Opinion of chiropractic and acupuncture?

[cbrsmurf]

Lately, it seems like a lot of my patients have been asking about chiropractic and acupuncture (most for back/neck pain). For acupuncture, I'm fine with them taking a shot at it since it would seem that complications would be unlikely. For chiropractors though, I am definitely more hesitant, as I have been biased against them by a few other docs. What's your opinion? What's the evidence?

[physasst]

Lately, it seems like a lot of my patients have been asking about chiropractic and acupuncture (most for back/neck pain). For acupuncture, I'm fine with them taking a shot at it since it would seem that complications would be unlikely. For chiropractors though, I am definitely more hesitant, as I have been biased against them by a few other docs. What's your opinion? What's the evidence?

 

 

I recommend both, along with massage, for my back and neck pain patients. For older patients, I definitely recommend against high velocity adjustments. I also steer my post fusion patients away from Chiro. Otherwise, I'll use it all day long if it helps.

 

I don't prescribe much in the way of pain meds. I practice in a non operative spine center seeing back and neck pain ALL day long. I can think of less than 12 times over the past year that I have written for narcotics. I do use Neurontin, Lyrica, Cymbalta, and the tricyclics occasionally, but not all the time.

 

My primary recommendations revolve around therapy, and some injections.

[LT_Oneal_PAC]

I don't know the evidence, but they have helped me twice for different problems with a single visit. They also helped my wife with her hip pain, though it doesn't last like it did for me. She usually does something that hurts it again and she'll go back for a few visits and be alright again. I suppose it would depend on the problem. I don't believe they can do half of what they say. However they do have a place with certain MSK issues. My sister, a DPT, recently got certified in spinal manipulation. She isn't the type to believe in voodoo, so I trust her that there is some benefit.

[MedicinePower]

Acupuncture is very effective in treating pain and chronic conditions, but it's efficacy is due to the placebo effect.

[myironlung]

i think it's all placebo. I worked with chiros for several years and it almost seemed like there was a certain mold that every patient fit aka gullible/ easy influenced/ you could b.s your way through them and they'd accept. Same thing for acupuncture. Everyone I knew who swore by it were mental cases.

[Guest JMPA]

its not placebo. both chiro and accu more so accu help to relieve muscle spasm as does message and pt. it is the muscle spasm that causes most discomfort in spinal injuries. yes it does not work all the time or on everybody but neither do most treatments. it works best in combination with other therapies

[MedicinePower]

Two studies demonstrating the placebo effect of acupuncture. If you get a chance to read the entire articles (not just the abstracts) it becomes clear the acupuncture is VERY effective, but the mechanism of action is not as purported.

 

Haake, M, HH Müller, BC Schade, HD Basler, et al. German acupuncture trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel

-group trial with 3 groups. Arch Intern Med. 2007; 167 (17):1892-1898.

 

[h=4]"CONCLUSIONS: Low back pain improved after acupuncture treatment for at least 6 months. Effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy."[/h]

Cherkin D, Sherman KJ, Avins AL, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009;169(9):858-866.

[h=4]"CONCLUSIONS: Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture's purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects."[/h]

[taotaox1]

I think it is important to remember that placebos work.

 

Personally, I have found Chiro to be helpful. Stick to the sport medicine guys (they tend to be a mix of PT and adjustments) and you will be good to go. If they are claiming to fix anything besides MSK issues.... well....

[EMEDPA]

I wrote a 30 page paper 2 terms ago on the scientific evidence for acupuncture. After a 12 week review I found that the research literature supports it for certain indications like post chemo therapy nausea, PMS, htn, and certain types of h/as .

acupuncture is felt to work through one of 3 mechanisms known as the gate, neuroendocrine, and local mediation theories.

for patients who have a condition shown to be amenable to acupuncture, I think it is a great tool used as part of a multidisciplinary approach.

[Will352ns]

I have a friend of mine (Physician) that does acupuncture. He had a pretty good take on it. He says it works off of the principle of FM....F%(8ing Magic. He didn't know nor did he care how it worked. Folks said they felt better....good enough.

 

This said, he gave me a series of treatments for shoulder pain....didn't do anything for me.

[physasst]

i think it's all placebo. I worked with chiros for several years and it almost seemed like there was a certain mold that every patient fit aka gullible/ easy influenced/ you could b.s your way through them and they'd accept. Same thing for acupuncture. Everyone I knew who swore by it were mental cases.

 

Doesn't matter how it works. I have a number of patients who do very well on it. I tell them that. I tell them that I have no scientific basis for how it works, but it helps some people. I advise that they try it and see if it will help them.

 

I think cognitive behavioral therapy probably works the best with chronic back pain...but not everyone has that access....

 

Sometimes we throw all of this at people and it doesn't work. In that case, there is no treatment.

