Pain in the neck
January 3, 2012 11:49 AM Subscribe

Tara Parker-Pope of the New York Times reported on a study from the Annals of Internal Medicine that found chiropractic manipulation to be more effective than medication in relieving acute and subacute neck pain. Light exercise worked too. No adverse effects were reported.
posted by Wordwoman (95 comments total) 9 users marked this as a favorite

to be effective than medication

I think the crucial word is missing here
posted by clockzero at 11:51 AM on January 3

To the right of that article, there is an ad for a Chiropractor directory featuring a creepy bearded man holding up a severed spine, as if its a trophy, much like the Predator creature would.
posted by Think_Long at 11:52 AM on January 3 [12 favorites]

So, save your money and do light exercise at home instead?
posted by defenestration at 11:54 AM on January 3 [6 favorites]

MORE

MORE effective than medication.
posted by 2bucksplus at 11:54 AM on January 3 [1 favorite]

[Typo fixed ]
posted by taz at 11:56 AM on January 3 [2 favorites]

Conclusion: For participants with acute and subacute neck pain, SMT (spinal manipulation therapy) was more effective than medication in both the short and long term. However, a few instructional sessions of HEA (home exercise with advice) resulted in similar outcomes at most time points
posted by found missing at 11:57 AM on January 3

Sorry, that was a quote from the article summary.
posted by found missing at 11:57 AM on January 3 [1 favorite]

If you believe the signs around my San Francisco neighborhood, chiropractic manipulation is more effective than measles vaccines, too.
posted by Nelson at 11:59 AM on January 3 [12 favorites]

Well it's a good job everyone who reads a newspaper knows that you shouldn't make up your mind about health issues based on a media report of a single study.
posted by le morte de bea arthur at 11:59 AM on January 3 [4 favorites]

Speaking as a believer in acupuncture (though not chiropractice), who knows the literature doesn't back up my own experience, there may be some very interesting reasons for these study results. That careful attention is being paid to pain may itself make a huge difference. Worth a read is this Atlantic article on the topic.
posted by bearwife at 12:02 PM on January 3 [3 favorites]

chiropractic manipulation

This is well-named.
posted by chavenet at 12:03 PM on January 3 [24 favorites]

“We hadn’t expected that they would be that close,” he said. “But I guess that’s good news for patients.”

Chiropractic, regardless of what it can, is wholly and irrevocably compromised as a treatment option. The woo has, pardon the pun, penetrated the field to the bone and the average person -- the sort who doesn't really have the time or skills to do deep research into what purports to be a medical field -- has no way to separate the new agey con artists from the actual professionals who are aware of the effectiveness and, more importantly, limits of what they can do.

I feel the same way about acupuncture and would never suggest that an easily suggestible person ever go to an acupuncturist. Sure, you can get one that will tell you this will work for pain relief only, but chances are you might also get someone who wants to sell you hundred-dollar bottles of little black tarballs consisting of god-only-knows-what.
posted by griphus at 12:07 PM on January 3 [17 favorites]

Per the study, participants were excluded if they had received any one of the three treatments in the last three months, which is good, but I'd love to know if there was a greater or lesser predisposition to believe in the efficacy of each treatment in each group before the study started. Like of those 57% of the chiropractic group who reported improvements, what proportion had previously used chiropractic and/or were predisposed to believe in its efficacy (and conversely what proportion of the 43% who didn't find it effective were predisposed to doubt its efficacy)?
posted by Lentrohamsanin at 12:09 PM on January 3

i read this as saying that chiropractic is effective to the extent that chiropractors do the same manipulations you would get from a physical therapist. it was frankly weird that the study limited PT to the dispensing of exercise advice, that's not what a real PT would do, most likely.

in any case, i'm glad they were smart enough to recognize that giving someone pain medication and not fixing their problem will not fix their problem. my aunt's dog knew that back in '04, but admittedly he's got smarts that are way above average.
posted by facetious at 12:10 PM on January 3 [5 favorites]

"So, save your money and do light exercise at home instead?"

Adequate diagnosis of the problem as well as prescription of proper exercises that will address it and not promote further injury is not something people should be trying at home, and Physical therapists arn't cheap to train either. The general medical consensus has been for a long time that chiropractics is equivalently effective to physical therapy for lower back pain and undetermined on most other uses. It is also about equivalently expensive. This study is pretty strong evidence that the same consensus should be expanded to neck pain. There will likely be an extensive review some time in the next five years or so that I'll look forward to reading.
posted by Blasdelb at 12:10 PM on January 3 [3 favorites]

The very ideas underlying Chiropractic are absurd and proven to be false (Subluxation. If th\is neck manipulation has any benefit (and that study certainly doesn't show that the method served any purpose above physical touch and attention) it's probably better to call it some kind of physical therapy rather than Chiropractic.
posted by PJLandis at 12:11 PM on January 3 [1 favorite]

Woo hoo. They've finally found some green jellybeans.
posted by teppic at 12:13 PM on January 3 [4 favorites]

So in terms of neck pain reduction, regular massage works a little better than taking drugs? Yeah, I'll buy that for now. If this was all that chiropractors did, I can't say I'd have a problem with them. But as griphus says, the woo runs deep. And I worry that studies like this will give legitimacy to the truly dangerous practitioners.
posted by lholladay at 12:13 PM on January 3 [7 favorites]

Here's a game you can play at home ... identify the five stages of grief occurring for virulently anti-chiropractic people as the scientific evidence for its efficacy mounts!

Remember, that is:

Denial ---> Anger ---> Bargaining ---> Depression ---> Acceptance

If you look closely you can see some in this thread already!
posted by Tell Me No Lies at 12:16 PM on January 3 [1 favorite]

To the extent that chiropractic has become a focused physical therapy on the back based upon a lot of clinical experience, it's become effective and studies have shown this.

To the extent that chiropractic follows any of its theoretical foundations, or attempts to treat anything other than spinal pain, it's pure quackery and occasionally very dangerous: never, ever allow a chiropractor to perform any violent maneuvers with your neck.

I mean, really, the activator device is exactly as scientific as a dowsing rod.
posted by Ivan Fyodorovich at 12:24 PM on January 3 [11 favorites]

So, to clarify, I'm referring to Chiropractic in regards to its core theory that problems with the spine (i.e., subluxations) are the root of all, or at least most, disease/illness/pain/discomfort and spinal manipulation will correct these irregularities (i.e., subluxations) thereby curing whatever ails you?

Whatever benefit Chiropractic techniques might have in terms of back or neck pain, serious Chiropractors would be better off abandoning the title and its absurd history and calling themselves Physical Therapists or something grounded in reality.
posted by PJLandis at 12:27 PM on January 3 [16 favorites]

Ten or so years ago I had terrible, chronic pain in my shoulder that did not respond to oral meds. The ortho doc I was sent to gave me tons of pills which only made me ill. Then he put a needle into the joint, injecting steroids and withdrawing all of my money. This went on for at least a year before I maxed out and tried going to a chiropractor.

Two months later I was free of pain and continue to be so. It cost me about $100.00. I went maybe three times.

The MD wanted to perform surgery.

I don't trust anyone in medicine anymore. All I know is that I was in pain and the chiropractor helped, whereas the MD did NOT.
posted by kinnakeet at 12:33 PM on January 3 [2 favorites]

Woo hoo. They've finally found some green jellybeans.

This wasn't a fishing expedition but a fairly well-designed, randomized study. The researchers randomly assigned people to either chiropractic (SMT), physical therapy (HEA) or drugs. They then followed each group for a full year to see how each group fared. They found the following:

- All three interventions helped relieve pain in the short and long term.
- Both SMT and HEA outperformed drugs in both the short and long term.
- The differences between SMT and HEA were not consistently statistically significant - e.g., they couldn't conclusively say that one was superior.
- To take just one of many different measured endpoints: at 52 weeks, the proportion of people reporting a 100% reduction in pain were: 37% of HEA, 27% of SMT, and 17% of drugs.

