Author Topic: Chiropractors more harm than good?  (Read 43452 times)

Krankenstein

  • Getbig V
  • *****
  • Posts: 11310
  • quit·ter : a person can't finish a task
Re: Chiropractors more harm than good?
« Reply #250 on: May 28, 2013, 03:13:30 PM »
Very nice. All the quacks and snake oil salesmen are ganging up on me. 
Anyway, I've go to go soon. I think my mom's almost done with dinner upstairs.

xo xo sweetie

viking1

  • Getbig V
  • *****
  • Posts: 5173
Re: Chiropractors more harm than good?
« Reply #251 on: May 28, 2013, 03:14:09 PM »

Big Chiro Flex

  • Competitors
  • Getbig V
  • *****
  • Posts: 10413
  • FREE FOOZLE
Re: Chiropractors more harm than good?
« Reply #252 on: May 28, 2013, 03:19:18 PM »
I'll just pull uo the first 5 results that pubmed shows. I'm perplexed at why people claim there's no evidence for what we do.   ???  ??? ???

I could spend all day posting pubmed links! I was at a seminar last month where all we did, for 8 hours, was go over the latest peer reviewed articles  from the last year supporting our profession. It was a long, drawn out day. There's so much info out there.

Here goes...

Big Chiro Flex

  • Competitors
  • Getbig V
  • *****
  • Posts: 10413
  • FREE FOOZLE
Re: Chiropractors more harm than good?
« Reply #253 on: May 28, 2013, 03:20:35 PM »
J Manipulative Physiol Ther. 2013 May 22. pii: S0161-4754(13)00057-2. doi: 10.1016/j.jmpt.2013.04.005. [Epub ahead of print]
Symptomatic Magnetic Resonance Imaging-Confirmed Lumbar Disk Herniation Patients: A Comparative Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated With Either High-Velocity, Low-Amplitude Spinal Manipulative Therapy or Imaging-Guided Lumbar Nerve Root Injections.
Peterson CK, Leemann S, Lechmann M, Pfirrmann CW, Hodler J, Humphreys BK.
Source
Professor, Departments of Chiropractic and Radiology, Orthopaedic University Hospital Balgrist, Zürich, Switzerland. Electronic address: cynthia.peterson@balgrist.ch.
Abstract
OBJECTIVES:
The purpose of this study was to compare self-reported pain and "improvement" of patients with symptomatic, magnetic resonance imaging-confirmed, lumbar disk herniations treated with either high-velocity, low-amplitude spinal manipulative therapy (SMT) or nerve root injections (NRI).
METHODS:
This prospective cohort comparative effectiveness study included 102 age- and sex-matched patients treated with either NRI or SMT. Numerical rating scale (NRS) pain data were collected before treatment. One month after treatment, current NRS pain levels and overall improvement assessed using the Patient Global Impression of Change scale were recorded. The proportion of patients, "improved" or "worse," was calculated for each treatment. Comparison of pretreatment and 1-month NRS scores used the paired t test. Numerical rating scale and NRS change scores for the 2 groups were compared using the unpaired t test. The groups were also compared for "improvement" using the χ2 test. Odds ratios with 95% confidence intervals were calculated. Average direct procedure costs for each treatment were calculated.
RESULTS:
No significant differences for self-reported pain or improvement were found between the 2 groups. "Improvement" was reported in 76.5% of SMT patients and in 62.7% of the NRI group. Both groups reported significantly reduced NRS scores at 1 month (P = .0001). Average cost for treatment with SMT was Swiss Francs 533.77 (US $558.75) and Swiss Francs 697 (US $729.61) for NRI.
CONCLUSIONS:
Most SMT and NRI patients with radicular low back pain and magnetic resonance imaging-confirmed disk herniation matching symptomatic presentation reported significant and clinically relevant reduction in self-reported pain level and increased global perception of improvement. There were no significant differences in outcomes between NRI and SMT. When considering direct procedure costs, the average cost of SMT was slightly less expensive.

Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
PMID: 23706678 [PubMed - as supplied by publisher]

Big Chiro Flex

  • Competitors
  • Getbig V
  • *****
  • Posts: 10413
  • FREE FOOZLE
Re: Chiropractors more harm than good?
« Reply #254 on: May 28, 2013, 03:25:12 PM »
Magnetic Resonance Imaging Zygapophyseal Joint Space Changes (Gapping) in Low Back Pain Patients Following Spinal Manipulation and Side-Posture Positioning: A Randomized Controlled Mechanisms Trial With Blinding.
Cramer GD, Cambron J, Cantu JA, Dexheimer JM, Pocius JD, Gregerson D, Fergus M, McKinnis R, Grieve TJ.
Source
Professor and Dean of Research, Department of Research, National University of Health Sciences, Lombard, IL. Electronic address: gcramer@nuhs.edu.
Abstract
OBJECTIVE:
The purpose of this study was to quantify lumbar zygapophyseal (Z) joint space separation (gapping) in low back pain (LBP) subjects after spinal manipulative therapy (SMT) or side-posture positioning (SPP).
METHODS:
This was a controlled mechanisms trial with randomization and blinding. Acute LBP subjects (N = 112; four n = 28 magnetic resonance imaging [MRI] protocol groups) had 2 MRI appointments (initial enrollment and after 2 weeks of chiropractic treatment, receiving 2 MRI scans of the L4/L5 and L5/S1 Z joints at each MRI appointment. After the first MRI scan of each appointment, subjects were randomized (initial enrollment appointment) or assigned (after 2 weeks of chiropractic treatment appointment) into SPP (nonmanipulation), SMT (manipulation), or control MRI protocol groups. After SPP or SMT, a second MRI was taken. The central anterior-posterior joint space was measured. Difference between most painful side anterior-posterior measurements taken postintervention and preintervention was the Z joint "gapping difference." Gapping differences were compared (analysis of variance) among protocol groups. Secondary measures of pain (visual analog scale, verbal numeric pain rating scale) and function (Bournemouth questionnaire) were assessed.
RESULTS:
Gapping differences were significant at the first (adjusted, P = .009; SPP, 0.66 ± 0.48 mm; SMT, 0.23 ± 0.86; control, 0.18 ± 0.71) and second (adjusted, P = .0005; SPP, 0.65 ± 0.92 mm; SMT, 0.89 ± 0.71; control, 0.35 ± 0.32) MRI appointments. Verbal numeric pain rating scale differences were significant at first MRI appointment (P = .04) with SMT showing the greatest improvement. Visual analog scale and Bournemouth questionnaire improved after 2 weeks of care in all groups (both P < .0001).
CONCLUSIONS:
Side-posture positioning showed greatest gapping at baseline. After 2 weeks, SMT resulted in greatest gapping. Side-posture positioning appeared to have additive therapeutic benefit to SMT.

Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Big Chiro Flex

  • Competitors
  • Getbig V
  • *****
  • Posts: 10413
  • FREE FOOZLE
Re: Chiropractors more harm than good?
« Reply #255 on: May 28, 2013, 03:29:36 PM »
No one is saying that u can't get symptom alleviation from chiropractic. But u can also get improvement from the local masseuse as well and she's not claiming to be some type of medical professional. And BTW, most, if not all, US courts of law deem chiropractors unqualified to testify as to the interpretation of MRI films.  

Oh I'm sorry, I thought you said we were worthless and contributed nothing to health care?

Don't worry, I have more...

Slik

  • Competitors
  • Getbig IV
  • *****
  • Posts: 3593
Re: Chiropractors more harm than good?
« Reply #256 on: May 28, 2013, 03:35:19 PM »
No one is saying that u can't get symptom alleviation from chiropractic. But u can also get improvement from the local masseuse as well and she's not claiming to be some type of medical professional. And BTW, most, if not all, US courts of law deem chiropractors unqualified to testify as to the interpretation of MRI films.  
ur dinner's gettin cold son

Big Chiro Flex

  • Competitors
  • Getbig V
  • *****
  • Posts: 10413
  • FREE FOOZLE
Re: Chiropractors more harm than good?
« Reply #257 on: May 28, 2013, 03:38:44 PM »
How about one from a real medical school not "National University of Health Sciences," which sounds impressive but is just some chiropractic mill admitting anyone who applies and can somehow figure out how to borrow the money to pay the tuition.

LOL. I've spoken with many MD's. Our peer reviewed research is legitimate. You are just scared to ever admit being wrong.

I'm sure you're familiar with the Clear Institute? Some of the most exciting stuff is coming out of there. They're making massive strides in spinal correction. The degree that they are improving hyper kyphosis is astounding, and quantifiable. Now, tell me how that translates to this?


FROM:   J Am Geriatr Soc 2004 (Oct);   52 (10):   1662—1667

Kado DM, Huang MH, Karlamangla AS, Barrett-Connor E, Greendale GA

Division of Geriatrics, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California 90095, USA. dkado@mednet.ucla.edu


OBJECTIVES:   To determine the association between hyperkyphotic posture and rate of mortality and cause-specific mortality in older persons.

DESIGN:   Prospective cohort study.

SETTING:   Rancho Bernardo, California.

PARTICIPANTS:   Subjects were 1,353 participants from the Rancho Bernardo Study who had measurements of kyphotic posture made at an osteoporosis visit between 1988 and 1991.

MEASURES:   Kyphotic posture was measured as the number of 1.7-cm blocks that needed to be placed under the participant's head to achieve a neutral head position when lying supine on a radiology table. Demographic and clinical characteristics and health behaviors were assessed at a clinic visit using standard questionnaires. Participants were followed for an average of 4.2 years, with mortality and cause of death confirmed using review of death certificates.

RESULTS:   Hyperkyphotic posture, defined as requiring one or more blocks under the occiput to achieve a neutral head position while lying supine, was more common in men than women (44% in men, 22% of women, P<.0001). In age- and sex-adjusted analyses, persons with hyperkyphotic posture had a 1.44 greater rate of mortality (95% confidence interval (CI)=1.12-1.86, P=.005). In multiply adjusted models, the increased rate of death associated with hyperkyphotic posture remained significant (relative hazard=1.40, 95% CI=1.08-1.81, P=.012). In cause-specific mortality analyses, hyperkyphotic posture was specifically associated with an increased rate of death due to atherosclerosis.

CONCLUSION:   Older men and women with hyperkyphotic posture have higher mortality rates.


Slik

  • Competitors
  • Getbig IV
  • *****
  • Posts: 3593
Re: Chiropractors more harm than good?
« Reply #258 on: May 28, 2013, 03:47:44 PM »
This is great! Thanks for the warm welcome to GB.
I'll see u guys on other threads.
Chiropractic is the best!!!
gimmck. Comes to Getbig expecting a warm welcome. Now that's some funny shit right there. N make sure to eat all ur peas.

