A study found 23 chiropractic systematic reviews, out of which 11 met defined criteria, showing chiropractic’s influence on the improvement of neck pain, shoulder and neck trigger points, and sports injuries.
(Salehi A, Hashemi N, Imanieh MH, Saber M. Chiropractic: Is it Efficient in Treatment of Diseases? Review of Systematic Reviews. Int J Community Based Nurs Midwifery. 2015 Oct;3(4):244-54. PMID: 26448951; PMCID: PMC4591574.)Early research led by a Harvard Medical School instructor and a NUHS alum is exploring how chiropractic spinal manipulation affects brain neural networks. This study, published in the Journal of Pain, suggests that manual therapy not only reduces low back pain but also modulates brain activity associated with pain processing. This research offers insights into the neurological mechanisms behind the pain-reducing effects of chiropractic treatment.
(Isenburg K, Mawla I, Loggia ML, Ellingsen DM, Protsenko E, Kowalski MH, Swensen D, O'Dwyer-Swensen D, Edwards RR, Napadow V, Kettner N. Increased Salience Network Connectivity Following Manual Therapy is Associated with Reduced Pain in Chronic Low Back Pain Patients. J Pain. 2021 May;22(5):545-555. doi: 10.1016/j.jpain.2020.11.007. Epub 2020 Dec 13. PMID: 33321196.)Manipulation has been included as an effective care option in several national and international guidelines on low back pain. Additional research in orthopedic assessment, exercise therapy, and biomechanics of the spine has influenced the chiropractic profession.
(Lefebvre R, Peterson D, Haas M. Evidence-Based Practice and Chiropractic Care. J Evid Based Complementary Altern Med. 2012 Dec 28;18(1):75-79. doi: 10.1177/2156587212458435. PMID: 23875117; PMCID: PMC3716373.)A review included 14 original research articles defining Maintenance Care as a secondary/tertiary preventive approach, recommended to patients with previous pain episodes who respond well to chiropractic care, and applied to about 30% of Scandinavian chiropractic patients.
(Iben A, Lise H, Charlotte LY. Chiropractic maintenance care - what's new? A systematic review of the literature. Chiropr Man Therap. 2019 Nov 21;27:63. doi: 10.1186/s12998-019-0283-6. Erratum in: Chiropr Man Therap. 2020 Jan 28;28(1):11. PMID: 31832142; PMCID: PMC6868774.)A systematic review and meta-analysis reported that patients receiving chiropractic care for non-cancer pain were 64% less likely to be prescribed opioids. This suggests that chiropractic care can play a significant role in pain management strategies, possibly reducing the reliance on opioid medications.
(Passmore S, Malone Q, Manansala C, Ferbers S, Toth EA, Olin GM. A retrospective analysis of pain changes and opioid use patterns temporally associated with a course of chiropractic care at a publicly funded inner-city facility. J Can Chiropr Assoc. 2022 Aug;66(2):107-117. PMID: 36275079; PMCID: PMC9512299.)A study found that chiropractic care for patients with chronic low back or neck pain was associated with significant improvements in health-related quality of life measures over a 3-month period. This study underscores the potential of chiropractic care in enhancing overall well-being and quality of life for individuals with chronic pain conditions.
(Hays RD, Sherbourne CD, Spritzer KL, Hilton LG, Ryan GW, Coulter ID, Herman PM. Experiences With Chiropractic Care for Patients With Low Back or Neck Pain. J Patient Exp. 2020 Jun;7(3):357-364. doi: 10.1177/2374373519846022. Epub 2019 May 31. PMID: 32821795; PMCID: PMC7410126.)This research focused on the effectiveness of chiropractic treatments, specifically manipulation of the upper cervical (neck) and upper thoracic (upper back) areas, for patients with chronic headaches (CH).
(Dunning, J.R., Butts, R., Mourad, F. et al. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord 17, 64 (2016). https://doi.org/10.1186/s12891-016-0912-3)The study underscores the potential advantages of chiropractic care and exercise over medication for managing mechanical neck pain, both in terms of immediate and long-term pain relief. This highlights the importance of considering drug-free treatment options in pain management strategies.
(Gert Bronfort, Roni Evans, Alfred V. Anderson, et al. Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial. Ann Intern Med.2012;156:1-10. [Epub 3 January 2012]. doi:10.7326/0003-4819-156-1-201201030-00002)For older adults with chronic low back pain, incorporating chiropractic care, either alone or in combination with medical treatment, could be a more economical and effective approach to managing pain and reducing treatment costs. This highlights the potential benefits of integrating chiropractic services into care plans for older patients with chronic pain conditions.