Also, one things that may not be immediately evident from the NYT gloss: the 'medication' group were taking pretty strong stuff. Every participant received opiods or muscle relaxants. 90% received both opiods and muscle relaxants, plus NSAIDs. This was lot more than just 'take two aspirin and call me in the morning.'

Finally, its important to note that this study says nothing about whether chiropractic (or physical therapy or even drugs, for that matter) "works" according to chiropractic theory (the authors say as much in their conclusion: "our study does not differentiate between the specific effects of treatment and the contextual (nonspecific) effects, including participant– provider interactions and expectations"). It only compares the three interventions.

It is entirely possible that the mechanism for all three interventions is to a large degree a placebo effect, and that the effect is simply stronger for SMT and HEA. Indeed, this would make sense, as there is evidence that, other things being equal, more direct interactions between patients and physicians produce greater therapeutic benefit.
posted by googly at 12:33 PM on January 3 [11 favorites]

myofascial trigger points. Learn about them. Seriously. Trigger point therapy is one of the least well understood musculoskeletal pain remediation therapies, where ironically, it has likely the best clinical basis in fact. (that is merely one study, if you check around PubMed and others, you can find more).

TrPs can be treated by any or all of a combo of knowledgeable chiropractic care, accurate/knowledgeable accupuncture, knowledgeable massage therapy, "spray and stretch" clinical care, physical therapy or self-massage. The catch is, the practicioner and patient both really need to understand the symptoms, where the pain is coming from, and how trigger points can "mimic" other symptoms, "radiate" (the pain travels from the trigger source) and, sadly, frequently recur. There is no perfect fix, but there can definitely be a lot of pain relief (neck and back pain are the best responders) from a well-understood program of treatment and maintenance.

I go to a chiro myself, but he is a "new-school" chiropractor who does much more soft tissue bodywork than spinal adjustment. In between visits, I do a lot of self massage using various trigger point devices (the "knobble", various balls, a foam roller, a Kong dog toy, no I'm not joking).

and it is a HELL of a lot cheaper and better for your health to do the research on this than to continue down a path of pain --> medication --> dysfunction --> surgery that I too-frequently see in things like sports medicine.

Talk to your massage therapist / chiropractor / PT. Make sure they have these books (my chiro does, and uses them).

The musculoskeletal system is the largest organ system in the body, and sadly is probably the least well understood by traditional medical practicioners, because it's systemic and holistic and not something you can easily specialize at. TrPs are also not something you can just give a course of drugs for, or cut out with a knife, and have them go away (actually surgery in most cases creates more "guarding"; i.e. trigger point proliferation).
posted by lonefrontranger at 12:36 PM on January 3 [12 favorites]

There are times when I just want someone to fix my neck. Honestly, if my insurance covered it I would go for faith-based Cthulhu witch doctor treatment if it worked.

Now admittedly I have some biases. If someone tells me "drugs are the answer, first hit is free" I will be ... skeptical. If someone tells me "massage is the answer," I VOLUNTEER TO PARTICIPATE IN THE CONTROLLED STUDY MANY TIMES, WHERE DO I SIGN.
posted by zomg at 12:38 PM on January 3 [1 favorite]

Tell Me No More Lies: Ok, I'm game. I will happily denounce my Chiropractic skepticism as chauvinism if methods unique to Chiropractic can reasonably be shown to be an effective intervention for a medical condition recognized by the AMA. Besides this study, what other mounting evidence for Chiropractic efficacy exists? A couple of ground rules: 1) Peer Review 2) Published in a mainstream scientific/medical journal* 3) Sample size of >40. Go.

*I'm happy to define this in terms of Impact Factor in Thompson Reuters WoS JCR, if you like...
posted by nonreflectiveobject at 12:40 PM on January 3 [4 favorites]

I VOLUNTEER TO PARTICIPATE IN THE CONTROLLED STUDY MANY TIMES, WHERE DO I SIGN.

"Nausea was then induced with a day at the carnival..."
posted by griphus at 12:40 PM on January 3 [4 favorites]

Some of my favorite references for non-traditional medicine:

Quackwatch
Bad Science
Science Based Medicine

I'd love to hear about some others...
posted by PJLandis at 12:42 PM on January 3 [1 favorite]

Interesting to see that the general tone of comments ar negative regarding chiropractic. There are over a hundred studies that have found chiropractic be safe, cheaper and more beneficial than medicine for certain conditions.

There's been a long history of attacks against chiropractic of course, but the courts have consistently upheld it's usefulness. The attacks have come from monied interests who influence the press and as below illegal activity by the AMA.

In the 1970's 4 chiropractor's successfully sued the AMA for "restraint of trade" and the AMA twice appealed. From Wikipedia: http://en.wikipedia.org/wiki/Wilk_v._American_Medical_Association

"Judge's findings in the second trial
On September 25, 1987, Getzendanner issued her opinion that the AMA had violated Section 1, but not 2, of the Sherman Act, and that it had engaged in an unlawful conspiracy in restraint of trade "to contain and eliminate the chiropractic profession." (Wilk v. American Medical Ass'n, 671 F. Supp. 1465, N.D. Ill. 1987). She further opined that the "AMA had entered into a long history of illegal behavior". And, she then issued a permanent injunction against the AMA under Section 16 of the Clayton Act to prevent such future behavior. However, she exonerated the two other remaining defendants, the Joint Commission on Accreditation of Hospitals and the American College of Physicians, and dismissed them from the case."

During the trial it came out that Ann Landers was paid by the AMA to disparage chiropractic in here writing. Also, in one of the trials the judge noted that many of chiropractic's principles/claims to be more scientifically valid than medical claims. They also noted that chiropractic eduction regarding the musculoskeletal system was far more comprehensive than medical doctors.

The impressive part of the link was that the NY Times - the keeper of the order- reported it, albeit on a blog.

To those who suggest avoiding "violent maneuvers with your neck" keep in mind that chiropractic is considered very safe from an actuarial table standpoint and medicine accounts for over 100,000 deaths due to a combination of iatrogenic illness, surgical errors and adverse reactions to medications. These go relatively unreported by the media for all of the obvious financial reasons.

Just like many things the general public gets hoodwinked by a media who are supported by big pharma and it's constant barrage of ads for the latest meds.

Lastly, must go back to work, the top abused drugs in our country are pain relievers and poses other dangers.
posted by noaccident at 12:45 PM on January 3 [1 favorite]

Interesting to see that the general tone of comments ar negative regarding chiropractic. There are over a hundred studies that have found chiropractic be safe, cheaper and more beneficial than medicine for certain conditions.

The problem that skeptics have with Chiropractic is that many (dare I say most) practitioners are not willing to stick to the scientifically-proven benefits and instead claim that chiropractic manipulation will cure anything and everything.

Imagine a radiologist claiming that radiation therapy will eradicate the flu virus. I may believe in the efficacy of radiation to cure cancer but I will also repudiate that radiologist.
posted by muddgirl at 12:51 PM on January 3 [17 favorites]

That last sentence was too vague - I meant to pose the situation where, say, many oncologists claim that radiation therapy is a safe and effective cure for the seasonal flu.
posted by muddgirl at 12:52 PM on January 3

"Also, in one of the trials the judge noted that many of chiropractic's principles/claims to be more scientifically valid than medical claims."

Yes, when I need medical advice, I consult my local federal judge.
posted by Ivan Fyodorovich at 12:53 PM on January 3 [10 favorites]

I'd really like to know the doses of opioids used.
posted by Maias at 12:54 PM on January 3

I have to disagree. Neck manipulation by a chiropractor is what caused this. C5-7 issues w/ annular tear, degenerative disc disease (well not that part but the tear).

Never had cervical issues until I saw her. Liked her and all and she defiantely helped with my hip/leg issue but the neck thing? I often have to sleep with a Flector patch because I can't move my neck without being in pain.

Good times. I'll take the Flector patch. I'm never going to a chrio again.
posted by stormpooper at 12:54 PM on January 3 [2 favorites]

All I know is that I was in pain and the chiropractor helped, whereas the MD did NOT.

