Chiropractic for low back pain

doi:10.1136/BMJ.317.7152.160

Paper

Chiropractic for low back pain

Published Jul 18, 1998 · E. Ernst, W. Assendelft

BMJ

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31

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0

Influential Citations

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Abstract

Chiropractic includes various techniques used in the hope of correcting vertebral disc displacements, freeing spinal joint adhesion, inhibiting nociceptive impulses, or correcting spinal misalignment. Several national guidelines on the treatment of low back pain recommend spinal manipulation, including chiropractic, as a symptomatic treatment for acute uncomplicated cases where pain fails to resolve spontaneously within the first months.1 How solidly are these recommendations based on evidence? There are many controlled trials of spinal manipulation and no fewer than 51 reviews.2 Surprisingly, in the review of Shekelle et al,3 which provided the basis for the recommendations …

Study Snapshot

Key takeawaySpinal manipulation is a symptomatic treatment for acute uncomplicated low back pain, but its effectiveness in reducing pain and improving function remains unclear.

PopulationOlder adults (50-71 years)

Sample size24

MethodsObservational

OutcomesBody Mass Index projections

ResultsSocial networks mitigate obesity in older groups.

Paper

Chiropractic for low back pain

References

The Back Pain Revolution

The Back Pain Revolution explores the history, epidemiology, risk factors, clinical course, physical impairment, psychological distress, beliefs about back pain, social influences, and a new clinical model for treating chronic back pain and disability.

A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain.

The McKenzie method of physical therapy and chiropractic manipulation both had similar effects and costs, with only marginally better outcomes than an educational booklet for patients with low back pain.

Chiropractors' use of X-rays.

Chiropractors often or always use X-rays in their work-up of new patients, with only 6% employing it seldom or never.

Congruence between Decisions To Initiate Chiropractic Spinal Manipulation for Low Back Pain and Appropriateness Criteria in North America

Spinal manipulation for low back pain is appropriate when expected health benefits exceed expected risks by a wide margin, as determined by a panel of experts.

Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies.

The incidence of serious and fatal adverse drug reactions in US hospitals is extremely high, making them the fourth or sixth leading cause of death.

Citations

"Methodological and epistemological challenges for the chiropractic profession in health care - a study of the history, status quo and future of research and clinical practices."

Chiropractic's clinical practice is different from medicine, but its legitimacy is questionable due to its uncertain professional status and institutional immaturity.

Prevention and management of chronic back pain.

Keeping active despite low back pain is healthy, and conservative treatments can provide significant relief for those who cannot manage their pain.

A Dutch View of the ‘‘Science’’ of CAM 1986—2003

Dutch government-subsidized research on complementary and alternative medicine (CAM) from 1986 to 2003 found mixed results, with some positive findings but methodological shortcomings affecting the conclusions.

Adverse events following chiropractic care for subjects with neck or low-back pain: do the benefits outweigh the risks?

Chiropractic care is a useful therapy for neck or low-back pain, with extremely low risks of serious adverse events.

How should clinical psychologists approach complementary and alternative medicine? Empirical, epistemological, and ethical considerations.

Clinical psychologists should not integrate complementary and alternative medicine practices into their practice due to poor evidence and potential incompatibility with their positivist scientific ethos.