News

Chiropractic treatment is of limited benefit

Scott Gottlieb, New York

Challenging the main reason that people decide to go to chiropractors, new research shows that spinal manipulations ease back pain no better than specialised physiotherapy and only slightly better than doing nothing at all.

The findings of the study, led by researchers from the University of Washington, are contrary to the growing acceptance of chiropractic spinal manipulation as a treatment for acute lower back pain. In recent years, federal health officials in the United States have endorsed such treatment, and many US insurance companies now pay for it.

The research tracked 321 patients diagnosed with back pain and followed these patients for a longer period of time than previous large studies that compared chiropractic manipulation with an active treatment, such as physiotherapy. The present study compared chiropractic manipulation with physiotherapy for back pain or a visit to a doctor who supplied patients with a booklet about coping with back pain. After two years, chiropractic spinal manipulation proved to be no more effective than physiotherapy or benign medical neglect. For example, people from each of the three groups were equally likely to lose at least a day of work to back pain or have a full relapse (New England Journal of Medicine 1998;339:1021-9).

A second study published in the same issue and funded by chiropractic groups debunks the notion that spinal manipulation can ease asthma symptoms in children. Eighty children with mild to moderate asthma received either a legitimate chiropractic spinal adjustment or a sham treatment, in which a practitioner merely moved their shoulder blades and legs. Both treatment groups showed similar rates of improvement in their asthma. Previously, some practitioners and chiropractic textbooks have reported success with chiropractic manipulations in the treatment of childhood asthma (New England Journal of Medicine 1998;339:1013-9).

Chiropractic medicine is based on the theory that spinal misalignments interfere with nerve function and therefore contribute to a wide range of disorders. By adjusting the spine, chiropractors say that they can help restore the body's innate healing powers. In the United States the number of chiropractic practitioners has doubled in the past two decades to 55000, according to the American Chiropractic Association.

Chiropractic experts said that they welcomed the studies as a sign that the once scorned practice is maturing into a scientific discipline. But they also criticised the studies as unfair. They cited the fact that the study was limited to just one type of spinal adjustment and noted that entrance criteria for the study on the 321 patients, for example, excluded many traditional chiropractic patients.

"They didn't allow pregnant women into the study, or patients with sciatica or those people recovering from back surgery. These are a large part of a chiropractor's patients," said Dr Jerome McAndrews, a retired chiropractor and national spokesman for the American Chiropractic Association. "This was a minor, highly limited study," he said (see p 1090).