This was my experience also. When my husband herniated a disc in his back, he first saw his MD, who said "take it easy for a couple of weeks while we schedule an MRI" (this to a large, very stoic man who was involuntarily weeping from the pain. The next day, on the advice of a co-worker he saw a local Chrio, and that man did three things for him:

1) took his pain seriously;

2) somehow managed to schedule a same-day MRI for my husband, which confirmed the disc issue;

3) treated him with a gentle combo of heat and massage (no "popping" involved) that at least made his pain levels manageable and give his MD the chance to look over the MRI results (which he took forever to do).

Although the MD prescribed steroid shots (not surgery, thank god) I truly believe it was the twice-a-week visits to the Chrio that kept my husband sane and functional until the steroids could do their stuff.

Conclusion: the better care is always going to come from the doctor who actually cares about his patients and their comfort and quality of life. Not to mention that, at least in our case, the Chrio was able to immediately identify a) what the issue probably was, and b) that it was something the couldn't fix.

Hate on Chiropractic all you want; all I know is that it made a much bigger difference for our family than conventional medicine did.
posted by anastasiav at 1:01 PM on January 3 [4 favorites]

I would like someone who supports Chiropractic medicine to explain the underlying theory.
posted by PJLandis at 1:02 PM on January 3

Also, in one of the trials the judge noted that many of chiropractic's principles/claims to be more scientifically valid than medical claims.

This is a mischaracterization of the court's ruling. Although the court found that the AMA had indeed engaged in anti-competitive conduct, the court declined to rule on the validity of chiropractic services:

The plaintiffs clearly want more from the court. They want a judicial pronouncement that chiropractic is a valid, efficacious, even scientific health care service. I believe that the answer to that question can only be provided by a well designed, controlled, scientific study... No such study has ever been done. In the absence of such a study, the court is left to decide the issue on the basis of largely anecdotal evidence. I decline to pronounce chiropractic valid or invalid on anecdotal evidence.

posted by monju_bosatsu at 1:04 PM on January 3 [8 favorites]

"the courts have consistently upheld it's usefulness."
Well, over here there's the one really quite notable case of chiropractors suing a critic then backing off before getting to the appeal court.
posted by edd at 1:06 PM on January 3

I hope everyone here understands the difference between anecdotes and evidence from a controlled study.

That your recovery and the Chiropractic treatment were coincidental is a real possibility, as is its effectiveness, but an anecdote can't tell us one way or the other. Same for those injured by Chiropractic.
posted by PJLandis at 1:07 PM on January 3 [6 favorites]

There are over a hundred studies that have found chiropractic be safe, cheaper and more beneficial than medicine for certain conditions.

Have you looked at those studies? Most of them are horrible. Chiropractors aren't scientists, and so many of their "research" articles are poorly designed, poorly controlled, and used subject response surveys (i.e. subjective measures) of the therapeutic effectiveness of their treatments. Importantly, chiropractors do not adopt an evidence-based approach to their profession (although, to be fair, neither did medicine for quite a long time too).

I happen to believe in the skill and effectiveness of chiropractors as physical therapists. But, as muddgirl points out, a lot of their chiropractors believe (and perpetuate to their patients) things for which they have absolutely zero evidence. And when they dress up the language, they sound knowledgeable, which makes them able to manipulate their patients into, say, visiting them every week at $50 a pop for the rest of their lives.
posted by kisch mokusch at 1:07 PM on January 3 [4 favorites]

more cites from PubMed on clinical studies of various trigger point therapies for pain management:

Study involving dry needling of the TrP vs. "sham" needling, done to minimize placebo effect. Note that TrPs can both be palpated and imaged on an MRI, so they're real.

study done in dogs to help understand the mechanics whilst cutting down on false reporting; yes apparently dogs get these too.

This case study analysis [in 138 men] indicates that MFRT combined with PRT represents an effective therapeutic approach for the management of CP/CPPS, providing pain and urinary symptom relief superior to that of traditional therapy

there's a raft of others. I think the chiro vs. anti-chiro argument really tosses the baby out with the bathwater. Yes, chiropractic has had a negative history of quackery. I don't deny that.

The truth is, however, that there is an entirely new generation of chiropractors out there (and yes, I agree they should focus on the "physical therapy" aspect) who understand the clinical mechanics behind pain management; and in particular, pain from musculoskeletal origins (which is what I've been on about in these comments), and the true fact of the matter is many of them do a very good job of helping people in pain because of that.

My chiropractor has a solid foundation in trigger point therapy, and does not use any sort of activators or old-school quackery. He is exceedingly gentle and won't manipulate a joint until he's worked out the surrounding soft tissue trigger points. If he can't enact an adjustment without forcing it, he does not do it. He has never, in the 2 years I've been going to him, adjusted anything anywhere above C5 (although he has done quite a bit of vigorous massage to release tension that was causing me headaches up there).

In fact, one of the first things he did was explain to me that he could help, but that for best results I was going to have to do self-maintenance between visits (and self-maintenance is free, so I'd like to point out that he effectively "loses money" on that equation by teaching his patients self-care) in order to see real relief.
posted by lonefrontranger at 1:08 PM on January 3 [4 favorites]

Here's a game you can play at home ... identify the five stages of grief occurring for virulently anti-chiropractic people as the scientific evidence for its efficacy mounts!

If someone believes that swallowing aspirin summons invisible extraterrestrial medics who use magical healing rays to cure whatever ails you their theory is not proven correct by a randomized study demonstrating that taking aspirin alleviates headache symptoms.
posted by yoink at 1:09 PM on January 3 [14 favorites]

It would be a godsend if fewer patients with back and neck pain came to MD's. Since so few people take time to exercise, counseling them about the futility of short term fixes is as fun as counseling recalcitrant alcoholics. Very few people really need any intervention outside of a regular exercise routine. Please, by all means, go see the local chiropractor who can tell you that your pain is coming from those cryptic shadows in your normal xrays, and not years of sedentary behavior. Handing out pills is useless but still the thing that people line up for.
posted by docpops at 1:09 PM on January 3 [8 favorites]

So, to clarify, I'm referring to Chiropractic in regards to its core theory that problems with the spine (i.e., subluxations) are the root of all, or at least most, disease/illness/pain/discomfort and spinal manipulation will correct these irregularities (i.e., subluxations) thereby curing whatever ails you?

Do you know what the original core theories for western medicine are? Do people even realize what cortisone shots do to your body? They are baaad news, but hey it's not woo right!?

For the most part I don't care about this debate. Chiropractic has helped a lot of people, so let's stop the skeptical circle jerk of how bad it is and figure out why physical manipulation modalities work.
posted by P.o.B. at 1:12 PM on January 3 [1 favorite]

stop the skeptical circle jerk of how bad it is and figure out why physical manipulation modalities work</i.

P.o.B., I'm trying. Follow those links.
posted by lonefrontranger at 1:16 PM on January 3

I would like someone who supports Chiropractic medicine to explain the underlying theory.

People in 1970 (and before, obviously) took Aspirin, which worked. We didn't have a solid theory for why until 1971.

We should hold practitioners of alternative medicine to good standards of proof of effectiveness. But we've had a lot of effective medicine that had poor (or wrong, or goofy in retrospect) underlying theory before, and that's fine. We should try to get accurate theories, of course, but in the meantime, if it works ....
posted by feckless at 1:24 PM on January 3 [2 favorites]

I agree with what you're saying lonefrontranger. One of two guys who helped me through injuries was a chiropractor who had a background in soft tissue manipulation. The other was a PT who does nothing but soft tissue stuff. I'd like to thin,k as you said, there is a new wave of these chiropractors that do havve a wider base of knowledge. Also not to take away from what you've said but there have been a few ideas pop up surrounding soft tissue manipulation, going at least back to Jone's Strain Counterstrain, and trigger point is just one of many.
posted by P.o.B. at 1:28 PM on January 3

"Do you know what the original core theories for western medicine are?"