(Weeks, William B, et al. “The association between use of chiropractic care and costs of care among older Medicare patients with chronic low back pain and multiple comorbidities.” Journal of Manipulative and Physiological Therapeutics, vol. 39, no. 2, 2016, https://doi.org/10.1016/j.jmpt.2016.01.006.)The American College of Physicians updated its guidelines for low back pain, acknowledging the significant benefits of spinal manipulative therapy (SMT) in pain relief and function improvement with minimal side effects. These guidelines are based on clinical trials over the last 30 years, recommending SMT as a primary treatment for low back and neck pain.
(https://www.acponline.org/acp-newsroom/american-college-of-physicians-issues-guideline-for-treating-nonradicular-low-back-pain)One of the largest studies of its kind compared the effectiveness of usual medical care and chiropractic care. It found that chiropractic care, combined with common medical care, provides greater pain relief than medical care alone. This large-scale trial reinforces the value of integrating chiropractic treatment in standard pain management protocols.
(Goertz CM, Long CR, Vining RD, Pohlman KA, Walter J, Coulter I. Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial. JAMA Netw Open. 2018;1(1):e180105. doi:10.1001/jamanetworkopen.2018.0105)The World Health Organization recommends spinal manipulative therapy (SMT) for patients with non-specific low back pain, both with and without radiculopathy. The guidelines suggest multimodal approaches that include education, exercise, and spinal manipulation, and intensive interdisciplinary rehabilitation for persistent pain.
(Zaina F, Côté P, Cancelliere C, Di Felice F, Donzelli S, Rauch A, Verville L, Negrini S, Nordin M. A systematic review of Clinical Practice Guidelines for persons with non-specific low back pain with and without radiculopathy: Identification of best evidence for rehabilitation to develop the WHO's Package of Interventions for Rehabilitation. Archives of Physical Medicine and Rehabilitation. 2023 Mar 23.)Research shows after nearly one million manipulations were reported – cervical spinal manipulation is not causally linked to cervical artery dissection. The risk of cervical artery dissection is not increased by cervical spinal manipulation, based on studies including one from the European Spine Journal and other supporting research.
(Chu, E.CP., Trager, R.J., Lee, L.YK. et al. A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy. Sci Rep 13, 1254 (2023). https://doi.org/10.1038/s41598-023-28520-4)A Cochrane Database review found no significant evidence supporting the effectiveness of pharmacological interventions for low back pain compared to placebo. Nonpharmacological interventions like SMT provide safer benefits.
(Feise RJ, Mathieson S, Kessler RS, Witenko C, Zaina F, Brown BT. Benefits and harms of treatments for chronic non-specific low back pain without radiculopathy: Systematic review and meta-analysis. The Spine Journal. 2022 Nov 17.)The study provided new insights for shared decision-making in sciatica treatment. It supported the effectiveness of nonopioid medication, epidural injections, disc surgery, spinal manipulation, acupuncture, and anti-inflammatory biological agents. Conversely, it did not support the effectiveness of opioid analgesia, bed rest, exercise therapy, and percutaneous discectomy for sciatica.
(Ruth A. Lewis, Nefyn H. Williams, Alex J. Sutton, Kim Burton, Nafees Ud Din, Hosam E. Matar, Maggie Hendry, Ceri J. Phillips, Sadia Nafees, Deborah Fitzsimmons, Ian Rickard, Clare Wilkinson, Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses, The Spine Journal, Volume 15, Issue 6, 2015, Pages 1461-1477, ISSN 1529-9430, https://doi.org/10.1016/j.spinee.2013.08.049.)Neurodynamic mobilization techniques significantly reduce symptoms, pain, and motor latency, and improve nerve conduction velocities in patients with mild-to-moderate carpal tunnel syndrome
(Zaheer SA, Ahmed Z. Neurodynamic Techniques in the Treatment of Mild-to-Moderate Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2023 Jul 25;12(15):4888.)A Journal of Pain research systematic review concluded that thoracic spine manipulation effectively reduces pain and neck disability in adults with chronic mechanical neck pain.
(Tsegay GS, Gebregergs GB, Weleslassie GG, Hailemariam TT. Effectiveness of Thoracic Spine Manipulation on the Management of Neck Pain: A Systematic Review and Meta-Analysis of Randomized Control Trials. Journal of Pain Research. 2023 Dec 31:597-609.)Chiropractic care for new-onset neck pain results in fewer and less costly imaging services and reduces the likelihood of invasive therapeutic interventions compared to initial care by physician providers.
(Fenton JJ, Fang SY, Ray M, Kennedy J, Padilla K, Amundson R, Elton D, Haldeman S, Lisi A, Sico J, Wayne PM. Longitudinal Care Patterns and Utilization Among Patients with New-Onset Neck Pain by Initial Provider Specialty. Spine.:10-97.)