Big Chiro Flex

  • Competitors
  • Getbig V
  • *****
  • Posts: 10413
  • FREE FOOZLE
Re: Chiropractors more harm than good?
« Reply #259 on: May 28, 2013, 03:48:38 PM »
FROM:   J Manipulative Physiol Ther. 2012 (Sep);   35 (7):   525-533

Cynthia K. Peterson, DC, MMedEd, Jennifer Bolton, PhD, MAEd, B. Kim Humphreys, DC, PhD

Chiropractic Department, Faculty of Medicine, University of Zürich, Zürich, Switzerland. Cynthia.peterson@balgrist.ch

OBJECTIVES:   The purpose of this study was to investigate outcomes and prognostic factors in patients with acute or chronic low back pain (LBP) undergoing chiropractic treatment.

METHODS:   This was a prognostic cohort study with medium-term outcomes. Adult patients with LBP of any duration who had not received chiropractic or manual therapy in the prior 3 months were recruited from multiple chiropractic practices in Switzerland. Participating doctors of chiropractic were allowed to use their typical treatment methods (such as chiropractic manipulation, soft tissue mobilization, or other methods) because the purpose of the study was to evaluate outcomes from routine chiropractic practice. Patients completed a numerical pain rating scale and Oswestry disability questionnaire immediately before treatment and at 1 week, 1 month, and 3 months after the start of treatment, together with self-reported improvement using the Patient Global Impression of Change.

RESULTS:   Patients with acute (<4 weeks; n = 523) and chronic (>3 months; n = 293) LBP were included. Baseline mean pain and disability scores were significantly (P < .001) higher in patients with acute LBP. In both groups of patients, there were significant (P < .0001) improvements in mean scores of pain and disability at 1 week, 1 month, and 3 months, although these change scores were significantly greater in the acute group. Similarly, a greater proportion of patients in the acute group reported improvement at each follow-up. The most consistent predictor was self-reported improvement at 1 week, which was independently associated with improvement at 1 month (adjusted odds ratio [OR], 2.4 [95% confidence interval, 1.3-4.5] and 5.0 [2.4-10.6]) and at 3 months (2.9 [1.3-6.6] and 3.3 [1.3-8.7]) in patients with acute and chronic pain, respectively. The presence of radiculopathy at baseline was not a predictor of outcome.

CONCLUSIONS:   Patients with chronic and acute pain reporting that they were "much better" or "better" on the Patient Global Impression of Change scale at 1 week after the first chiropractic visit were 4 to 5 times more likely to be improved at both 1 and 3 months compared with patients who were not improved at 1 week. Patients with acute pain reported more severe pain and disability initially but recovered faster. Patients with chronic and acute back pain both reported good outcomes, and most patients with radiculopathy also improved.


From the FULL TEXT Article

Introduction:

Research into mechanical low back pain (LBP) is ongoing because it is so common and leads to high health care costs. [1-19] The point prevalence of LBP is stated to be between 15% and 30%, the 1-year period prevalence between 15% and 45%, and a life-time prevalence of 50% to 80%. [7, 18, 19] It is also expensive to treat, with billions of dollars and billions of Euros spent per year in Western societies. [7, 18, 19] Between the years 1997 and 2005, the total estimated expenditures for patients with spine problems in the United States increased 65%, which was higher than overall health expenditures. [18] People with neck or back pain who also reported that physical impairment increased from 20.7% to 24.7% in that same period. [18] Low back pain is a significant burden not only to the individual who has it but also to their families, workplace, and society in general. In Europe, the yearly burden of LBP to society amounts to €211 per person in Sweden and €260 per person in the United Kingdom. [19]

Although LBP remains the most common musculoskeletal complaint presenting to physicians and other therapists, controversy remains surrounding the precise cause of the pain in many patients, appropriate therapies, subgroups of patients likely to improve with treatment and/or have more favorable prognoses, and associated medical costs. [1-10] To date, there is more evidence supporting chiropractic treatment of chronic LBP and LBP without concomitant radiating leg pain than for patients with acute or subacute pain and those with radiculopathy or sciatica. [2, 10-12] In chronic LBP, recent studies indicate that significant improvement is often fairly rapid, usually by the fourth visit, and that patients initially receiving treatment 3 to 4 times a week have better outcomes. [7, 8, 14] Although evidence is less clear for patients complaining of LBP of less than 3-month duration, it is suggested that spinal manipulation produces slightly better results than placebo, no treatment, and other noninvasive therapies. [5]

Some authors claim that patients more likely to respond to spinal manipulative therapy in the short term can be identified by specific physical and demographic factors. [2] However, many of these studies on spinal manipulative therapy are compromised by fairly small sample sizes and short-term follow-up, [2, 4, 7] and more research is needed to substantiate or refute these findings. Other larger studies with similar research protocols to this study have attempted to subgroup patients with LBP based on the clinical course of their condition. [8, 9, 13-15] Few demographic variables that are linked to clinical improvement in patients with LBP have been found thus far. The strongest and most consistent finding in studies looking at predictors of improvement is how quickly the patient responds to treatment. [8, 9, 13-15] It appears that if a patient will have a favorable outcome, the response to therapy is rapid. Although it is known that most patients with acute LBP improve very quickly and that this improvement may depend little on the treatment given, it is the patients with chronic LBP that provide the major challenge to clinicians and insurers. Patients with chronic LBP are also responsible for considerable costs because of a higher number of diagnostic procedures, treatment, and loss of productivity. [16, 17] Further large, prospective, cohort studies from other cultural environments are needed to confirm the prognostic factors reported in previous studies, as well as to investigate additional predictors of positive or negative outcomes, particularly coexisting radiculopathy.

It is not known if these same prognostic factors are applicable to chiropractic patients from other cultural or geographic regions. Therefore, this study was designed to investigate outcomes and prognostic factors linked with clinically significant improvement for patients with either acute or chronic LBP undergoing chiropractic treatment.