As it happens, I do. And, you know, there is not a single MD that I've ever heard of who practices medicine based upon the notion of the four humours and temperaments. On the other hand, I'd wager some money that I could find with a bit of Googling some alternative medical practitioners who do.

There are chiropractors—quite a few of them—who practice their therapy according to its original theory, with only minor modifications. The fundamental theory of chiropractic is that almost all (or all!) ailments result from "misalignment" of the skeleton. It posits an essential and detailed relationship between the skeletal and nervous systems that is flatly contradicted by subsequent anatomical research.

The problem is not when chiropractic is essentially a parallel and older form of physical therapy, because, as such, it's developed therapies over time that have some modest efficacy in a context where basically no one has found any good therapeutic solutions.

The problem is, as mudgirl wrote, that chiropractors still treat conditions that they cannot possibly be effectively treating unless the manifestly wrong theoretical foundation of the field were actually true. Which it's not. And so they treat things which they cannot—and, in fact, have been shown to not—be effective in treating.
posted by Ivan Fyodorovich at 1:35 PM on January 3 [6 favorites]

Conclusion: the better care is always going to come from the doctor who actually cares about his patients and their comfort and quality of life.

Yup. There is a disturbing trend I've encountered in the past 5 years. Doctors simply aren't taking their patients seriously. They aren't spending enough time working with the patient, and it takes far too long to see them.

My dad had a small cyst in his back that was causing intense pain. He was given this same song-and-dance brush-off by his GP and the first specialist he saw.

Went for a second opinion with a well-respected specialist, who was the first MD to bother to look at the X-rays himself rather than blindly trusting the radiologist. A simple outpatient operation to remove that "cryptic shadow", and the pain he'd been suffering for years, trying to treat with stupid exercises, simply vanished.

Then there was my Mom, who had a trick knee. Kept going out on her. GP didn't even bother to look at her, just scheduled an appointment with an ortho specialist a few months out, and who kept re-scheduling her appt. further and further out. After she took a nasty fall right out his front door on the day they told her she had been cancelled at the last minute, he deigned to see her later that week. Oh, a fractured vertebrae was rubbing against a nerve, causing temporary paralysis in the leg, not a knee issue at all, and it was dangerously close to paralyzing her for good. Oops.

Then there's my wife, who's been spitting up blood off and on for a year. The doc ordered a barium scan, and when it came back negative for reflux, she dismissed my wife as a hypochondriac. Never once opened her mouth to look inside.

Enough was enough, and I drove her to the ER the last time it happened. The Nurse Practitioner took one look down her throat, saw her tonsils had grown back enough to become cryptic, and that had caused an ongoing infection. A nightly salt-water gargle and a round of Amoxicillin was all it took.

Doctors are overbooked, overpaid, and hence uninterested. If you get a good doc, who'll listen to you and put some effort into diagnosis before rattling of a snap judgement, you're lucky. The healthcare system in this country is broken and getting worse.

No wonder people are turning to snakeoil for relief.
posted by Slap*Happy at 1:35 PM on January 3 [32 favorites]

I've mangled various bits of my musculoskeletal system over the years, and while I have generally seen physiotherapists to get the kinks worked out, I've seen a couple of well-recommended chiropractors as well. One did a fast, great job of wiping out some referred neck and back pain, while the other couldn't do a damn thing for a bad shoulder. I had to go to a physiotherapist to get it working again.

From my experience, there's a lot of overlap between the techniques used by chiros and PTs to relieve real pain and help heal real injuries. The good ones I've seen have given me a small number of effective home exercises that worked. So the results of this study aren't shocking: proper massage, stretching, positioning, patterning and exercise prescriptions will help a lot of people.

(And when hands-on therapy doesn't help enough, a cortisone shot can be a fucking miracle. It shouldn't be anyone's first option, but when nothing else works for weeks, then months, getting back your full range of motion within a week of a shot is glorious.)

If you find a good, hands-on chiropractor who can relieve your pain, yay! But I don't buy the theory that a chiro, any chiro, is superior to any doctor or physiotherapist.
posted by maudlin at 1:35 PM on January 3 [1 favorite]

Let's be clear: Chiropractic techniques can treat back pain in the same sense that homeopathy can treat dehydration.

This looks like a well-designed study: decent sample sizing and randomisation, good controls, as blinded as reasonably possible, peer-reviewed and published in a good journal. I have no doubt that the reported effect is real, pace the usual disclaimer that the scientific (and especially medical) literature is prone to false positives.

What the linked study has shown is that a mixture of (chiropractic) neck massages and stretching excercises is as good as (physiotheraputic*) neck excercises and stretches. And that both are better than pain meds, which is hardly a surprise, as chronic pain is notoriously difficult to treat with medication.** So, neck massages work better than pain medication. That's awesome to know, and will hopefully make patients' lives better.

However, this does NOT mean that "chiropracty works"! The underlying principle of chriopracty, that of manipulating (imaginary) "subluxations", is -- and I hope you'll forgive a technical scientific term here -- a complete crock of shit. They're trying to do something impossible to something that doesn't exist. That it leads them to massage the neck of someone with neck pain is all well and good, but the same logic also leads them to give spinal massages to treat infectious diseases, damaged tissues in distant sites on the body, allergies, auto-immune conditions, inherited diseases, etc. None of these are remotely connected to the exact angle of your spine, and any perceived benefit from the treatment is from the usual cocktail of time, placebo and simply having someone warmer and more caring than a doctor sit down and talk to you.

Now, you might say that this is fine: if a patient goes to a chiropracter and feels better, what's the harm? Take another look at that study, specifically the exclusion criteria:

Exclusion criteria were cervical spine instability, frac-
ture, neck pain referred from peripheral joints or viscera,
progressive neurologic deficits, existing cardiac disease re-
quiring medical treatment, blood clotting disorders, diffuse
idiopathic hyperostosis, inflammatory or destructive tissue
changes of the cervical spine, infectious disease or other
severe disabling health problems, substance abuse, preg-
nancy or breastfeeding, previous cervical spine surgery, and
pending or current litigation. In addition, participants
were excluded if they had received any of the study treat-
ments in the past 3 months.

These chiropractic massages were given to patients who'd been carefully screened by medical doctors, to ensure that no-one in an at-risk population was included. This identification of patients who're not too vulnerable, and not well-suited to an existing, better-regulated and more effective treatment is *important*. And until all chiropracters have the same standard of medical training as medical doctors and the ethical standards to send unsuited to send those inappropriate-but-lucrative patients away, I will continue to remind people how stupid and potentially dangerous their beliefs are. The occasional successes of a practice based on bollocks and wishful thinking do not outweigh the harm caused.

(Disclosure: Not a medical doctor, working in academic (i.e. non-profit) medical research.)

*No, I don't think that's a real word either. But you know what I mean.
**It is, however, powerfully responsive to the placebo effect. There's a lovely study that I've written about before on the blue, showing that both real and sham acupuncture are better than medication for treating lower back pain. I can't find a link right now (I'm not at work, so no journal access), but from a quick google search here's basically the same thing done for knee pain.
posted by metaBugs at 1:37 PM on January 3 [29 favorites]

whatever, i hate my fucking neck anyway. what good has it ever done me?
posted by This, of course, alludes to you at 1:43 PM on January 3 [1 favorite]

Imagine a radiologist claiming that radiation therapy will eradicate the flu virus

I can actually see a scientific basis for that. Of course, I'd be really worried about the side effects of enough ionizing radiation to kill most of the influenza virus in your body, but I can at least see *how* it would do so.

Manipulating the spine to kill influenza viruses lacks even that.
posted by eriko at 1:43 PM on January 3 [1 favorite]

I ask about the underlying theories because they're relevant to understanding the evidence. Modern medicine has solid theories underlying the reasons for using most treatments and for judging what might be worth testing.

If Chiropractors or Homeopaths cannot produce a reasonable theory underlying their practices then the hurdle of proof is higher than for a plausible treatment. Extraordinary claims require extraordinary evidence. If someone says something has traveled faster than light, while it may be true, they need strong evidence to back up such a startling claim.

