Chiropractic for low back pain
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7178.261a (Published 23 January 1999) Cite this as: BMJ 1999;318:261
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Firstly, the study conducted by Cherkin et al is a remarkably
unscientific approach to evaluation of the efficacy of chiropractic
treatment. The results of this study show very little indeed, whilst the
methodology of the study simply shows the author's complete ignorance
about the process of chiropratctic treatment. The study shows exactly
what should be expected, that after a month of treatment and eighteen
months observation there is very little observable benefit from
chiropractic care. A more useful study would allow the chiropractor to
dictate the course of treatment as they feel is appropriate for the
particular patient. This would produce results of some clinical
significance, rather than the largely hypothetical results seen in this
study.
Secondly, immunisation should not be seen as the only approach that
parents can take for their children. There are certainly two sides to
this argument, and a wealth of documentation showing not only possible
benefits from immunisation, also the possible hazards associated with the
process.
Thirdly, in terms of clinical significance, and relevance to the
patient, is there a problem with use of their comfort levels as a means of
evaluation of a method of treatment? Certainly this is not as objective,
or as scientific, but in real terms this is very valuable information
Fourthly, the constant emnity between "medical" profesionals and
chiropractors, plainly evident in your research, is of no benefit to the
public, and can opnly be deemed a threat to the scientific evaluation fo
chiropractic treatment.
Competing interests: No competing interests
Editor
Patient satisfaction is increasingly recognised as an important
outcome in trials. Whatever interpretation Ernst and Assendelft (23rd
January) themselves place on changes in the Oswestry score, they did not
mention that regardless of whether patients in our trial[1] were recruited
from hospitals or chiropractic centres, significantly more of those
treated by chiropractic expressed satisfaction with their outcome at three
years than those treated in hospital, i.e. 84.7% (127/150) compared with
65.5% (76/116) for those referred by chiropractors: (p<0.0001), 79.2%,
(103/130) compared with 60.2% (71/118) for those recruited from hospitals
(p=0.001). This aspect was assessed three years after entry to the trial.
The main stimulus to the Medical Research Council's current trial
were the suggestive results and further questions raised by our own
initial observations. Assendelft's critique[2] can hardly be considered to
have been one of its "starting points".
Professor TW Meade
MRC Epidemiology and Medical Care Unit
Wolfson Institute of Preventive Medicine
Charterhouse Square
London EC1M 6BQ
1 Meade TW, Dyer S, Browne W, Frank AO. Randomised comparison of
chiropractic and hospital outpatient management for low back pain: results
from extended follow-up. Br Med J, 1995;311:349-351.
2 Assendelft WJJ, Bouter LM, Kessels AGH. Effectiveness of
chiropractic and physiotherapy in the treatment of low back pain: a
critical discussion of the British randomized clinical trial. J
Manipulative Physiol Ther, 1991;14:281-286.
Competing interests: No competing interests
Medical bias exists without good reason
Sir,back pain and rugby players is second only to the link between
orthopaedic surgeons and rugby football .Every clinic we see patients with
mechanical back pain and invariably they leave disillusioned with the
medical profession as we are impotent to treat their needs if there is no
obvious surgical target.I have conducted a study of over forty patients
who have had episodes of chronic back pain which I`m sure is related to
the rigours of playing in the tight five of the rugby scrum and none of
them have been helped by the medical profession except for palliative
analgesia as they have no specific surgical target.
Strangely more than 85% have gained considerable relief from "sports
massage" or chiropractic.Doen`t this suggest that GP`s should consider
local practitioners who are experienced in manipulative techniques rather
than clogging up clinics with recalcitrant "mechanical patients".A sound
neurological examination should give them the confidence to do this!
Competing interests: No competing interests