Discussion:

This prognostic cohort study with medium-term outcomes supports previous research that patients with LBP undergoing chiropractic treatment who are likely to respond do so very quickly. [8, 9, 13-15] This was not only true for patients presenting with acute (<4 weeks) LBP but, importantly, also for patients with chronic pain for greater than 3 months. Patients with chronic and acute pain reporting that they were much better or better on the PGIC scale at 1 week after the first chiropractic visit were 4 to 5 times more likely to be improved at both 1 and 3 months compared with patients who were not improved at 1 week. Patients who reported that they were “slightly better” on the PGIC scale were not considered improved in this study to err on the side of caution in defining clinically relevant improvement. Improvement is much more than just changes in the pain severity. It incorporates functional status and quality of life parameters, as well. The PGIC scale allows patients to express their multidimensional experience from their own viewpoint as to what is important to them in terms of “improvement” or “not-improved.” [23] Several other related studies, particularly from Denmark, have also reported that chiropractic patients who respond early on in the course of treatment usually have a more favorable outcome. [8-10, 13-15, 24] This current study, however, found that unlike previous work that reported that patients only improved up to week 7, [14] the patients with acute and chronic pain in Switzerland continued to improve on all outcome measures at each time point including at 3 months after the first chiropractic consultation.

Although in the univariate analysis, several potential predictors of outcome were identified, in the adjusted models, relatively few were identified as independently associated with improvement. None of the baseline variables collected in this study independently predicted outcome at 1 or 3 months for patients with acute or chronic pain, with the exception of trauma as the cause of the LBP in patients with chronic pain. This was only independently associated with outcome at 1 month, however. The most consistent independent association with improvement for both patients with acute pain and patients with chronic pain at both the 1- and 3-month time points was patient-reported improvement at 1 week after the start of treatment. Patients with acute and chronic pain who were improved at 1 week were approximately 3 times more likely to be improved at 3 months. Patients with chronic pain who also had a larger baseline to 1-month NRS change score were more likely to be improved at 3 months. Improvement at 1 month was also independently associated with improvement at 3 months for patients with acute pain.

The patients with acute pain in this study had significantly higher baseline NRS and Oswestry scores compared with the patients with chronic pain, as well as improved faster and with greater magnitude. At 3 months, 88% reported being much better or better. Their 3-month mean Oswestry score decreased by 74%, and their mean NRS score was 72% lower at 3 months compared with baseline. Much of this improvement is likely to be due to the natural history of LBP, and any specific treatment effects cannot be determined from a prospective cohort study of this type. However, even the patients with chronic pain demonstrated significant improvement at each time point, with 69% stating that they were much better or better at 3 months. This is unlikely to be due to the natural history of LBP because these patients have already passed the period when natural history occurs. The mean 3-month Oswestry score for the patients with chronic pain was decreased by 37%, and their mean NRS score was 39% lower than the baseline score. These values are well beyond the 30% reduction in NRS and Oswestry scores that has been identified as clinically meaningful improvement. [8, 25]

Although the Oswestry pain and disability questionnaire is probably not the best outcome measure for this patient population, having been designed for more severe and surgical cases, it was used because it had been translated and validated into German and French. Certainly, the fairly low mean baseline scores of 14.7 for patients with acute pain and 10.1 for patients with chronic pain of a maximum of 50 points reflects the inadequacy of this questionnaire for this patient population. Another questionnaire would have been preferred but was not available in the required languages. Interestingly, the univariate predictors showed that male patients were more likely to improve compared with female patients at 1 week, 1 month, and even 3 months in the acute patient group. Although sex was no longer a predictor of outcome in the multivariate model, other research has found that men have better outcomes than did women when undergoing chiropractic treatment. [9, 26] This sex difference was also seen when looking at the proportion of men and women in the acute and chronic subgroups in this study. Patients with acute pain showed a fairly even sex distribution, whereas a significantly higher percentage of patients with chronic pain were female (58%). This supports the observation that being male leads to a more favorable outcome when presenting with acute LBP. One possible explanation for the higher prevalence of patients with chronic pain being female is that degenerative lumbar instability is more common in middle-aged and older women. [27, 28]

An important and unique finding in this current study is that although 123 (23%) of the patients with acute LBP and 71 (24%) of the patients with chronic LBP were diagnosed by their chiropractors as having radiculopathy, this finding was not a negative predictor of improvement. Radiculopathy was not simply defined as leg pain but required clinical signs of nerve root compression as determined by the examining chiropractor. Previous studies investigating outcomes from patients with LBP undergoing spinal manipulation have purposely excluded patients with radiculopathy, [2, 10, 29] and others have found that the presence of leg pain is a negative predictor of improvement. [12, 24, 30] This study purposely included these patients to evaluate this subgroup. It is quite common for patients with LBP experiencing radiculopathy to seek chiropractic care in Switzerland and to receive spinal manipulative therapy as one of the treatment options.

The results of this study could help practicing chiropractors make more confident decisions about patient prognosis based on how quickly individual patients respond to their treatment. Chiropractors can also expect most of their patients with acute and chronic pain to continue to improve at least up to 3 months after the start of treatment, even if they are no longer being treated. These results also offer support for the use of chiropractic treatment for patients with radiculopathy.

Future follow-up studies from this project, in addition to the longer-term outcomes and prognostic variables being currently collected, could include qualitative studies comparing practice characteristics and techniques that may be linked with improved outcomes. During data entry, one of the authors noticed that certain practitioners seemed to obtain better patient outcomes compared with others. Obtaining detailed information concerning practice environments, types of treatments used, treatment schedules, doctor-patient communication styles, and types of patients who seek care from those individual practitioners with better patient outcomes would be beneficial for chiropractic education at both the undergraduate and the postgraduate level. These data could help to inform “best practice.”

