computer.

These are healthy individuals, for the most part, who may mention their neck shoulder pain complaint during a routine checkup at the doctor’s office. In many cases they have resigned themselves to the fact that neck soreness is part of their work situation and is something they have to live with. In an attempt to eliminate soreness they have used over-the-counter pain medications, topical creams, hot showers, or just sitting and waiting for the soreness to go away. Often their neck complaints escalate to the point that they need to see a doctor and have four or more weeks of physical therapy treatments.

But a few simple preventative techniques can be used in the work setting to avoid neck back pain or provide neck pain relief from office activities. The goal is not only to prevent and avoid turning the injury into a chronic neck pain condition. My clients have these techniques and use them as needed.

Although people are busy today, few are active enough to help maintain muscle tone. These tired and busy office workers and managers have to fit in an exercise regime in addition to their other activities.

The funny thing is that I have seen active and sedentary people needing prevention. The active individuals had the proper muscle tone but need to add appropriate stretching to their daily routine to quell their neck soreness.

A healthy routine should consist of 20 to 30 minutes of activity per day. This activity can be split up into 10 minute bouts at opportune times throughout the day. Add more on less busy days and as you are able. Stretches and movement activities can be performed proactively before prolonged activities at your desk or computer. They are also helpful during time spent at your computer, and after to reduce the after effects of prolonged sitting.

Keywords: neck shoulder pain, chronic neck pain, neck back pain, neck pain relief, neck pain.

About the Author:
Rob Tworek, PT is a Physical Therapist (Physiotherapist) specializing in the prevention and care of neck and low back pain. He successfully assisted numerous clients in returning to their office positions with resolved neck and low back pain, little or no manageable symptoms and renewed hope of maintaining a quality of work and life that they could enjoy.

mailto:avoidneckpain@yahoo.com
http://www.officecoachplus.com
 

The Pharmaceutical Industry controls the American Medical Association. The Pharmaceutical Industry provides training and seminars (and vacations) to medical doctors. I'm not sure exactly how much the Pharmaceutical Industry spends per day in advertising, but I vaguely remember that is was over 30 million dollars per day!!! Now, chiropractors just cannot compete with that advertising budget. Nor, can the Chiropractic Associations afford to conduct studies to the degree that the Pharmaceutical Industry can. The Pharmaceutical Industry pays for the studies that medical doctors base their care on. It can destroy studies that it doesn't like, and promote the studies that conforms to the benefits of taking pills. The pharmaceutical industry doesn't care about the health of people. It has one main objective and that is to make lots of money.
 

It is disturbing to see people post comments about the chiropractic profession and make claims about the effectiveness of allopathic and homeopathic medical practices when they hide behind the walls of anonymity. If you claim to be a doctor (MD, DO, DC, Ph.D) I would sincerely hope that you had the moral fiber to back up your statements with your name.

I do not claim to have a doctorate of any sort, but I would make certain that claims I made about the effectiveness of any medical practice were reinforced by research for the benefit of all users of this forum.

For those who wish to know more about the practices of chiropractors, look in Wikipedia and the American Chiropractic Association website.

It should also be pointed out that there are doctors (MD, DO) that believe alternative medicine will cure just about anything. In that same mindset, there are chiropractors who believe that manipulation of the spine will cure everything. This does not mean that all physicians and chiropractors believe in such extremes.

In summary, do your research people. Don't listen to those who make claims of being physicians, but don't provide (A) references or (B) their name.
 

In addition, I have noticed comments stating that if people require on-going chiropractic manipulations, then chiropractors are not helpful. How is this different from people who need medication for the rest of their lives due to chronic conditions?

Because an alternative form of medicine requires on-going treatment does not make it any less valid than an allopathic treatment that requires on-going treatment via medication.

I am a strong believer in taking the best from both disciplines. Use the best combination of remedies to treat the patient. For example, if a patient has cancer, then use allopathic means to eradicate the cancer cells and combine it with homeopathic means to treat pain, fatigue, and help reduce the chance of relapsing.
 

My personal experience with chiropractic is my job which is a chiropractor. Everyday I see patients who respond terrifically to spinal manipulation plus the other things we add (stretches, strengthening, heat, massage). Many of the studies just look at spinal manipulation alone and who knows the abilities of those performing it. This is as much an art as a science so certain providers will see far superior results with their patients than others. I cannot just count on the "research" which changes it's mind constantly.
 

"But, and here is the rub, what they do, and what they theorize, is not really valid, from a scientific standpoint. Their knowledge of anatomy, physiology, and pathology is really rudimentary."

I find this comment laughable, at best. A chiropractors education in anatomy, physiology, and pathology is intensive and thorough. Just because they don't hold the same mindset as you does not mean they are uneducated, or that their knowledge is rudimentary. The following is an excerpt from the NYSED requirements for chiropractic licensure. Every state has their own requirements, but this is reflective of most states:

"Examination: pass examinations satisfactory to the board and in accordance with the commissioner`s regulations, in clinical chiropractic analysis, the practice of chiropractic, X-ray as it relates to chiropractic analysis, and examinations satisfactory to the department in anatomy, physiology, pathology, chemistry, microbiology, diagnosis, and the use and effect of X-ray."
http://www.op.nysed.gov/article132.htm

Chiropractors are educated professionals, and your disagreement with their philosophy does not negate their years of education, their board exams, and their licensing requirements.
 

In regards to the study on amitriptyline and chiropractic care for migraines, I like the way you manipulated the results. The study showed that chiropractic was just as successful as the drug but the combination of the 2 did not improve outcomes. Furthermore, people in the chiropractic group reported continued benefit once the treatment was stopped. The same cannot be said for the amitriptyline group. If you're going to have a blog, please try to represent the facts and material without bias. You just lost all credibility to anyone who has actually read the study.

Lastly, when someone brings up the risk for cervical manipulation and stroke, it's always anecdotal. Where's the research?Many more people have a stroke following a hairwash at their beauticians. Why isn't there an uproar on the safety of hairwashing? Why is chiropractic malpractice $2,000 and M.D.'s 10k to over 100K if it's so dangerous? The number of people who die everyday from OTC pain meds far exceeds the number of deaths attributed to chiropractic care in its history. Let's not forget that the Journal of the American Medical Association sites iatrogenic disease as the number 3 killer in America, 225,000 deaths every year from our medical system!!! Dr. Pearce
 

6 months down the line with what started out as numbness/pain in the left arm/hand and absolutely useless help from GP's and medical practitioners, I fail to see how this article can really assure me to stick with the medical profession?!!!

I now have widespread pain/numbness, limited movement in my neck/shoulders etc, seen a neurologist, had an mri etc etc

Ended up on Monday at a Chiropractor, who took x-rays and straight away it was evident what the problems were! NO-ONE else before this seemed to have achieved this 'simple' task!!

So, I will stay open minded and am about to start very intense treatment/adjustments - basically, it's my only option left open to me and I am willing to pay to see if it can be sorted. I don't see why I should jeapordise my career and my hobby (running).

At the end of the day, we can each choose how we see fit to be treated and if the NHS don't care, then go elsewhere!