If they do prove effectiveness, do you really think we should rethink spinal irregularities as the basis of all our ills or should we look to plausible and more reasonable explanations. The explanation is important because it helps us to move forward by refining and developing further treatments but if we're focused on curing imaginary subluxuations and accidental progress made by Chiropractors will remain just that, a lucky guess.

And modern medicine isn't based on psuedo-science, its based on chemistry, biology, physics, and testable, repeatable, falsifiable hypotheis...not quantum mechanics or the as yet undiscovered Life Force, nor meridians or Chi, or any other untestable, unverifiable ideas that someone has made up...
posted by PJLandis at 1:47 PM on January 3

Imagine a radiologist claiming that radiation therapy will eradicate the flu virus

"All bleeding stops eventually."
"Hypoxia is the best anesthetic."

- My favorite anesthesiologist when I was an orderly.
posted by Mister Fabulous at 1:47 PM on January 3 [1 favorite]

So in terms of neck pain reduction, regular massage works a little better than taking drugs? Yeah, I'll buy that for now.

This has certainly been my experience, given a massage therapist who specializes in soft-tissue injury work rather than (or in addition to) spa-style relaxation massage. Weekly massage has been wonderful for my repetitive-stress neck and wrist issues. It got so bad that I was afraid I might have to retire, because stretching, exercise, and wrist braces just weren't enough... but as long as I keep my massage appointment I don't even have to bother with the braces most of the time, and I rarely get the stress headaches which were becoming a weekly and even daily event. Like lonefrontranger said, massage also helps teach you where and how to press to relieve tension and pain yourself -- you can do some serious self-care magic with a foam roller and a lacrosse ball.

That said, I tried chiropractic for nearly a year, and I found it much less effective than straight-up massage (and it included some massage prior to the adjustment -- I feel like the former might have been responsible for most of the relief). The relief never lasted longer than a day or two, but the chiropractor seemed happy to have me come back "next Wednesday" for eternity. The insurance co-pays were significant, too. I wouldn't go back... and having done some research since, I haven't seen any evidence that would lead me to recommend chiropractic as currently practiced, not when massage and/or regular ol' physical therapy are less risky and just as effective.

I'm with PJLandis: chiropractic ought to be regulated and adopted by the mainstream medical system, along with other "alternative" therapies which have been shown to work. Likewise, mainstream doctors ought to take a page from the "alternative" book and start spending more time and care on their patients, since this seems to have a large effect on self-care, patient compliance, and eventual outcomes.
posted by vorfeed at 1:49 PM on January 3 [2 favorites]

I also agree P.o.B. - there is no simple answer here, which is sad because simple clearcut answers are what clinical medicine and pharmacology seek to define (I work at a big pharmaco for the record).

on the plus side of trigger point therapy (which is essentially soft tissue manipulation, however you define it), there is quite a bit of research floating around out there, however you have to dig for it. Dr. Janet Travell did extensive studies and published over 40 papers on TrPs and therapeutic pain management, going back to 1942 or thereabouts. Since about 1992 or so, there has been increased interest in her work, and the latter part of the 2000s saw a good bit of decent followup research using modern methodology.

I think the most complicating factor here is this:

"The trigger point concept remains unknown to most doctors and is not generally taught in allopathic (MD) medical school curricula. Among MDs, typically only physiatrists (physicians specializing in physical medicine and rehabilitation) are well versed in trigger point diagnosis and therapy. Osteopathic medical schools, however, include trigger points in their Osteopathic manipulative medicine training, and DOs treat trigger points in clinical practice. Other health professionals, such as physiotherapists, chiropractors, acupuncturists, massage therapists and structural integrators are also aware of these ideas and many of them make use of trigger points in their clinical work as well.

Travell and Simons' seminal work on the subject, Myofascial Pain and Dysfunction: The Trigger Point Manual, states the following:

Around 75% of pain clinic patients have a trigger point as the sole source of their pain.
Arthritis is often cited as the cause for pain even though pain is not always concomitant with arthritis. The real culprit may be a trigger point, normally activated by a certain activity involving the muscles used in the motion, by chronically bad posture, bad mechanics, repetitive motion, structural deficiencies such as a lower limb length inequality or a small hemipelvis, or nutritional deficiencies.
The following conditions are also frequently misdiagnosed as the cause of pain when trigger points are the true cause: carpal tunnel syndrome, bursitis, tendinitis, angina pectoris, and sciatic symptoms, along with many other pain problems.

source, with further citations

the bottom line is that things like soft tissue manipulation and trigger point therapies don't catch on with the academic mindset because the vast majority of MDs are specialists who really don't grok the concept of holistic functionality all that well. Thus despite some pretty good foundation in clinical research, it's relegated to the "woo" bin far too often.
posted by lonefrontranger at 1:49 PM on January 3

lonefrontranger - a bigger problem is that most patients don't understand holistic health. Trying to connect tobacco abuse and a lack of exercise with symptoms of pain is impossible in many patients. People who have a solid grasp of holistic health get better no matter what magic wand you wave, in most cases, because a holistic approach to health that stresses nutrition, mindset, exercise, etc., inevitably produces higher scores of symptom relief.
posted by docpops at 1:53 PM on January 3 [2 favorites]

There are massage therapists and some physical therapists that will do many of the beneficial things that chiropractors do, but (generally, in my experience) do so within a science-based framework and without a lot of "woo" or claims that they can cure cancer, the flu, appendicitis, etc.

Unfortunately, at least in some states, chiropractors have managed to get themselves into a much better place in terms of receiving insurance reimbursements without a referral from a MD than physical therapists, and certainly massage therapists. My understanding is that this is slowly changing, though.
posted by Kadin2048 at 1:54 PM on January 3 [1 favorite]

In the earlier days of chropractice "doctors" claimed they could fix just about anything...They no longer make such claims, but this form of treatment did not catch on till th3ey were allowed to accept health insurance and govt forms of help, thus having clients make many return trips for manipulation (pun intended) Treatments sometimes do indeed help, but there are any number of people who complain of serious injuries suffered as a result of spinal manipulation.

Years ago there was device on market that allowed you to hang upside down to "fix " you....I was told by a chiropractor that they would never direct a person to such a device since it did what many of them did in their offices.
posted by Postroad at 1:59 PM on January 3 [1 favorite]

whatever, i hate my fucking neck anyway. what good has it ever done me?

Showing off hickeys?
posted by stormpooper at 2:04 PM on January 3 [1 favorite]

I just noticed the word "allopathic" which is strangely a derisive word which means medicine, or medicine based on science and evidence. I'm unsure why we would call anything else medicine.
posted by PJLandis at 2:08 PM on January 3 [1 favorite]

So, save your money and do light exercise at home instead?

Sure. Why not, http://www.yogasite.com/neckandshoulders.htm
posted by rough ashlar at 2:08 PM on January 3 [1 favorite]

More and more chiropractors are rational folks who limit their diagnosis and treatment abilities to your spine. I don't see how the existence of snake oil chiropractors is any different than the range of quality you find with MDs. Some are great and some are fucking terrible. In fact, I prefer how it is with chiropractors. It's a lot harder for me to tell if an MD is talking out of his/her ass.
posted by Roman Graves at 2:10 PM on January 3 [1 favorite]

Extraordinary claims require extraordinary evidence.

I'm not sure I agree with that. People who are suffering don't care whether the cure is extraordinary. They just want their suffering to be relieved. If the goal is to relieve suffering, rather than serve your ideological crusade against "woo," then I'm not sure why ordinary evidence wouldn't be good enough.

I don't know. I got physical therapy for my neck pain, and it helped a ton. I personally feel much better about seeing a physical therapist than a chiropractor, because there does seem to be a lot of quackery in chiropractic stuff. But I would have tried anything that had evidence to back up its efficacy, and I kind of resent having my health held hostage to other people's skeptic crusade.

