Hi, I dont have much time right now, but at first sight—I think some parts of this blog are wrong. You write that these interventions are recommended for pain treatment:
- Chiropractic manipulation for chronic back pain - Acupuncture for chronic back pain
But probably they are not.
For manipulation there is some high quality evidence of “thats nothing special” (Rubinstein, S.M., et al., 2011. Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review. Spine, 36(13), pp.E825-E846. and Gross, A. et al., 2015. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database of Systematic Reviews, (9).Vancouver).
No doubt there is evidence for “some effect”, but its important to aknowledge what is control group recieving and also in what time-frame are the outcomes measured. Immediate effect for pain—probably. Long-term effect for pain, disability and quality of life? Doesnt seem so... Most experts (from what I know) in this field share view, that mobilisation/manipulation can be used as adjunct (Lin, Ivan, et al. “What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review.” Br J Sports Med (2019): bjsports-2018. APA), but not as stand-alone treatment. It should be used just to help chronic pain patients to be more active (because of possible short-term pain relief). Some are against completely since it can lead to dependence, passive coping, lower self-efficacy etc. - all this can have negative effect on chronic pain and adaptive coping.
For acupuncture it is also tricky. Some people are saying that only studies from “biased” researchers (but who is not?) show some effect and if the studies are methodologicaly good, the results are not good et all (Derry, C. J., et al. “Systematic review of systematic reviews of acupuncture published 1996–2005.” Clinical Medicine 6.4 (2006): 381-386. and Ernst, E., Lee, M. S., & Choi, T. Y. (2011). Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. PAIN®, 152(4), 755-764.). Again, the effect doesnt seem to be clinicaly relevant.
I understand and support effort to manage opioid-crisis, but the recomendations should be really precise—there are serious risks, if they are not. Please consult it with some physiotherapist/medical doctor/psychotherapist, who is experienced in treating chronic pain and also scientifically educated—its really complicated topic and the research is really biased.
If EA is interested in this topic, Id like to help somehow...
Sorry I am just seeing this comment now, 4 years after you posted it! In the full version of the report ( http://www.harvardea.org/s/Final-Presentation-PAF-LJAF-Report-on-Opioid-Epidemic-clean.pdf ), we point out that the evidence for these interventions is shoddy. However, even if they are only providing placebo effect, they can still have a great positive value in substituting for opioids as a treatment for chronic pain. Opioids also don’t work, but they cause much more damage than chiropractic or acupuncture could ever do.
Hi,
I dont have much time right now, but at first sight—I think some parts of this blog are wrong.
You write that these interventions are recommended for pain treatment:
- Chiropractic manipulation for chronic back pain
- Acupuncture for chronic back pain
But probably they are not.
For manipulation there is some high quality evidence of “thats nothing special” (Rubinstein, S.M., et al., 2011. Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review. Spine, 36(13), pp.E825-E846. and Gross, A. et al., 2015. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database of Systematic Reviews, (9).Vancouver).
No doubt there is evidence for “some effect”, but its important to aknowledge what is control group recieving and also in what time-frame are the outcomes measured. Immediate effect for pain—probably. Long-term effect for pain, disability and quality of life? Doesnt seem so...
Most experts (from what I know) in this field share view, that mobilisation/manipulation can be used as adjunct (Lin, Ivan, et al. “What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review.” Br J Sports Med (2019): bjsports-2018. APA), but not as stand-alone treatment. It should be used just to help chronic pain patients to be more active (because of possible short-term pain relief). Some are against completely since it can lead to dependence, passive coping, lower self-efficacy etc. - all this can have negative effect on chronic pain and adaptive coping.
For acupuncture it is also tricky. Some people are saying that only studies from “biased” researchers (but who is not?) show some effect and if the studies are methodologicaly good, the results are not good et all (Derry, C. J., et al. “Systematic review of systematic reviews of acupuncture published 1996–2005.” Clinical Medicine 6.4 (2006): 381-386. and Ernst, E., Lee, M. S., & Choi, T. Y. (2011). Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. PAIN®, 152(4), 755-764.). Again, the effect doesnt seem to be clinicaly relevant.
I understand and support effort to manage opioid-crisis, but the recomendations should be really precise—there are serious risks, if they are not. Please consult it with some physiotherapist/medical doctor/psychotherapist, who is experienced in treating chronic pain and also scientifically educated—its really complicated topic and the research is really biased.
If EA is interested in this topic, Id like to help somehow...
Sorry I am just seeing this comment now, 4 years after you posted it!
In the full version of the report ( http://www.harvardea.org/s/Final-Presentation-PAF-LJAF-Report-on-Opioid-Epidemic-clean.pdf ), we point out that the evidence for these interventions is shoddy.
However, even if they are only providing placebo effect, they can still have a great positive value in substituting for opioids as a treatment for chronic pain. Opioids also don’t work, but they cause much more damage than chiropractic or acupuncture could ever do.