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Chiropractic Research

Today, millions of dollars are spent each year on chiropractic research in North America, with solid medical studies covering basic science, health and education. But this hasn't always been the case. For most of the last century, the field of chiropractic -- which began in 1895 -- has been criticized for its lack of clinical research. Insufficient funds were the main reason research was neglected. For chiropractors, there were more pressing concerns: obtaining the legal right to practice and overcoming immense skepticism from the medical community.

That's not to say there wasn't an effort to conduct formal research. In 1944, the National Chiropractic Association (NCA) was established, spawning the Chiropractic Research Foundation (CRF). CRF's original purpose was to promote the funding needed to develop sound chiropractic research. However, with the 1960s came the realization that developing educational standards in chiropractic schools was the profession's top priority. With that, the CRF was renamed the Foundation for Accredited Chiropractic Education (FACE), and a new emphasis was placed on gaining nationally recognized accreditation. While this was good news for chiropractic colleges, it also meant that advancements in research were put on hold.

During the next decade, the profession tried again. This time, FACE was reorganized to form the Foundation of Chiropractic Education and Research (FCER), which remains the profession's primary source of funding even today. But without a standard accreditation system in chiropractic schools, the focus remained largely on education for the next several years.

The real turnaround began in the last 25 years. In 1974, the Council on Chiropractic Education (CCE) was finally recognized as the accrediting agency for chiropractic schools, making way for more time and effort to be directed to research. In 1975, the first US federally funded research conference on chiropractic and spinal manipulation took place in Maryland, which was a major step in uniting researchers across the country. Later in the '70s, publications such as the Journal of Manipulative and Physiological Therapeutics and Modern Developments in the Principles and Practices of Chiropractic provided a platform for important clinical research. The latter was the first major interdisciplinary text written by both chiropractors and medical doctors.

Several organizations have also contributed to advances in research. In 1996, Iowa's Consortial Center for Chiropractic Research began to hold annual workshops to establish a research agenda and attract private and public research funds. In 1997, the workshop led to a grant of over $4 million from US federal agencies. Although this amount pales in comparison to that given to medical research (with grants totaling over $13 billion in 1997), it is more than the total federal funding ever previously granted to chiropractic research. It is also sure to help the profession build on a body of research that already includes comprehensive studies supporting chiropractic care in the following areas:

Low back pain

Low back pain is the most commonly treated condition in the chiropractic profession, accounting for over 65% of patient complaints. Numerous studies confirm that chiropractic care is an effective form of low back pain management.

In 1995, a study published in the British Medical Journal compared the ongoing chiropractic and hospital outpatient management for over 700 patients with low back pain. After three years, those treated by a chiropractor showed an improvement rate nearly 30% higher than those treated in a hospital. Similarly, in 1993 the Government of Ontario commissioned a report into the safety and effectiveness of chiropractic treatment of lower back pain that concluded overwhelmingly in its favor. The following year, that report was endorsed by government-sponsored practice guidelines in the US and the UK.

References:

Journals

Hurwitz, E., et al. "Use of chiropractic services from 1985 through 1991 in the United States and Canada." American Journal of Public Health, Vol. 8 (1998): 771-776.

Meade, T., et al. "Randomized comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up." British Medical Journal, Vol. 311 (1995): 349-351.

Manga, P., et al. "The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low Back Pain." Ottawa, Ontario: Pran Manga and Associates, 1993.

Books

Chapman-Smith, D. The Chiropractic Profession. West Des Moines: NCMIC Group Inc., 2000.

Neck pain

In recent years, chiropractic treatment of the neck has received a lot of negative attention. However, in the past five years, three major studies have concluded that neck manipulation and mobilization are safe and effective methods of treatment for patients with neck pain. The "Quebec Task Force Report", the "RAND Corporation Report" and the "Cochrane Collaboration Systematic Review" have all produced evidence that neck pain is more effectively managed by chiropractic manipulation than treatments commonly administered by medical professionals.

References:

Coulter, I., et al. "The appropriateness of manipulation and mobilization of the cervical spine." Santa Monica, California: RAND, 1996.

Aker, P., et al. "Conservative management of mechanical neck pain: systematic overview and meta- analysis." British Medical Journal, Vol. 313 (1996): 1291-1296.

Spitzer, W., et al. "Scientific monograph of the Quebec task force on whiplash-associated disorders: redefining whiplash and its management." Spine, Vol. 20 (1995): 85.