Limitations

Because this was a prospective cohort study and not a randomized trial, the observed outcomes cannot be definitively attributed to treatment. However, that a high percentage of patients with chronic pain improved is unlikely to be the result of the natural history of LBP. In addition, based on the pragmatic nature of this study, we do not know how many times the patients were treated during the treatment period or the specifics of the therapeutic interventions. However, based on the Swiss Job Analysis Survey 2009, it is likely that most patients were treated with diversified chiropractic spinal manipulation. It has been suggested that there is a positive relationship between the number of chiropractic treatments on LBP and disability for patients with chronic pain. [7] These would be interesting research areas to pursue in future studies.

Using telephone interviews, as compared with questionnaires or text messaging, may have had a positive effect on the outcomes obtained, as reported in other studies. [31-33] An attempt to minimize this effect was done by employing anonymous research assistants who collected the data from the university rather than contacting the patients directly from chiropractic offices. We also do not know if these 44 chiropractors who chose to contribute patients for this study are a fair representation of the “typical” Swiss DC. Because the participating DCs seem to be more interested in furthering chiropractic research, they may be a special population. Finally, patients in the subacute category, the least common presentation period in this database, were not included in this study, and there is a need to evaluate this patient group in the future.


Conclusions:

In this study, most patients with acute and chronic LBP undergoing chiropractic treatment reported clinically significant improvement. Unlike previously reported studies, patients continued to improve, even after 3 months. As expected, improvement was quicker and more substantial for patients with acute pain. The strongest independent predictor for improvement at 1 and 3 months in both patients with acute pain and patients with chronic pain was whether or not the patient had improved by 1 week. Patients with chronic pain whose LBP was caused by trauma were also more likely to improve at 1 month. Also, unlike previous studies, the presence of radiculopathy in addition to LBP was not a negative predictor for improvement.

Krankenstein

  • Getbig V
  • *****
  • Posts: 11310
  • quit·ter : a person can't finish a task
Re: Chiropractors more harm than good?
« Reply #260 on: May 28, 2013, 03:49:42 PM »
No one is saying that u can't get symptom alleviation from chiropractic. But u can also get improvement from the local masseuse as well and she's not claiming to be some type of medical professional. And BTW, most, if not all, US courts of law deem chiropractors unqualified to testify as to the interpretation of MRI films.  

Show the law or cite a case sir.  We may not be able to bill for technical component, but we can bill for professional.  Are you are that any film studies have two components to that?  

You aren't going to cry any time soon...are you?  

Big Chiro Flex

  • Competitors
  • Getbig V
  • *****
  • Posts: 10413
  • FREE FOOZLE
Re: Chiropractors more harm than good?
« Reply #261 on: May 28, 2013, 03:51:10 PM »

FROM:   Spine 2013 (Apr 1);   38 (7):   540–548

von Heymann, Wolfgang J. Dr. Med; Schloemer, Patrick Dipl. Math; Timm, Juergen Dr. RER, NAT, PhD; Muehlbauer, Bernd Dr. Med

STUDY DESIGN:   A randomized, double-blinded, placebo-controlled, parallel trial with 3 arms.

OBJECTIVE:   To investigate in acute nonspecific low back pain (LBP) the effectiveness of spinal high-velocity low-amplitude (HVLA) manipulation compared with the nonsteroidal anti-inflammatory drug diclofenac and with placebo.

SUMMARY OF BACKGROUND DATA:   LBP is an important economical factor in all industrialized countries. Few studies have evaluated the effectiveness of spinal manipulation in comparison to nonsteroidal anti-inflammatory drugs or placebo regarding satisfaction and function of the patient, off-work time, and rescue medication.

METHODS:   A total of 101 patients with acute LBP (for <48 hr) were recruited from 5 outpatient practices, exclusion criteria were numerous and strict. The subjects were randomized to 3 groups:

(1) spinal manipulation and placebo-diclofenac;

(2) sham manipulation and diclofenac;

(3) sham manipulation and placebo-diclofenac.
Outcomes registered by a second and blinded investigator included self-rated physical disability, function (SF-12), off-work time, and rescue medication between baseline and 12 weeks after randomization.

RESULTS:   Thirty-seven subjects received spinal manipulation, 38 diclofenac, and 25 no active treatment. The placebo group with a high number of dropouts for unsustainable pain was closed praecox. Comparing the 2 active arms with the placebo group the intervention groups were significantly superior to the control group. Ninety subjects were analyzed in the collective intention to treat. Comparing the 2 intervention groups, the manipulation group was significantly better than the diclofenac group (Mann-Whitney test: P = 0.0134). No adverse effects or harm was registered.

CONCLUSION:   In a subgroup of patients with acute nonspecific LBP, spinal manipulation was significantly better than nonsteroidal anti-inflammatory drug diclofenac and clinically superior to placebo.

Big Chiro Flex

  • Competitors
  • Getbig V
  • *****
  • Posts: 10413
  • FREE FOOZLE
Re: Chiropractors more harm than good?
« Reply #262 on: May 28, 2013, 03:58:28 PM »
Slightly off topic, but I thought that this rate of failed surgery was interesting. Especially to the two gentlemen here who claim what we do is quackery.


New Study Reveals That Back Surgery
Fails 74% of the Time


This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org
   
 
          
Editorial Commentary:

Researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in hopes of curing low back pain. The other half had no surgery, even though they had comparable diagnoses.

After two years, just 26 percent of those who had surgery had actually returned to work. That’s compared to 67 percent of patients who didn’t have surgery. In what might be the most troubling study finding, researchers determined that there was a 41 percent increase in the use of painkillers, specifically opiates, in those who had surgery.

