There Will Never Be Enough Research
To Satisfy Our Critics
A Chiro.Org Editorial
For some, there will never be enough research to support the use of chiropractic. These people will forever hide behind the claim that they wish to protect patients from quackish practices.
For those who may have forgotten, or for those who never knew, organized medicine spent decades and tens of millions of dollars trying to discredit and destroy chiropractic. Today, the vestiges of that oppression is still found on fringe web sites that ignore the body of peer-reviewed research supporting chiropractic care.
The Wilk anti-trust case against the AMA and 20 other named medical groups revealed that the AMA Plan was to:
Undermine Chiropractic schools
Undercut insurance programs for Chiropractic patients
Conceal evidence of the effectiveness of Chiropractic care
Subvert government inquires into the effectiveness of Chiropractic, and
Promote other activities that would control the monopoly that the AMA had on health care
They even threatened their own ranks: any MD who taught in our schools, performed research with chiropractors, or accepted a referral from, or made a referral to a chiropractor, would lose their hospital privileges, leaving them unable to treat patients.
while, all along, they knew that:
There also was some evidence before the Committee that chiropractic was effective – more effective than the medical profession in treating certain kinds of problems such as workmen’s back injuries.
The Committee on Quackery was also aware that some medical physicians believed chiropractic to be effective and that chiropractors were better trained to deal with musculoskeletal problems than most medical physicians.
(Opinion pp. 7)
The Wilk suit demonstrated that the defendants had participated for decades in an illegal conspiracy to destroy chiropractic. On August 24, 1987, following 11 years of legal action, U.S. District Court judge Susan Getzendanner ruled that the AMA and its officials were guilty, as charged, of attempting to eliminate the chiropractic profession.
She ruled that the AMA had engaged in a “lengthy, systematic, successful and unlawful boycott” designed to restrict cooperation between MDs and chiropractors, in order to eliminate the profession of chiropractic as a competitor in the United States health care system.
Even so, with the hatchet supposedly buried, organized medicine and a small, loose organization of pseudo-evidence-based proponents have continued to try to deny the truth.
The first Meade study (British Medical Journal 1990) randomized 741 patients to receive either chiropractic care or standard hospital management for low back pain. The outcome was that Chiropractic treatment was more effective than hospital outpatient management for these patients, and the authors concluded that:
“For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.”
It didn’t take long for the vultures to circle, claiming that the overall improvement in the chiropractic group was not dramatic enough, and that it was not clear that chiropractic was effective for chronic low back pain over the long run.
As a response to this criticism, Meade tracked this same group of patients for an additional 3 years (British Medical Journal 1995), finding the improvement in the chiropractic group was 29 percent greater than those treated by hospitals, and this was equally true for those with acute AND chronic low back pain.
Organized Medicine “blew a blood vessel” when the AHCPR published the “Acute Low Back Problems in Adults” series in 1994. This extensive review of all the forms of treatment for low back pain stated that most medical treatments were untested, questionable, or harmful, and of all the types of management they reviewed, only chiropractic care (spinal manipulation) could both reduce pain AND improve function.
Amusingly enough, at the same time that medicine was criticising these chiropractic studies, Timothy Carey, MD was organizing short courses to teach primary care physicians (MDs) how to perform spinal manipulation.
Even though chiropractors take around 1000 class hours in technique to master spinal adjusting, Carey’s complete training program entailed two one-day training sessions, along with a refresher session, adding up to a grand total of 18 hours of training. Impressive! Then this group performed a randomized trial to gauge their impact on patients with low back pain.
In 2004, the publication of the:
demonstrated that Government and Researchers ARE reviewing the literature. Our June 25th, 2010 review of these Guidelines is available for your review.
The salient points include the fact that almost ALL of what’s considered “standard conservative medical treatment” is listed as invasive treatments, that should NOT be recommended for non-specific Chronic Low Back Pain (CLBP).
(see complete list below)
Aside from recommending spinal manipulation as a well-supported treatment, the invasive treatments they rail against include:
- Bed rest
- Local facet nerve blocks
- Epidural corticosteroids
- Intradiscal injections
- Trigger point injections
- Intra-articular (facet) steroid injections
- Botulinum toxin
- Intradiscal radiofrequency lesioning
- Intradiscal electrothermal therapy
- Radiofrequency facet denervation
- Radiofrequency lesioning of the dorsal root ganglion, and
- Spinal cord stimulation
Most recently, the University of Pittsburgh Medical Center Health Plan now mandates conservative care before even considering surgery for chronic Low Back Pain by adopting these landmark guidelines for the management of chronic low back pain.
As of Jan. 1, 2012, candidates for spine surgery must receive “prior authorization to determine medical necessity,” which includes verification that the patient has “tried and failed a 3-month course of conservative management that included physical therapy, chiropractic therapy, and medication.”
They even put teeth into it:
“Surgical procedures for low back surgery performed without prior authorization will not be reimbursed at either the specialist or the hospital level.”
Since those heady early days, the
Chronic Neck Pain and Chiropractic Page have continued to document the vast superiority of chiropractic care over standard medical management for these same musculoskeletal complaints.
The following study is just another, in a long line of studies that shows the benefits of chiropractic care, by helping to clarify which groups of patients may benefit the most from care, and which groups may be refractory to care.
Predictors of Improvement in Patients With Acute and Chronic Low Back Pain Undergoing Chiropractic Treatment
J Manipulative Physiol Ther. 2012 (Sep); 35 (7): 525-33
Cynthia K. Peterson, DC, Jennifer Bolton, PhD, MAEd, B.
Kim Humphreys, DC, PhD
Professor, Chiropractic Department,
Faculty of Medicine,
University of Zürich,
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.