The Benefits of Chiropractic Care for Chronic Pain Conditions

By Steven G. Yeomans, DC

The question of whether one should see a chiropractor for a specific pain condition rather than a traditional medical practitioner has long been a struggle for patients. This article attempts to provide insight by offering a brief history of chiropractic care, as well as an overview of evidence-based research for pain conditions that are commonly treated by doctors of chiropractic.

Chiropractic evolved from an event that occurred in 1894, when the hearing of a man was restored after spinal manipulation therapy (SMT)—commonly called “an adjustment”—was administered to the cervical spine by D.D. Palmer. The practice of chiropractic was formally founded in 1895, and the first chiropractic school opened in 1897 in Davenport, Iowa. The Palmer College of Chiropractic remains active and strong to this day.

It didn’t take long for chiropractic to grow; by 1925, there were seven colleges. Today, there are 19 chiropractic colleges or universities in the United States. Chiropractic colleges have proliferated in other countries, including Canada, England, France, Australia, New Zealand, Spain, Japan, Brazil, Chile and Denmark.

Chiropractic has frequently been described as the most popular and commonly utilized form of complementary and alternative medicine.

Chiropractic focuses on the diagnosis and treatment of primarily neuromuscular disorders, with an emphasis on treatment utilizing manual techniques and other types of manipulation and/or mobilization of the spine. Manual techniques for extremity conditions also are emphasized. These manual therapy options vary depending on the type of tissue being treated, such as longitudinal and/or transverse friction massage for conditions (e.g., muscle spasms).

Chiropractic is classified by definition as a form of primary care, as anyone can access chiropractic without a referral. That said, chiropractic has frequently been described as the most popular and commonly utilized form of complementary and alternative medicine.

In two meta-analyses—published in 2010¹ and a follow-up in 2014²—peer-reviewed literature was reviewed to determine the strength of scientific evidence regarding the effectiveness of manual treatment for both musculoskeletal (MSK) and non-musculoskeletal (non-MSK) conditions.

Bronfort et al¹ reviewed 49 recent relevant systematic reviews, 16 evidence-based clinical guidelines and 46 randomized controlled trials not yet included in the former. They identified 26 categories of conditions treated with manual therapy, consisting of 13 MSK conditions, four types of chronic headache and nine non-MSK conditions.

In conclusion, SMT/mobilization was found to be effective in adults for acute, subacute and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; and for several extremity joint conditions. Of note, thoracic manipulation/mobilization was reportedly effective for acute and subacute neck pain, but the evidence was inconclusive for cervical manipulation/mobilization alone for neck pain of any duration.

SMT/mobilization also was inconclusive for middle back pain, sciatica, tension headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome and pneumonia. It also was not found effective for asthma, dysmenorrhea when compared with sham SMT, or for stage 1 hypertension when added to an antihypertensive diet. In children, the evidence was inconclusive regarding effectiveness for otitis media and enuresis, and not effective for infantile colic when compared with sham SMT.

Massage was reportedly effective in adults for chronic low back pain and neck pain but inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache and premenstrual syndrome. In children, the evidence was inconclusive for asthma and infantile colic.

In the 2014 follow-up study,² the researchers reported that an additional literature search between 2011 and 2013 included 25,539 records, of which 178 were new and/or additional studies: 72 were systematic reviews; 96 were randomized controlled trials; and 10 were nonrandomized primary studies.

Clar et al² reported that most previously found “inconclusive” or “moderate” evidence ratings from the 2010 report were confirmed. Evidence that changed in a positive direction (from inconclusive to moderate) was found for three conditions: manipulation/mobilization (with exercise) for rotator cuff disorders, spinal mobilization for cervicogenic headache and mobilization for miscellaneous headache.

This review added a large number of non-MSK conditions not previously considered; in most instances, the evidence was rated as inconclusive. The investigators also highlighted areas requiring further research.

These two meta-analyses are significantly helpful for those considering chiropractic care for specific conditions. With the wide diversity of practice methods and styles, choosing the “right” chiropractor for you should include considering those who embrace the principles of evidence-based, patient-centered care described in this article.

Dr. Yeomans has been in chiropractic practice for over 38 years; he currently serves as the managing editor for Chiro-Trust.org.

References

1. Bronfort G, Haas M, Evans R, et al. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010;18:3. doi: 10.1186/1746-1340-18-3
2. Clar C, Tsertsvadze A, Court R, et al. Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report. Chiropr Man Therap. 2014;22:12. doi: 10.1186/2045-709X-22-12