The Trials of Evidence:
Interpreting Research and the Case for Chiropractic
If you are a clinician at work in a typical chiropractic practice you see many patients with acute and chronic back pain, neck pain and headaches.
If you are making best efforts to keep up with the ongoing flood of research and evidence-informed clinical guidelines you can feel confident that the scientific evidence now supports your clinical experience that spinal manipulation specifically, and chiropractic management incorporating manual care generally, are very helpful for most patients with these complaints. Therefore for example:
For the great majority of patients with both acute and chronic low-back pain, namely those without diagnostic red flags, spinal manipulation is recommended by evidence-informed guidelines from many authoritative sources – whether chiropractic (the UK Evidence Report from Bronfort, Haas et al. ), medical (the 2007 Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society ) or interdisciplinary (the European Back Pain Guidelines ).
For the great majority of patients with acute and chronic neck pain, and those with cervicogenic headache, spinal manipulation is similarly recommended, most recently and authoritatively by the Bone and Joint Decade Neck Pain Task Force . For headache, including migraine headaches, see evidence reviews and recommendations from the Evidence-Based Practice Center at Duke University  and Bryans Descarreaux et al. in Canada .
What are we to make, then, of a new systematic review for the Cochrane Collaboration, looking at chronic back pain and published last month in Spine? This is from Rubenstein, van Middelkoop et al., an experienced research team at the VU University, Amsterdam which includes noted epidemiologist Dr. Maurits van Tulder, so will attract attention. It concludes that the evidence suggests “there is no clinically relevant difference between spinal manipulative therapy (SMT) and other interventions for reducing pain and improving function in patients with chronic low-back pain”. . (more…)