I just noticed the word "allopathic" which is strangely a derisive word which means medicine, or medicine based on science and evidence. I'm unsure why we would call anything else medicine.

Osteopathic is also evidence-based, I believe. DOs compete with allopathic doctors for resident positions, for instance.
posted by craichead at 2:12 PM on January 3

docpops, I absolutely agree. Most of the people I know who are best about doing this kind of self-care / pain maintenance, and are well educated about it, are the athlete types like myself living here in Boulder Colorado (the "woo" healthcare capital of the nation, if you ask me; just google Naropa University if you want a good laugh).

However, these upper-middle class white people with disposable income, good insurance policies, and time to exercise absolutely aren't the ones who need this information the most, and that's yet another huge can of wriggly sociopolitical worms. The ones who need it most are the people who have the least access to this kind of information - inner-city patients under stress, overweight, working multiple jobs, with little to no access to insurance or quality healthcare, much less "alternative" healthcare, who are eating poor diets because that's what they can afford, self-medicating with nicotine/alcohol because that's the only thing that makes them feel better, etcetera, etcetera. Trust me, I get it.

It's a really, really, complicated issue, made worse by the fact that what Kadin2048 just pointed out seems to be the case with insurance (and that's even yet another can of worms).

I think the challenge here lies partly in semantics, partly in tradition, and partly in patient education. It is really sad to me that it has to matter what label a practicioner falls under in order for someone to be able to get help from them; where it's blatantly obvious that the label (full disclosure; not only do I have a REALLY GOOD chiro now, I've also been to a REALLY BAD chiropractor in the past) masks a pure crapshoot as far as insurance coverage and the patient's assessment of probable quality of care, etc.

That said, my mom lost most of her lower bowel and 2 years of her life in and out of hospital, plus 8 days in a coma and nearly died because an MD (who in hindsight we likely could have sued for malpractice) kept saying "oh you're fine, we'll just keep increasing the Prednisone dosage..." so quality of care isn't necessarily bulletproof with an MD degree either.

To be clear, because I probably haven't been. I AM NOT advocating for or against chiropractic here.

I am effectively pleading with the readership of this thread to simply educate themselves as much as possible on a therapy that has a pretty solid basis in clinical fact, because once you understand the basic concept behind TrPs, soft tissue manipulation, whatever you want to label it, then self-care can be so, so very simple and cost effective.
posted by lonefrontranger at 2:13 PM on January 3 [1 favorite]

Massage therapy trumps Tylenol for muscle pain is not exactly a huge surprise. Wake me when they show that chiropractors to a better job than morphine in people who've just had a rogue organ removed.
posted by Kid Charlemagne at 2:14 PM on January 3 [1 favorite]

Allopathic is a deragoratory term, it isn't a counter-point to Osteopath (who are not very different from MD's, they both rely on science and evidence, Osteopaths have abandoned much of their historical quackery in favor of a different approach to patients not medicine). Allopath was coined by Homeopaths who thought evidence based, rather than theory based, medicine was foolish .

As for extraordinary evidence, I stand by the extraordinary claims remark. Curing your pain is not extraordinary and requires a less strict standard. Claiming your pain was cured by fixing subluxations , which contradicts basic knowledge or science or medicine. I was only saying that if the methods work, why not look for a realistic explanation and stop using a term which is based on magic. A Chiropractor who cures neck pain using physical therapy type methods is like a Witch Doctor using anti-biotics to treat infection; they should both call themselves doctors/theraptist and scientists.
posted by PJLandis at 2:21 PM on January 3

No one is claiming tissue point manipulation might not be effective and evidence based, but what makes it unique to chiropractic as opposed to medicine in general. If its because they are the only ones using the method, then I for one supprt better research and more widespread use of any safe and effective treatment. I just wonder why you wouldn't go to a physical therapist or other MD who offers that as one part of their practice or encourage your Chiropractor to take on a more descriptive moniker.
posted by PJLandis at 2:24 PM on January 3

"...just google Naropa University if you want a good laugh"

Excuse me, but Naropa is a respectable Buddhist liberal arts school that does not have as its focus alternative medicine and it's inaccurate to characterize it that way. Yes, as some of the philosophies involved are deeply intertwined with traditional Eastern alternative medicine, such things do make an appearance and I don't doubt the woo factor is more pronounced there as compared to, say, Colorado College. But the same is no doubt true of numerous world-class Asian universities as compared to Euroamerican universities. And we have Freud and Jung, just to pick two examples, so it's not like we have much room to throw stones.
posted by Ivan Fyodorovich at 2:25 PM on January 3 [2 favorites]

the bottom line is that things like soft tissue manipulation and trigger point therapies don't catch on with the academic mindset because the vast majority of MDs are specialists who really don't grok the concept of holistic functionality all that well. Thus despite some pretty good foundation in clinical research, it's relegated to the "woo" bin far too often.

Agreed. Being in the woo bin also means that patients can be exposed to a whole range of treatments when seeking chiropractic or acupuncture... and some of them are not only hokum, they're extremely dangerous hokum perpetrated by out-and-out scammers who should hang their heads in shame before society. For example, the "energy healing"/"psychic surgery" nonsense is quite common around here, up to and including "healers" who openly claim that they can cure things like cancer and AIDS.

Because the alternative crowd is so deeply invested in the idea that mainstream medicine is against them, it can be very difficult to talk to otherwise-reasonable people about the stuff that's actually dangerous -- if it's at all "possible" that these things could work (and we're talking The Secret/What The Bleep Do We Know levels of "possible") then there's no refuting it. I have to wonder how many people have gone in for a perfectly reasonable and effective treatment, only to fall for crystal-healing crap posted on the bulletin board. It makes me despair to see effective treatments associated with this quackery.
posted by vorfeed at 2:25 PM on January 3 [1 favorite]

What's wrong with Frued and Jung?

Even if their theories turned to be incorrect or unhelpful their application of a more rigorous and scientific approach to mental health was revolutionary and important. Aristotle and many ancients were amazingly wrong on a variety of subjects, due to error, hubris, or lack of information but their methods, if crude, were important and inspired bigger and greater things.
posted by PJLandis at 2:30 PM on January 3

respectable Buddhist liberal arts school
*snerk*

I'll keep that in mind next time I have to detour around one of their drum circles on the bike path. the trustafarians who attend the place certainly do NOT give them any sort of good reputation in this town FYI.
posted by lonefrontranger at 2:34 PM on January 3

Allopathic is a deragoratory term, it isn't a counter-point to Osteopath

In the world of medical education it's definitely widely used as a neutral way of differentiating it from osteopathic. Hopkins uses it in pre-med advising, for instance. It may be a loaded term, but I don't think there's a better one.
posted by craichead at 2:37 PM on January 3 [1 favorite]

Still predicated on scarcity.
posted by Smedleyman at 2:41 PM on January 3

I was only saying that if the methods work, why not look for a realistic explanation and stop using a term which is based on magic.

It's just as likely that realistic explanations for those aspects of any alternative medicine which are found to work will keep some of the terms, and reroute them (over time) to the realistic explanation. Modern medicine has a lot of terms that originate from ancient and totally woo ideas (all the way back to the four humors!) which have somehow stuck around because of habit, but which are now attached to a current understanding of their mechanisms. Happens in other fields too.
posted by feckless at 2:43 PM on January 3

I am pretty sure that every college everywhere has drum circles composed of stoned dreadlocked white kids from the suburbs. I think you lose Federal funding otherwise. Even West Point had a university-wide initiative to form a Phish cover band.
posted by griphus at 2:48 PM on January 3

I think it's a poor choice by Hopkins, and they do seem to realize it's origin because they mention it on that page as a counter-point to Homeopathy. I'm not sure it informs more than it confuses as an Osteopath is trained parallel to an MD, using "Allopathic Medicine."
posted by PJLandis at 2:53 PM on January 3

Yeah, I don't really buy into any of this woo about the broad-spectrum efficacy of chiropractic therapy, either, as most of the ones I've personally met seem to be mentally unstable or wildly imaginative...

