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Spinal Manipulation: The Right Choice
for Relieving Low Back Pain
The Chiro.Org Blog
Spinal High-velocity Low Amplitude Manipulation in Acute Nonspecific Low Back Pain: A Double-blinded Randomized Controlled Trial in Comparison With Diclofenac and Placebo
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
Competence Center for Clinical Studies; and †Institute for Biometrics, University of Bremen, Bremen, Germany
Thanks to Dynamic Chiropractic for access to these Key Findings from the study
- “There was a clear difference between the treatment groups: the subjects [receiving] spinal manipulation showed a faster and quantitatively more distinct reduction in the RMS” (compared to subjects receiving diclofenac therapy).
- “Subjects [also] noticed a faster and quantitatively more distinct reduction in [their] subjective estimation of pain after manipulation. … A similar observation was made when comparing the somatic part of the SF-12 inventory … indicating that the subjects experienced better quality of life after the spinal manipulation compared to diclofenac.”
- “The rescue medication was calculated both for the mean cumulative dose (numbers of 500 mg paracetamol tablets) and for the number of days on which rescue medication was taken. … In the diclofenac arm, the patients on average took almost 3 times as many tablets and the number of days [taking the tablets] was almost twice as high” compared to patients in the manipulation arm. While the authors note that these results were not significant due to large between-individual variations (meaning a few patients could have taken many tablets, throwing off the overall totals), it still suggests that value of spinal manipulation vs. drug therapy (because even if both patient groups had taken the same amount of rescue medication for the same number of days, it wouldn’t discount the fact that patients in the manipulation group showed significant improvement on outcome variables compared to patients in the diclofenac group).
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The Placebo, the Sensory Trick and Chiropractic
The Chiro.Org Blog
Chiropractic J. Australia 2004 (Jun); 34 (2): 58–62
Brian S. Budgell, DC, MSc
School of Health Sciences, Faculty of Medicine, Kyoto University, Kyoto, Japan
Thanks to Dr. Brian S. Budgell and Dr. Rolf Peters, editor of the Chiropractic Journal of Australia for permission to republish this Full Text article, exclusively at Chiro.Org!
Background: As standards for randomised, controlled, clinical trials in medicine evolve, there is debate about whether the RCT model of investigation is appropriate for chiropractic and other forms of so-called “complementary and alternative medicine.” There may be some question as to whether the use of placebo interventions can be justified ethically and scientifically given that experimental treatments must eventually compete in a marketplace where there is often already a clinical alternative which is more effective than placebo. Beyond these concerns, design of an appropriate placebo for chiropractic trials is particularly problematic since the therapeutic component of overall chiropractic treatment may be difficult to isolate.
Objective: To compare placebo interventions in current use in chiropractic clinical research with simple somatic stimuli that produce significant physiological effects in a selected group of patients (those suffering from dystonia).
Methods: A literature search was made using MEDLINE, with the key words dystonia, sensory trick and geste antagoniste. Articles were reviewed for descriptions of these stimuli. The stimuli were compared, in terms of site and modality, with placebo interventions used in recent chiropractic clinical trials.
Results: Stimuli used as placebo procedures in recent chiropractic clinical trials are quite similar, in terms of site and modality, to the “sensory tricks” that either cause substantial temporary relief, or, alternatively, provocation of symptoms in dystonic patients.
Conclusions: Caution should be used in assuming that control (placebo) procedures used in chiropractic clinical trials—procedures that involve physical contact or positioning of patients—lack specific effects on neuromusculoskeletal symptomatology.
INDEX TERMS: (MeSH) PLACEBO, SENSORY TRICK, GESTE ANTAGONISTE, CHIROPRACTIC
In common parlance, the placebo may be thought of as a sham treatment given to placate the gullible or troublesome patient. In medical practice, it is more often thought of as medication, most often a pill, which has no specific action against the complaint for which it is prescribed. More recently, standards for design of clinical research have demanded more rigorous definition of what has been called “the imaginary term in medicine’s algebraic formula.” 
For purposes of pharmacological research, it is possible to select placebo substances that appear, with a very high level of probability, to be physiologically inert in humans, or at least to have no specific action against a disorder that is the target of investigation. Nonetheless, various studies have indicated that such supposedly inert substances may be associated with impressive levels of therapeutic effects, sometimes rivalling the medications, which are known to have specific pharmacological effects. 
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The Chiropractic Care of Patients with Asthma: A Systematic Review of the Literature to Inform Clinical Practice
The Chiro.Org Blog
Clinical Chiropractic 2012 (Mar); 15 (1): 23–30
Joel Alcantara, Joey D. Alcantara, Junjoe Alcantara
International Chiropractic Pediatric Association, Media, 327 N Middletown Rd, Media, PA 19063, USA
Introduction Estimates place some 300 million people worldwide suffer from asthma with 180,000 deaths attributed to the disease. The financial burden from Asthma in Western countries ranges from $300 to $1,300 per patient per year. In the United States, asthma medication costs between $1 billion and $6.2 billion per annum. With an increasing prevalence of 50% every decade, there is no question that the burden of asthma is tremendous. The prevalence of complementary and alternative medicine (CAM) use amongst adult asthmatics ranges from 4% to 79% whilst, in children, it ranges from 33% to 89%. Of the various practitioner-based CAM therapies, chiropractic stands as the most popular for both children and adults. As with other chiropractors, the authors aspire to the principles of evidence-based practice in the care of asthma sufferers. Recent systematic reviews of the literature places into question the effectiveness of chiropractic. To assuage the discord between our clinical experience and those of our patients with the dissonant literature, we performed a systematic review of the literature on the chiropractic care of patients with asthma.