“The study [1] provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs don’t work”, says the study’s lead author Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine. [2]

Just a month after back surgery, Nancy Scatena was once again in excruciating pain. The medications her doctor prescribed barely took the edge off the unrelenting back aches and searing jolts down her left leg. “The pain just kept intensifying,” says the 52-year-old Scottsdale, Ariz., woman who suffers from spinal stenosis, a narrowing of the chanel through which spinal nerves pass. “I was suicidal.”

Finally, Scatena made an appointment with another surgeon, one whom friends had called a “miracle worker.” The new doctor assured her that this second operation would fix everything, and in the pain-free weeks following an operation to fuse two of her vertebrae it seemed that he was right. But then the pain came roaring back.

Experts estimate that nearly 600,000 Americans opt for back operations each year. But for many like Scatena, surgery is just an empty promise, say pain management experts and some surgeons.

This Spine Journal study [1] shows that, in many cases, surgery can backfire, leaving patients in even more pain.

The study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs don’t work, says the study’s lead author Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine. [3]

27 Million Adults With Back Problems

A recent report by the Agency for Healthcare Research and Quality, a federal organization, found that in 2007, twenty-seven million adults reported back problems, with $30.3 billion spent on treatments to ease the pain. While some of that money is spent on physical therapy, pain management, chiropractor visits, and other non invasive therapies, a big chunk pays for spine surgeries.

Complicated spine surgeries that involve fusing two or more vertebrae are on the rise. In just 15 years, there was an eight-fold jump in this type of operation, according to a study published in Spine in July. That has some surgeons and public health experts concerned. [4]

You may also want to review the recently published European Guidelines for the Management of Acute and Chronic Nonspecific Low Back Pain, which specifically states:
"Surgery for non-specific CLBP cannot be recommended unless 2 years of all other recommended conservative treatments — including multidisciplinary approaches with combined programs of cognitive intervention and exercises — have failed".
This study re-confirms the findings of the UK BEAM Trial, published in the British Medical Journal in 2004. [5] Those authors stated:
"Manipulation, with or without exercise, improved symptoms more than best care (medical care) alone after three and 12 months.   However, analysis of the cost utility of different strategies shows that manipulation alone probably gives better value for money than manipulation followed by exercise" (page 1381).
You may also want to read these 3 recent Editorials:

Why Do Spinal Surgery Rates Continue To Rise?
Chiro.Org Blog ~ April 10th, 2010

New Study Finds Chiropractic Care Superior to Family Physician-directed Usual Care
Chiro.Org Blog ~ October 7th, 2010

If Not Chiropractic Care, Then What’s Your Alternative?
Chiro.Org Blog ~ September 25th, 2010

REFERENCES:

Long-term Outcomes of Lumbar Fusion Among Workers' Compensation Subjects: An Historical Cohort Study
SPINE (Phila Pa 1976) 2011 (Feb 15);   36 (4):   320–331

Study Says Back Surgery Often Makes Things Worse
The Daily Hit ~ Oct 14, 2010

Back Surgery May Backfire On Patients In Pain
MSNBC.com ~ Oct 14, 2010

Why Do Spinal Surgery Rates Continue To Rise?
Chiro.Org Blog Editorial ~ April 10th, 2010

Findings from the: “United Kingdom Back Pain Exercise and Manipulation (UK BEAM) Randomised Trial”
British Medical Journal 2004 (Dec 11); 329 (7479)

Big Chiro Flex

  • Competitors
  • Getbig V
  • *****
  • Posts: 10413
  • FREE FOOZLE
Re: Chiropractors more harm than good?
« Reply #263 on: May 28, 2013, 04:08:18 PM »
Alright I'm done for now. there's literally thousands of articles of peer reviewed literature backing what we do. And I only posted ones regarding LBP!  :D I even found new sources listing hundreds more.

Here's what it comes Down to. This old school attitude that ether/cholo have is dying out. They claim we have zero research. Then when I provide a few PR'd articles, they claim they are irrelevant because they are not done by their profession   ??? The new docs like Danny-boy, and all the other MD's I know, share a mutual respect.

This logic would mean that I could say "the medical profession's research is irrelevant because it was done by biased observers."  ::)

There is a plethora of PR'd articles out there that show our effectiveness, within our scope of practice. I don't have to argue it...the research speaks for itself.

Krankenstein

  • Getbig V
  • *****
  • Posts: 11310
  • quit·ter : a person can't finish a task
Re: Chiropractors more harm than good?
« Reply #264 on: May 28, 2013, 04:16:11 PM »
Alright I'm done for now. there's literally thousands of articles of peer reviewed literature backing what we do. And I only posted ones regarding LBP!  :D I even found new sources listing hundreds more.

Here's what it comes Down to. This old school attitude that ether/cholo have is dying out. They claim we have zero research. Then when I provide a few PR'd articles, they claim they are irrelevant because they are not done by their profession   ??? The new docs like Danny-boy, and all the other MD's I know, share a mutual respect.

This logic would mean that I could say "the medical profession's research is irrelevant because it was done by biased observers."  ::)

There is a plethora of PR'd articles out there that show our effectiveness, within our scope of practice. I don't have to argue it...the research speaks for itself.


Just shut up and go massage someone's back already.  Stop being a moron.   >:(

Big Chiro Flex

  • Competitors
  • Getbig V
  • *****
  • Posts: 10413
  • FREE FOOZLE
Re: Chiropractors more harm than good?
« Reply #265 on: May 28, 2013, 04:21:23 PM »
Just shut up and go massage someone's back already.  Stop being a moron.   >:(

Im all out of magic crystals though...you know I never perform "healing" without my magic crystals.