...except for the bit about the actual paying of attention to the patient combined with laying on of hands. Whatever it is, it just works.

It works on a massage therapy table between complete strangers. It not only works for premature and full term infants - but appears to be essential to surviving birth and bonding with family and the human race at large. It works between parent and child. It works between platonic friends offering sympathy and empathy, and it seems to work even better between intimate lovers or partners.

And it seems to be a deeply missing component of modern medicine - real sympathy and/or empathy combined with sincere, innocent touch.

If people really want to get into some deep, mystical woo - try explaining what that is all about? I obviously have my own wild ideas - but I strongly believe we're missing and discounting something essential there, a real forest for the trees scenario.

Yeah, you can help yourself with self massage and it it mostly works. Active body arts like yoga and tai chi seem to provide some of same benefits, as do exercise and actually moving around.

But would anyone argue that rubbing your own neck was better than having someone do it for you? How about the difference between a stranger and someone you care about rubbing your neck?

There's some kind of yet to be explained magic, there. There's a "more than" going on. For lack of a better word - energy.

And if so - then the snake oil doesn't matter as much, does it? It may as well be a sugar pill, some kind words, and a hug from someone who genuinely cares. Maybe the real secret ingredient to many of these improbable treatments isn't unknown at all. Maybe it's just "love", again, for lack of more scientific words.

And I've learned a few (admittedly mystical) things about the many kinds of "love" in my life. One of the most striking things I've learned is that it doesn't like being observed, measured, tested or otherwise quantified. It often withers in the cold sterility of a purely clinical setting. It shirks at scrutiny. It can't be bottled up and saved for later, except perhaps by poets and artists.

It may be able to be bought and sold - but I'd argue that the capacity to care and love would have to be there in the first place to be sold. The best healers cared before they ever figured out how to turn it into a pay check or a specialty.

But perhaps it is exceedingly difficult to test or quantify. If there's one thing in this universe that I think and feel would be (yet) untestable by the usually infallible scientific method - love would be it.

TL;DR: Maybe everyone really just needs a good hug, and often.
posted by loquacious at 2:56 PM on January 3 [5 favorites]

I don't think the use of Humor names just gradually travelled over to amodern understanding of bile. Rather, we abandoned the Humors and borrowed the name. My point was that basing the treatment on absurd ideas can't help, and could hurt, its just better to say you don't know. Otherwise you develop a whole system based on an idea that doesn't make sense such as Chiropractic or Homeopathy.

Clean hospitals might have been the norm much earlier if Homeopaths had abandoned the woo and looked into how their medicine really worked, and Chirporactic treatments for back or neck pain might be better understood, more widely used, more effective, and the basis of further treatments using similar principles if it hadn't taken a hundred years for most Chiropractors to wonder if spinal manipulation really can cure a cold.
posted by PJLandis at 2:58 PM on January 3

I think your talking about psychology and consciousness. I can put a spike in your head an erase that feeling of love, among other things, but you'd still walk around just fine. We don't understand them well, but they're not real "woo" they're just very subjective.

Caring and compassion can be a part of science/evidence based medicine, and we can quantify it's effects in terms of death or illness to some degree.

It's fine to think in mystical terms but its dangerous to base medicine upon such thinking. I sure would like a loved one by my bedside and a treating physician who shows empathy, but I'll take a heartless yet talented doctor over Patch Adams in the operating room any day.
posted by PJLandis at 3:05 PM on January 3 [1 favorite]

loquacious, I don't think anyone's arguing directly against that. There is a clear and demonstrated placebo effect at play with any massage therapy; it's been cited above and I don't think anyone's denying that. Where the real meat of the prize is, is in actual lasting benefit and continued improvement and mobility, which is something a well-educated scientific PT or chiropractor can, in fact provide.

However the bigger issue is conflation, because far and away what tends to happen with the practicioners who subscribe to your "laying on of hands" mentality is that WHILE they're laying on hands and giving you a decent massage which probably makes you feel better, they're also burning sage and lighting Himalayan salt lamps and ringing temple bells and swathing you in purple silk and god only knows what other smoke-and-mirrors bullshit methodology that EVERY Naropa graduate CMT I've known subscribes to and which NONE of the Boulder College of Massage Therapy practicioners I've known do (which is why I took a free slam at Naropa, because they do tend to perpetuate that whole woo nutcase hippie mentality that degrades the industry).

This kind of thing, coupled with the sort of quackery being discussed above that goes on in "traditional" chiropractic thoroughly confuses the issue of efficacy, and it needs to STOP, period because not only is it arrant mystical bullshit, it also severely harms the credibility of those knowledgeable practicioners who fall under the same label but who DO go through the hard work and study to really learn the mechanics behind real pain relief.
posted by lonefrontranger at 3:11 PM on January 3

Yeah, if you have some serious musco-skeletal problems and you go to see an ART practitioner, they will be doing more than rubbing and will be able to do a hell of a lot more than you could do on your own.
posted by P.o.B. at 3:17 PM on January 3

Diagnosing and healing the human body is hard. The difference is that most M.D.'s (most, not all) I've met are well aware of their limitations, and are upfront about it. I have not had that same experience with alternative medicine practitioners, who are often very confident in their healing powers. This is extremely dangerous. Medicine should not be a confidence game.
posted by Doleful Creature at 3:33 PM on January 3

This kind of thing, coupled with the sort of quackery being discussed above that goes on in "traditional" chiropractic thoroughly confuses the issue of efficacy, and it needs to STOP, period

Oh, not arguing against this at all. Not at all. I like science. I like modern medicine and not having plagues running about and real cures (and preventatives) for cancer or fatal diseases that aren't "here, smell some incense, that'll be $500".

I also don't have a problem with fancy, pretty candles or traditions, as long as they're not sold as something else. Art cures the soul, too, and has its own perfectly reasonable and effective place.

My only main point is that all healing seems to work better with, well, actually giving a shit about the patient. I've personally met perfectly well educated and trained MDs that probably shouldn't actually be in the field because they don't care about anything except the paycheck and lifestyle or something, and it shows in both their level of care as well as their touch, if any.

The other point being is that touch is important. Arguably beyond placebo. It induces natural endorphins and physiological changes in pretty much every living creature, and my argument is that intent and genuine care both matter. Or, to simplify - it's difficult to fake a real hug.

Which is admittedly perhaps more woo than magic candles or purple silks.
posted by loquacious at 3:59 PM on January 3 [1 favorite]

I love science and science based medicine. I hate quackery, homeopathy, fuckhead "practitioners" of BS that let people die, and oh god anti-vaxxers, fuck those people most of all. But when these debates come up I just can't help thinking that I've never once met an MD worth fighting for or had a western medicine experience were I felt like anyone gave a shit about anything but being done for the day.
I think what so many people on the skeptic side miss is that when people are looking for an "alternative", they aren't looking for an alternative to western medicine or science, they are looking for an alternative to our current system, which is incredibly opaque to the average person.
Imagine a guy has serious chronic back pain and decides one day that enough is enough so he decides to seek professional help via the normal route. How much of what happens next has anything to do with science? His experience will be dictated largely by economics, liability issues, medical administration, insurance, etc. He'll get his ten minutes where most likely some doctor will just write a perscription and think to himself:
"It would be a godsend if fewer patients with back and neck pain came to MD's. Since so few people take time to exercise, counseling them about the futility of short term fixes is as fun as counseling recalcitrant alcoholics. Very few people really need any intervention outside of a regular exercise routine. Please, by all means, go see the local chiropractor who can tell you that your pain is coming from those cryptic shadows in your normal xrays, and not years of sedentary behavior. Handing out pills is useless but still the thing that people line up for."

Chiro is crap, but so are the ways that so much of real medicine is administered.
posted by Stonestock Relentless at 4:31 PM on January 3 [5 favorites]

For those who think that MD's should determine access to chiropractic HAH! That's like letting the Republicans control the Democrats. For those who think it's dangerous explain to me why in the U.S. the average chiropractor pays less than $5K annually for malpractice and rates for MD's range from $40,000 to $150,000 depending upon the specialty.

