Is Chiropractic Effective?

Giles et al. compared 3 treatment groups for low back pain: Chiropractic, Acupuncture, and Medication.

Interesting Outcomes:
The results of this efficacy study suggest that spinal manipulation, if not contraindicated, may be superior to needle acupuncture or medication for the successful treatment of patients with chronic spinal pain syndrome.

This was a very interesting study, comparing what is often considered the “standard approach” by M.D.s to the approach of chiropractors and acupuncturists. In this study, not only did chiropractic have the best results, it also had the:
  • quickest results (8 early recovery patients vs. 1 for medication, and 1 for acupuncture)
  • no side effects experienced (vs. 7 cases with the medication group)
  • lowest “no-effect” response (8 patients vs. 10 in the acupuncture group and 11 in the medication group)
  • highest patient satisfaction (2 patients changed treatment groups vs. 9 from the medication group and 5 from acupuncture)
  • patients felt it helped their general well being (SF-36 results showed 47% improvement for chiropractic group, vs. 18% for the medication group, and 15% for the acupuncture group
Considering that the patients in this study had experienced chronic spinal pain syndrome for an average of:
  • 4.5 years in the medication group
  • 6.4 years in the acupuncture group
  • 8.3 years in the spinal manipulation group
It is notable that manipulation, during a maximum treatment duration of 9 weeks, achieved asymptomatic status for every fourth patient (27%). This result is superior to the percentages for acupuncture (9.4%) and medication (5%) for short-term outcomes.

Medication apparently did not achieve a marked improvement in chronic spinal pain and caused adverse reactions in 6.1% of the patients. Interestingly, although “new” medication (i.e., not previously tried by patients) showed no significant improvement for the subjective pain and disability measures or the objective measures, the Short-Form-36 Health Survey questionnaire did show an improvement of 18% for general health status, as compared with 15% for acupuncture and 47% for spinal manipulation.

Spinal manipulation appears to provide the best short-term benefit for some patients with chronic spinal pain syndrome.

The summary is as follows:

115 patients with criteria of being over 17 years age.
  • Patients were randomized to one of three groups, with the other treatments acting as controls.
  • The patients randomized to medication normally were given Celebrex (200–400 mg/day) unless it had previously been tried. The next drug of choice was Vioxx (12.5–25 mg/day), followed by paracetamol (up to 4 g/day).
  • Because the patients randomized to medication had previously tried medication without success, an attempt was made to overcome lower expectation bias by telling them that a very promising “new” medication would be tried.
  • Chiropractic treatment included high-velocity, low-amplitude thrust spinal manipulation to a joint. Two treatments per week defined this intervention.
  • Acupuncture was performed during 20-minute appointments, and included 8 to 10 needles in local paraspinal intramuscular maximum pain areas, and approximately 5 needles were placed in distal acupuncture point meridians according to the “near and far” technique. Two treatments per week defined this intervention.
Is Chiropractic effective?
*Recovery means patient reached an “Asymptomatic status.”

1. Giles, L.G. and R. Muller, Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine, 2003. 28(14): p. 1490-502; discussion 1502-3.

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