Headaches

There are several types of headaches, including migraine, tension and cervicogenic (arising from the cervical spine). Numerous controlled trials now support the effectiveness of chiropractic treatment for all three. In a controlled trial conducted by Macquarie University in Australia, for example, 172 migraine sufferers were treated with spinal manipulation therapy (SMT) for a six-month period. Results showed that over 20% of participants reported a dramatic reduction in the number of migraines experienced after only two months of therapy. Likewise, the majority of participants reported a marked improvement in the severity of their migraine episodes.

References:

Bonello, R., et al. "A Randomized Controlled Trial of Chiropractic Spinal Manipulation Therapy for Migraine." Proceedings of the 5th Biennial Congress of the World Federation of Chiropractic (1999): 183- 184.

Bronfort, G., et al. "The Efficacy of Spinal Manipulation, Amitriptyline and the Combination of Both Therapies for the Prophylaxis of Migraine Headache." The Journal of Manipulative and Physiological Therapeutics, Vol. 21 (1998): 511-519.

Christensen, H.W., et al. "The Effect of Spinal Manipulation in the Treatment of Cervicogenic Headache." The Journal of Manipulative and Physiological Therapeutics, Vol. 20 (1997): 326-330.

Boline, P., et al. "Spinal Manipulation vs Amitriptyline for the Treatment of Chronic Tension-Type Headaches." The Journal of Manipulative and Physiological Therapeutics, Vol. 18 (1995): 148-154.

Parker G.B., et al. "Why Does Migraine Improve during a Clinical Trial? Further Results from a Trial of Cervical Manipulation for Migraine." Australian and New Zealand Journal of Medicine, Vol. 10 (1980): 192-198.

Parker G., et al. "A Controlled Trial of Cervical Manipulation for Migraine." Australian and New Zealand Journal of Medicine, Vol. 8 (1978): 589-593.

Colic

Studies suggest that infantile colic, a persistent crying in otherwise healthy babies, may be attributed to problems in the spine. In a study conducted in Denmark of 316 infants with both colic and some form of spinal disturbance (i.e. limited movement of the back), chiropractic treatment over the course of two weeks resulted in a 94% success rate. In 60% of the infants, the symptoms stopped completely; 34% of infants showed significant improvement. In a more recent study, researchers compared the treatment results of two groups of colicky babies, with one group being treated by spinal manipulation and the other by the drug dimethicone. Outcomes were measured in the number of hours the babies cried, as recorded in a diary. During trial days four to seven, babies being treated with spinal manipulation cried 1.4 hours less than those being treated by dimethicone. On days eight through 11, this number increased to 1.7 hours. The study concluded that spinal manipulation can be an effective treatment in relieving infantile colic.

References:

Wiberg, J.M.M., et al. "The Short-Term Effect of Spinal Manipulation in the Treatment of Infantile Colic: A Randomized Controlled Clinical Trial with a Blinded Observer." Journal of Manipulative and Physiological Therapeutics, Vol. 22, No. 8 (1999).

Klougar, N., et al. "Infantile Colic Treated by Chiropractors: A Prospective Study of 316 Cases." Journal of Manipulative and Physiological Therapeutics, Vol. 12 (1989): 281-288.

Asthma

The 1979 New Zealand Commission of Inquiry into Chiropractic found that chiropractic treatment, paired with medical care, can be an effective way of managing asthma. The inquiry cites the case of a two-year-old asthmatic whose condition had not been improving under the care of a medical specialist. Upon examination by a chiropractor, it was suggested that the child may have fallen and injured his neck. The chiropractor adjusted the patient's back and his symptoms diminished significantly. Since then, studies have shown mixed results in the effectiveness of chiropractic treatment in asthmatic children with some form of spinal dysfunction. While patients have reported relief from symptoms and decreased dependency on medication, rates of peak airflow have shown less improvement.

References:

Balon, J., et al. "A Comparision of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma." New England Journal of Medicine, Vol. 339 (1998): 1013-1020.

Bronfort, G. "Asthma and Chiropractic." European Journal of Chiropractic, Vol. 44 (1996): 1-7.

Hviid, C. "A Comparison of the Effect of Chiropractic Treatment on Respiratory Function in Patients with Respiratory Distress Symptoms and Patients without." Bulletin of the European Chiropractic Union, Vol. 26 (1978): 17-34.

Enuresis (bed-wetting)

Twenty percent of children between the ages of four and five suffer from bed-wetting. While the causes are not entirely known, chiropractors have reported successful treatment in bed wetters with some form of spinal dysfunction. In an Australian study of 171 children between the ages of four and 15, chiropractic treatment alone was found to be more effective than psychotherapy, but less effective than dry bed training methods. Chiropractors believe that combining chiropractic care with other treatment methods, such as fluid restriction, would improve these results significantly.