Methods Our systematic review utilized the following databases for the years indicated: MANTIS [1965–2010]; Pubmed [1966–2010]; ICL [1984–2010]; EMBASE [1974–2010], AMED [1967–2010], CINAHL [1964–2010], Index to Chiropractic Literature [1984–2010], Alt-Health Watch [1965–2010] and PsychINFO [1965–2010]. Inclusion criteria for manuscript review were manuscripts of primary investigation/report published in peer-reviewed journals in the English language involving the care of asthmatic patients.
Results The studies found span of research designs from non-experimental to true experimental studies consisting of 3 randomized controlled clinical trials (RCTs), 10 case reports, 3 case series, 7 cohort studies, 3 survey studies, 5 commentaries8 and 6 systematic reviews. The lower level design studies provide some measure of evidence on the effectiveness of chiropractic care for patients with asthma while a critical appraisal of 3 RCTs revealed questionable validity of the sham SMTs involved and hence the conclusions and interpretations derived from them. The RCTs on chiropractic and asthma are arguably comparison trials rather than controlled clinical trials per se.
Conclusion Chiropractic may offer an alternative care approach for asthmatic patients. Future investigations of this conservative care approach for patients with asthma should pave the way for higher-level design studies such as randomized controlled clinical trials.
From the FULL TEXT Article:
The burden of asthma is tremendous. Prevalence estimates of asthma range from 7% in France and Germany to 11% in the United States and as high as 15–18% in the United Kingdom.  In Britain, asthma is the commonest chronic childhood disease.   In the United States, approximately 6.7 million children (or 9.1% of the pediatric population) have asthma. Some 10.6 million office visits to medical physicians are attributed to the symptoms of asthma. Deaths as a result of asthma have been estimated at approximately 1.2 deaths per 100,000 population.  Asthma medications alone have been placed at costing $1 billion per year in the United States. In 1985, the burden of asthma was placed at almost $4.5 billion and extrapolated to $6.2 billion in 1990 in the United States. Given the ever increasing prevalence of asthma since the 1990s, the cost to society undoubtedly enormous. 
An examination of the prevalence of complementary and alternative medicine (CAM) use for asthma sufferers found that adult CAM use ranged from 4% to 79% whilst, for children, CAM use ranged from 33% to 89%.  Of the various practitioner-based CAM therapies, chiropractic stands as the most popular for both children and adults.  Given the popularity of chiropractic, it stands to reason that individuals with asthma would consider a trial of chiropractic care; indeed, the chiropractic clinical experience is such that asthmatics benefit from chiropractic care (i.e., improved symptoms of dyspnea and decrease medication use) (unpublished observations). Recent systematic reviews of the literature on chiropractic, however, spinal manipulative therapy (SMT) and asthma [7, 8] place into question the effectiveness of chiropractic for this patient population. As stated above, this is dissonant with the chiropractic clinical experience and the reported benefits experienced by chiropractic patients. In keeping with evidence-based practice and to reconcile the “conscientious, explicit, and judicious use of current best evidence” with that of empirical clinical experience, a systematic review of the literature on the chiropractic care of patients with asthma was performed.
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Manipulative Therapy: Just a Placebo?
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By John J. Triano, DC, PhD
Excerpted from: Triano J: Manipulative Therapy in the Management of Pain.
Clinical Pain Management: A Practical Approach 3rd Edition, Lippincott, Williams & Wilkins Pub, November 2001.
Chiropractic care, particularly spinal manipulation or adjustment, is an increasingly frequent topic in medicine and health care policy circles. As evidence has accumulated to support use of these services, there is frequent reference to a presumption of placebo effect being the mechanism of favorable responses reported in the literature. These charges are easily refuted by specific data. In my experience, a professional head-on response silences these critiques and allows the discussion to refocus on a much more useful topic: appropriate use the paragraphs that follow were crafted as a part of a book chapter on the role of chiropractic manipulation in management of pain the basis often used to set the stage for a claim of a placebo effect. An effective rejoinder follows.
Discourse on manipulation usually raises the question of placebo effect. A frequent observation is that chiropractic patients are more satisfied by their treatment experience than when they are attended by other proaviders. [1, 2]
A number of elements contribute to this popular contentment, including physician-patient interaction. Manipulation treatment often requires several encounters involving physical contact and direct physician attention over a focused time interval. Can these factors be responsible for the perceived clinical benefits?
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