 :D

syntaxmachine

  • Getbig IV
  • ****
  • Posts: 2687
Re: Chiropractors more harm than good?
« Reply #266 on: May 28, 2013, 04:35:01 PM »
I don't know about the gimmicks, but I at least don't doubt the efficacy of certain chiropractic treatments; I'm simply asking for a single study indicating that these treatments are efficacious above and beyond the placebo effect. I still haven't seen one such study.

Big Chiro Flex

  • Competitors
  • Getbig V
  • *****
  • Posts: 10413
  • FREE FOOZLE
Re: Chiropractors more harm than good?
« Reply #267 on: May 28, 2013, 04:39:03 PM »
Don't really understand your post bro. There's thousands of these studies. I posted like 3. One even compared to placebo effect.

Big Chiro Flex

  • Competitors
  • Getbig V
  • *****
  • Posts: 10413
  • FREE FOOZLE
Re: Chiropractors more harm than good?
« Reply #268 on: May 28, 2013, 04:43:04 PM »
I don't know about the gimmicks, but I at least don't doubt the efficacy of certain chiropractic treatments; I'm simply asking for a single study indicating that these treatments are efficacious above and beyond the placebo effect. I still haven't seen one such study.


CONCLUSION:   In a subgroup of patients with acute nonspecific LBP, spinal manipulation was significantly better than nonsteroidal anti-inflammatory drug diclofenac and clinically superior to placebo.

Slik

  • Competitors
  • Getbig IV
  • *****
  • Posts: 3593
Re: Chiropractors more harm than good?
« Reply #269 on: May 28, 2013, 04:49:39 PM »
I don't know about the gimmicks, but I at least don't doubt the efficacy of certain chiropractic treatments; I'm simply asking for a single study indicating that these treatments are efficacious above and beyond the placebo effect. I still haven't seen one such study.
off the top of my head how about the landmark Rand study on Chiro?  I'm in a car so just google it. Yeah I'm parked right now  :)

Krankenstein

  • Getbig V
  • *****
  • Posts: 11310
  • quit·ter : a person can't finish a task
Re: Chiropractors more harm than good?
« Reply #270 on: May 28, 2013, 04:56:35 PM »
I don't know about the gimmicks, but I at least don't doubt the efficacy of certain chiropractic treatments; I'm simply asking for a single study indicating that these treatments are efficacious above and beyond the placebo effect. I still haven't seen one such study.

April 2007 Newsletter:
Acute Moderate Back pain or Discal hernia and  Sciatica: RCT of Chiropractic vs. Placebo

The most recent randomized control group trial of chiropractic manipulation for acute moderate back or disc pain with leg pain (sciatica) was reported in the prestigious medical journal Spine last year.  Sixty-four men and 38 women aged 19 to 63 were randomized to chiropractic manipulation (53) or placebo (49) manipulations, at rehabilitation centers in and around Rome, Italy. Chiropractic adjustments or simulated adjustments (placebo) were administered five times per week for up to one month, and blinded examiners evaluated the patients.  Six months later only 6% of patients receiving placebo adjustments were free of back pain, while 28% of patients receiving actual chiropractic adjustments no longer had back pain. Similarly, only 20% of patients with sciatica were pain free after placebo, while 55% of patients with leg pain were pain free after chiropractic adjustments at six months. Patients receiving actual chiropractic adjustments had fewer days with pain, and fewer days with moderate or severe pain as well. All findings were statistically significant, as well as clinically meaningful.  Only two patients failed to improve at all, one receiving chiropractic adjustments, and one receiving placebo adjustments. There were no adverse reactions reported. So what does this study tell us?  First, the study confirms many other studies in the past two decades that show that the natural history of even moderate to severe back and leg pain favors remission. Put simply, patients receiving both chiropractic treatment and placebo improved over six months. Remember that May 2005 study reported in the British Medical Journal that revealed no clinically meaningful differences two years after chronic disc hernia patients were randomized to back surgery or rehabilitative exercises? Surgeons concluded that there was no compelling evidence that surgery was more effective than exercise, and that both groups had significant reductions in disability two years later. Still another study of 501 subjects reported in the Journal of the American Medical Association in November 2006, that there were no meaningful differences in outcomes between patients randomized to surgical diskectomy or non-operative treatment
including physical therapy.

Excuse me while I go dance around a patient with some incense and chant a little.  He dropped his wallet so I hope I can distract him long enough to look through it and get his credit card info.  I love my job!!!!   ;D

YngiweRhoads

  • Getbig V
  • *****
  • Posts: 4259
  • Shreddin'
Re: Chiropractors more harm than good?
« Reply #271 on: May 28, 2013, 05:00:01 PM »
6

Krankenstein

  • Getbig V
  • *****
  • Posts: 11310
  • quit·ter : a person can't finish a task
Re: Chiropractors more harm than good?
« Reply #272 on: May 28, 2013, 05:19:08 PM »
http://www.chirobase.org/

Ahhhh the old Barrett guy.  Just a little info on this little gem...

Stephen Barrett -  Professional Crackpot...

Barrett never achieved any success in the medical profession.  His claim to being a "retired Psychiatrist" is laughable.  He is, in fact, a "failed Psychiatrist," and a "failed MD."

The Psychiatric profession rejected Barrett years ago,  for Barrett could NOT pass the examinations necessary to become "Board Certified."  Which, is no doubt why Barrett was, throughout his career, relegated to lower level "part time" positions.