References:

LeBoeuf-Yde, C., et al. "Chiropractic Care of Children with Nocturnal Enuresis: A Prospective Outcome Study." The Journal of Manipulative and Physiological Therapeutics, Vol. 14 (1991): 110- 115.

Otitis media (middle ear infection)

Otitis media (OM) is an inflammation of the middle ear caused by complications of colds, sore throats and sinusitis. While chiropractic treatment is not advised for the treatment of OM, in some cases it has been known to prevent chronic cases. A 1992 US study examined a two-year-old girl suffering from chronic OM in both ears, despite several routine treatments with antibiotics. After six months without results, her parents consulted a chiropractor. The first chiropractic examination found that the girl's spine was out of alignment and after an initial treatment to restore the normal range-of-motion, there was a significant reduction in pain and ear discharge; further treatment brought total relief. Any recurrences over the next six months were alleviated after chiropractic care and today the girl is free of symptoms. The likely explanation for these results is that chiropractic manipulation restores motion in the spine, which alters the nervous system and therefore improves the drainage of the ear's eustachian tubes. Further studies are now underway to determine whether medical treatment, chiropractic treatment or a combination of both is the most effective method of treatment for patients with OM.

References:

Fallon, J.M. "The Role of Chiropractic Adjustment in the Care and Treatment of 332 Children with Otitis Media." Journal of Clinical Chiropractic Pediatrics, Vol. 2 (1997): 167-183.

Froehle, R.M. "Ear Infection: A Retrospective Study Examining Improvement from Chiropractic Care and Analyzing for Influencing Factors." Journal of Manipulative and Physiology Therapeutics, Vol. 19, No. 3 (March-April 1996): 169-177.

Phillips, N.J. "Vertebral Subluxation and Otitis Media: A Case Study, Chiropractic." Journal Chiropractic Research and Clinical Investigation, Vol. 8 (1992): 38-39.

Pelvic disorders and dysmenorrhea (Painful Menstruation)

In a study published in The Journal of Manipulative and Physiological Therapeutics, it was found that a variety of gynecological, sexual and bowel disorders may be successfully managed under chiropractic care. The most detailed report cited the case of a 41-year-old woman who had experienced several years of low back and pelvic disorders, including difficulty in urination. After chiropractic examination, it was determined that the woman had a disk herniation in the low back.  Adjustment by a chiropractor brought relief from the pain and an end to her urinary problems. Likewise, a study done by the National College of Chiropractic found that chiropractic care has provided relief in patients suffering from dysmenorrhea (painful menstruation). Further research on this subject is underway.

References:

Browning, J.E. "Chiropractic Distractive Decompression in the Treatment of Pelvic Pain and Organic Dysfunction in Patients with Evidence of Lower Sacral Nerve Root Compression." The Journal of Manipulative and Physiological Therapeutics, Vol. 11 (1998): 436-442.

Kokjohn, K., et al. "The Effect of Spinal Manipulation on Pain and Prostaglandin Levels in Primary Dysmenorrhea." The Journal of Manipulative and Physiological Therapeutics, Vol. 15 (1992): 279-285.

Cost-effectiveness

A 1997 study conducted by Miron Stano at Michigan's Oakland University compared the costs of health care for patients of medicine and patients of chiropractic. By reviewing the insurance claims paid by patients, Stano found that those receiving chiropractic treatment, either by itself or with medical care, had health- care costs averaging $1,000 less than those receiving medical care alone. Furthermore, patients receiving only chiropractic care paid 30% less in total insurance costs than those under the care of a medical doctor. Similarly, numerous studies show that patients with low back pain who are treated by a chiropractor often avoid thousands of dollars in medical expenses, such as surgery and medication.

References:

Journals

Smith, M. and M. Stano. "Costs and Recurrences of Chiropractic and Medical Episodes of Low-Back Care." The Journal of Manipulative and Physiological Therapeutics, Vol. 20, No. 1 (1997): 5-12.

Books

Chapman-Smith, D. The Chiropractic Profession. West Des Moines: NCMIC Group Inc., 2000.

Patient Satisfaction

A 1989 survey conducted by Dr. Daniel Cherkin and Dr. Frederick MacCornack found that patients receiving care from health maintenance organizations (HMOs) in the state of Washington were three times as likely to report satisfaction with chiropractic care than they were from other health-care providers. Early in the 1990s, a similar study conducted by the Gallup Organization found that 90% of chiropractic patients felt their care was effective. Over 80% were satisfied with their care, and close to 75% felt that their expectations had been met.

References:

Cherkin, D.C. and F.A. MacCornack. "Patient Evaluations of Low Back Pain from Family Physicians and Chiropractors." Western Journal of Medicine, Vol. 151, No. 1 (July 1989): 83-84.

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