MDs see an order of magnitude more patients, often with life-threatening problems (i.e. not just back pain). They can also prescribe controlled substances, send patients to specialists, perform surgery minor or major, etc. In short, they do a lot more than chiropractors do, so it should be obvious why their malpractice insurance costs more.

Also, suggesting that MDs should determine access to chiropractic is not "letting the Republicans control the Democrats". It's more like suggesting that the Republicans adopt parts of the Democrats' platform... which would probably improve both, frankly.
posted by vorfeed at 4:35 PM on January 3 [1 favorite]

I went to an anti-vax, "adjustments are necessary from birth on!", must see you every Tuesday until you are fully indoctrinated to the cult chiropractor... and he wasn't very good.

I switched. Now I go to a chiro who just has me mark on a figure where I'm stiff or sore. He's not claiming to treat asthma or allergies or IBS. He says that he and his massage therapists can help back/neck/shoulder pain, numbness/tingling, headaches, tension/anxiety, and sleep difficulty. Those are the claims his practice makes, which I think are fair- pain often leads to anxiety, headaches, and sleeplessness, to being able to alleviate pain is to be able to treat those issues.

My husband has some pretty severe hip and back problems that are quite possibly unique. (When he had his first surgery as a kid, they wrote a journal article about him.) I got him, after years of pestering, to see a chiro and it has helped him immeasurably.

I tend to think that it's just as silly to say that chiropractic cannot relieve back/neck pain as it is to say that it can cure asthma. Yes, chiropractic care grew out of a silly concept (subluxation), but so did modern medicine (the four humors, bleeding for health- hell, the Hippocratic Oath says that physicians must not provide a "pessary for abortion").
posted by Leta at 7:05 PM on January 3 [3 favorites]

noaccident: “For those who think that MD's should determine access to chiropractic HAH! That's like letting the Republicans control the Democrats.”

Nobody here has said that. This is a ridiculous chiropractic canard left over from the Holy Wars between the Palmers and the AMA. Look, I'll be perfectly blunt: the AMA has, throughout its history, represented almost exclusively a small handful of monied interests which are at best only tangentially related to science-based medicine the way doctors all over the world practice it. The AMA started its fight against government health care in the 1930s – and it was bribing politicians and greasing palms in order to keep medical treatment out of the hands of the poor long before "lobbyist" was even a word used in Washington. Most recently it has, arguably successfully, once again fought hard to put health care beyond the reach of millions of average citizens in the United States. So you will not get any argument from me when you proclaim the AMA morally bankrupt.

But the subtext of this whole AMA vs Chiropractic narrative that always gets pushed is the implication that Chiropractic, or maybe "alternative medicine" generally, is exclusively the alternative to the AMA. This is a bit like noting that capitalism has produced a broad range of morally bankrupt characters and concluding: 'well, we just all ought to be strict Marxists, then!' What, I ask, is the point of trading one cartel for another?

Here's the thing –

All the advances in health over the past two hundred years; all of the general improvements in the lives of a statistically significant number of people; the cures for hundreds, perhaps thousands, of diseases – all of these things are down to one thing. You know what that one thing is?

Science-based medicine.

Science-based medicine isn't the AMA. It's not "traditional Western medicine" (since, as everyone should know, there is no such thing as "traditional Western medicine.") It's not the monied interests, or the pharmaceutical companies, or the insurance companies. Science-based medicine is an international collection of doctors and scientists dedicated to actually laying down a rational basis for medicine, dedicated to finding new and significant ways to improve the health of people all over the world, on the basis of science.

And, while I know this is seen as passe now in many quarters, I happen to prefer that the medicine my tax dollars pay for be determined and proven by medicine. So a few studies show that the massage therapy that chiropractors do can be somewhat beneficial; that doesn't make it science-based. At this point it's an entirely too expensive form of simply massage therapy, and one that the government is giving millions of our tax dollars every year. So chiropractic is as effective as massage therapy? Fine. Let massage therapy, which generally isn't ridiculously overpriced, be covered by Medicare. And when it's proven that chiropractic can do something for people that no other known therapy can, come to me and we'll talk again. So far, that has not happened.

I'm not asking that "MD's" – a shadowy group you seem to identify with the AMA, which, as I've said, is flat wrong – should be allowed to determine who sees chiropractors. What I want is for chiropractic to be stripped of its favored status in society as a respected quasi-scientific treatment, and specifically I want to stop having to pay for chiropractic's (and the AMA's) continued practice of ripping people off wholesale.
posted by koeselitz at 7:10 PM on January 3 [4 favorites]

Leta: “I tend to think that it's just as silly to say that chiropractic cannot relieve back/neck pain as it is to say that it can cure asthma.”

It may work; but so does massage therapy. And massage therapists generally aren't con artists trying to take your money, so massage therapy often costs a hell of a lot less.
posted by koeselitz at 7:12 PM on January 3 [1 favorite]

Denial ---> Anger ---> Bargaining ---> Depression ---> Acceptance

I go through the same five stages talking to climate change denialists, people who believe in ghosts, people who believe in ESP, etc. So what's your point? If it's that talking to stupid people follows a 'no...no, seriously...have you considered...fuck, are you really that stupid?...fine, I'm outta here' pattern, then duh.
posted by obiwanwasabi at 10:22 PM on January 3 [1 favorite]

(I'm outta here.)
posted by obiwanwasabi at 10:23 PM on January 3

I has said that chiropractic care has been found to have positive benefits in over a hundred studies and kisch mokusch finds that most have horrible design. I don't know if that's true but I do see studies published on the American Chiropractic Website performed by...

Look for a paper that doesn't have some kind of survey as it's read-out of effectiveness, and preferably one that was commissioned by a non-chiropractic-affiliated organisation. Unfortunately, the best case for chiropractic care is as a treatment for back pain, and pain is a very subjective thing. There's no really good way of measuring it other than to ask somebody "are you in pain", which is incredibly subjective. So even the better studies out there are still based around subjective measurements.

But the thing is, as much as those studies make it appear as though chiropractors are taking and evidence-based approach to their job, evidence-based medicine isn't just about doing the research to justify your existence, you have to actually believe in it, too. Which means believing the data that says when not to do something, too. If you find out that taking thalidomide during pregnancy is bad for for the baby, you stop giving thalidomide to pregnant women. But there are chiropractors out there adjusting infants for no good reason. And if a study were to come out and say it does nothing or, worse, can cause harm, I bet you even money that there would be chiropractors out there that ignore the study and continue doing whatever they wanted because they don't care for the evidence-based approach. The American Chiropractic Website may be happy to post any study that leans in their favour on the website, but the American Chiropractic Association aren't kicking out their wackier members that over-sell the profession. They should, because they do the good practitioners a disservice by keeping them in.

I'm glad that chiropractic care was of benefit to your sister. And I'm especially glad that she wasn't forced to sit for an hour, in pain, watching a "Philosophy of Chiro" video or made to commit to a lifetime of chiropractic care before the chiropractor would agree to treat her.

Like I said above, I actually believe there is a place for chiropractors in health care. I personally know a few chiropractors, and have a lot of respect for their understanding of the musculoskeletal system. I think they are better trained than physiotherapists for spinal manipulation, which I believe to be effective for the relief of pain in particular scenarios.

But please don't keep throwing studies out into the argument that you haven't even read, especially when it seems that your pro-chiro position is based largely on personal experience.
posted by kisch mokusch at 1:33 AM on January 4 [1 favorite]

Just to revisit this post, I didn't really consider the possibility of Chiropractors policing their own because despite the lessening prominence of psuedoscience in the profession almost all schools still teach it and a majority of practicioners subscribe to theories like subluxation but I think the Chiropractic supporters here and elsewhere should be condemning the hucksters/frauds who give their trusted Chiropractor such a bad professional name.
posted by PJLandis at 11:16 AM on January 6

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Pain in the neck January 3, 2012 11:49 AM Subscribe

Pain in the neck
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