Barrett, we know, was forced to give up his medical license in Pennsylvania in 1993 when his "part-time" employment at the State Mental Hospital was terminated, and he had so few (nine) private patients during his last five years of practice, that he couldn't afford the Malpractice Insurance premiums Pennsylvania requires.

In a job market in the United States, where there is a "doctor shortage," Stephen Barrett, after his termination by the State mental Hospital, couldn't find employment.  He was in his mid-50s at the time.  He should have been at the top of his craft - yet, apparently, he couldn't find work.

It is obvious, that, after one humiliation after another, in 1993 Barrett simply gave up his medical aspirations,  turned in his MD license, and retreated, in bitterness and frustration, to his basement.

It was in that basement, where Barrett took up "quackbusting" - which, in reality, means that Barrett attacks "cutting-edge" health professionals and paradigms - those that ARE achieving success in their segment of health care.

And there, in "quackbusting" is where Barrett finally found the attention and  recognition he seems to crave - for, a while, that is, until three California Judges, in a PUBLISHED Appeals Court decision, took a HARD look at Barrett's activities, and declared him "biased, and unworthy of credibility."

Bitterness against successful  health professionals is Barrett's hallmark.  To him they're all "quacks."  In this, his essays are repetitive and pedestrian.

Barrett, in his writings,  says the same things, the same way, every time - change the victim and the subject, and still you yawn your way through his offerings.  It's like he's filling out a form somebody gave him...

Take an overactive self importance, couple it with glaring failure and rejection in his chosen profession, add a cup of molten hatred for those that do succeed, pop it in the oven - and out comes Stephen Barrett - self-styled "expert in everything."

Barrett, we know, along with his website, was named, among other things, in a racketeering (RICO) case in Federal Court in Colorado.

He's also being sued for his nefarious activities in Ontario, Canada.

Barrett, in the Canadian case, has formally admitted, according to Canadian law, to a number of situations put to him by the Plaintiff, including:

"The sole purpose of the activities of Barrett & Baratz are to discredit and cause damage and harm to health care practitioners, businesses that make alternative health therapies or products available, and advocates of non-allopathic therapies and health freedom."

"Barrett has interfered with the civil rights of numerous Americans, in his efforts to have his critics silenced."

"Barrett has strategically orchestrated the filing of legal actions in improper jurisdictions for the purpose of frustrating the victims of such lawsuits and increasing his victims costs."

"Barrett failed the exams he was required to pass to become a Board Certified Medical Doctor."

Slik

  • Competitors
  • Getbig IV
  • *****
  • Posts: 3593
Re: Chiropractors more harm than good?
« Reply #273 on: May 28, 2013, 06:12:53 PM »
Ahhhh the old Barrett guy.  Just a little info on this little gem...

Stephen Barrett -  Professional Crackpot...

Barrett never achieved any success in the medical profession.  His claim to being a "retired Psychiatrist" is laughable.  He is, in fact, a "failed Psychiatrist," and a "failed MD."

The Psychiatric profession rejected Barrett years ago,  for Barrett could NOT pass the examinations necessary to become "Board Certified."  Which, is no doubt why Barrett was, throughout his career, relegated to lower level "part time" positions.

Barrett, we know, was forced to give up his medical license in Pennsylvania in 1993 when his "part-time" employment at the State Mental Hospital was terminated, and he had so few (nine) private patients during his last five years of practice, that he couldn't afford the Malpractice Insurance premiums Pennsylvania requires.

In a job market in the United States, where there is a "doctor shortage," Stephen Barrett, after his termination by the State mental Hospital, couldn't find employment.  He was in his mid-50s at the time.  He should have been at the top of his craft - yet, apparently, he couldn't find work.

It is obvious, that, after one humiliation after another, in 1993 Barrett simply gave up his medical aspirations,  turned in his MD license, and retreated, in bitterness and frustration, to his basement.

It was in that basement, where Barrett took up "quackbusting" - which, in reality, means that Barrett attacks "cutting-edge" health professionals and paradigms - those that ARE achieving success in their segment of health care.

And there, in "quackbusting" is where Barrett finally found the attention and  recognition he seems to crave - for, a while, that is, until three California Judges, in a PUBLISHED Appeals Court decision, took a HARD look at Barrett's activities, and declared him "biased, and unworthy of credibility."

Bitterness against successful  health professionals is Barrett's hallmark.  To him they're all "quacks."  In this, his essays are repetitive and pedestrian.

Barrett, in his writings,  says the same things, the same way, every time - change the victim and the subject, and still you yawn your way through his offerings.  It's like he's filling out a form somebody gave him...

Take an overactive self importance, couple it with glaring failure and rejection in his chosen profession, add a cup of molten hatred for those that do succeed, pop it in the oven - and out comes Stephen Barrett - self-styled "expert in everything."

Barrett, we know, along with his website, was named, among other things, in a racketeering (RICO) case in Federal Court in Colorado.

He's also being sued for his nefarious activities in Ontario, Canada.

Barrett, in the Canadian case, has formally admitted, according to Canadian law, to a number of situations put to him by the Plaintiff, including:

"The sole purpose of the activities of Barrett & Baratz are to discredit and cause damage and harm to health care practitioners, businesses that make alternative health therapies or products available, and advocates of non-allopathic therapies and health freedom."

"Barrett has interfered with the civil rights of numerous Americans, in his efforts to have his critics silenced."

"Barrett has strategically orchestrated the filing of legal actions in improper jurisdictions for the purpose of frustrating the victims of such lawsuits and increasing his victims costs."

"Barrett failed the exams he was required to pass to become a Board Certified Medical Doctor."
sounds like a real getbigger. Does he post here?