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9. What has scientific research found out about whether chiropractic
works for low back pain?
For this report, the results of individual clinical trials and reviews of groups
of clinical trials were examined. Sources were drawn from the National Library
of Medicine's PubMed database; were published in English; and studied chiropractic
techniques that were identified as such (e.g., "chiropractic manipulation")
rather than some other forms of "manipulation" or "spinal manipulation therapy"--which,
as noted above, may be delivered by certain other health care providers.
So far, the scientific research on chiropractic and low back pain has focused
on if, and how well, chiropractic care helps in relieving pain and other symptoms
that people have with low back pain. This research often compares chiropractic
to other treatments.
Research studies
Appendix I gives detailed findings from seven controlled clinical trials and
one prospective observational study of chiropractic treatment for low back
pain published between January 1994 and June 2003.
• Summary of the research findings
The studies all found at least some benefit to the participants from chiropractic
treatment. However, in six of the eight studies, chiropractic and conventional
treatments were found to be similar in effectiveness.(22,25-29) One trial
found greater improvement in the chiropractic group than in groups receiving
either sham manipulation or back school.30. Another trial found treatment
at a chiropractic clinic to be more effective than outpatient hospital treatment.(31)
General reviews, systematic reviews, and meta-analyses
Appendix II lists three reviews of clinical trials on chiropractic treatment
for back pain, published between October 1996 and June 2003.
• Summary of the research findings
Overall, the evidence was seen as weak and less than convincing for the effectiveness
of chiropractic for back pain. Specifically, the 1996 systematic review reported
that there were major quality problems in the studies analyzed; for example,
statistics could not be effectively combined because of missing and poor-quality
data. The review concludes that the data "did not provide convincing evidence
for the effectiveness of chiropractic.(32) The 2003 general review states
that since the 1996 systematic review, emerging trial data "have not tended
to be encouraging…. The effectiveness of chiropractic spinal manipulation
for back pain is thus at best uncertain.(33) The 2003 meta-analysis found
spinal manipulation to be more effective than sham therapy but no more or
no less effective than other treatments.(10)
Several other points are helpful to keep in mind about the research findings.
Many clinical trials of chiropractic analyze the effects of chiropractic manipulation
alone, but chiropractic practice includes more than manipulation (see Question
5).(34) Results of a trial performed in one setting (such as a managed care
organization or a chiropractic college) may not completely apply in other
settings.(29,35) And, researchers have observed that the placebo effect may
be at work in chiropractic care,(34) as in other forms of health care.
Note: This fact sheet often uses the term "adjustment" to refer to chiropractic
manipulation. In Question 9 and Appendices I and II, "manipulation" is used
where it is used in the source(s) on chiropractic being discussed.
10. Are there scientific controversies associated with chiropractic?
Yes, there are scientific controversies about chiropractic, both inside and
outside the profession. For example, within the profession, there have been
disagreements about the use of physical therapy techniques, which techniques
are most appropriate for certain conditions, and the concept of subluxations.
Outside views have questioned the effectiveness of chiropractic treatments,
their scientific basis, and the potential risks in subsets of patients (for
example, the risks of certain types of adjustments to patients with osteoporosis
or risk factors for osteoporosis, compared to patients with healthier bone structures.(33,36)
Research studies on chiropractic are ongoing. The results are expected to expand
scientific understanding of chiropractic. A key area of research is the basic
science of what happens in the body (including its cells and nerves) when specific
chiropractic treatments are given.
11. Is NCCAM funding research on chiropractic?
Yes. For example, recent projects supported by NCCAM include:
• Comparing conventional medical care for acute back pain with an "expanded
benefits" package (consisting of conventional care plus a choice of chiropractic,
massage, or acupuncture)
• Finding out what happens (through measurement) in the lumbar portion
of the spine after chiropractic positioning and adjustment
• Evaluating the effects of the speed of spinal adjustment on muscles
and nerves * Studying the effectiveness of chiropractic adjustment for a variety
of conditions, including neck pain, chronic pelvic pain, and temporomandibular
disorders (TMD) in the jaw
National Center for Complementary and Alternative Medicine(NCCAM)
http://nccam.nih.gov/health/chiropractic/index.htm
National Institutes of Health, U.S. Department of Health and Human Services
NCCAM Publication No. D196 November 2003
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