 

I had 3 patients last week with this situation. I told all of them, I have nothing to offer them. There were no further options to explore. They weren't surgical candidates, and they had exhausted conservative care.

 

They asked what they could do. Try and live with it and good luck was my reply.

[bobuddy]

I am in the believer camp. I even have had a chiropractor adjust my horses that are "off" or showing pain in some way that we are not able to put a finger on the cause. To have a horse go from 2 months of "not quite right" to perfectly sound with one adjustment was all the proof I need. Besides, horses cant lie - and there is no placebo effect with them.

 

My sister's horse suffered a broken pelvis and a sweeney shoulder paralysis from a traumatic injury in the pasture. The sweeney shoulder was treated with acupuncture with about 3 visits- dramatic difference for her healing time. And, again, horses cant lie. They are either better or they aren't.

[True Anomaly]

One thing I've never been able to wrap my head around is having chiropractic manipulation done on an INFANT. I wouldn't have believed it for myself had I not see my friend's pictures of his infant child being manipulated by his brother-in-law chiro.

[MedicinePower]

One thing I've never been able to wrap my head around is having chiropractic manipulation done on an INFANT. I wouldn't have believed it for myself had I not see my friend's pictures of his infant child being manipulated by his brother-in-law chiro.

 

http://www.realclearscience.com/blog/2012/05/take.html

[sk732]

Never been to a chiropractor, however, have had accupuncture for a few injuries in the past from my PT's and found it helpful. When people ask me about chiro, I always tell them to stick with someone that gives them exercises to help themselves out for their problem as well as manipulation...if they have them come back repeatedly or get their backs up at giving self help things, I tell them to look for someone else.

 

My physio told me that accupuncture is a hit or miss thing regarding getting a take or not - some people respond well compared to others and they can usually tell by the local reaction of where the needles go in how well the person will respond. I went in pretty skeptical of it actually - and was sold. Take that for what it's worth.

 

SK

[UpRegulated]

my friend's pictures of his infant child being manipulated by his brother-in-law chiro.

 

All chiropractors are manipulators. ;)

[Proballr32]

Having recently just left a position at a MSK multi-disciplinary clinic which included a chiropractor, I know first hand how shady chiropractic medicine is. I had previously worked in Orthopedic surgery and had always been taught to view chiropractors as "physical therapists for the spine." After working in the same building as a chiropractor for the past year, we shared most of the same patients. I had my reservations about chiropractors prior to starting the position and had figured that most of them were quacks. My reservations were quickly confirmed. Chiropractors will NEVER review a spine X-ray and call it normal, or WNL.....EVERYBODY is out of alignment, lol. It amazed me. I would review a lumbar spine film and educate the patient that they have some degenerative disc disease, but nothing serious was going on, only to hear the chiropractor review the SAME xrays with the patient later and tell them how bad their back was screwed up. Only thing I could do was laugh, and of course feel bad for the patient who just heard conflicting information but they think the chiropractor must be correct because he's the "doctor." We even had some where the radiologist was actually bold enough to call a film "normal"(which almost never happens) and the chiropractor still went on his spiel about how alignment was off, etc. Drove me nuts! Also, he would come behind me and tell every patient who I prescribed NSAIDs for a lumbar or cervical sprain/strain that all medicines were bad and just covered up the problem, and he was actually going to fix it. Oh and by the way it would have to be 3-4 visits/week and then maybe you could be transitioned to a couple times a month....but you HAD to keep coming back. The issue I have with them is that there never is curing anyone...it's all about required maintenance every month and scare tactics to keep the patients coming back.

[physasst]

Having recently just left a position at a MSK multi-disciplinary clinic which included a chiropractor, I know first hand how shady chiropractic medicine is. I had previously worked in Orthopedic surgery and had always been taught to view chiropractors as "physical therapists for the spine." After working in the same building as a chiropractor for the past year, we shared most of the same patients. I had my reservations about chiropractors prior to starting the position and had figured that most of them were quacks. My reservations were quickly confirmed. Chiropractors will NEVER review a spine X-ray and call it normal, or WNL.....EVERYBODY is out of alignment, lol. It amazed me. I would review a lumbar spine film and educate the patient that they have some degenerative disc disease, but nothing serious was going on, only to hear the chiropractor review the SAME xrays with the patient later and tell them how bad their back was screwed up. Only thing I could do was laugh, and of course feel bad for the patient who just heard conflicting information but they think the chiropractor must be correct because he's the "doctor." We even had some where the radiologist was actually bold enough to call a film "normal"(which almost never happens) and the chiropractor still went on his spiel about how alignment was off, etc. Drove me nuts! Also, he would come behind me and tell every patient who I prescribed NSAIDs for a lumbar or cervical sprain/strain that all medicines were bad and just covered up the problem, and he was actually going to fix it. Oh and by the way it would have to be 3-4 visits/week and then maybe you could be transitioned to a couple times a month....but you HAD to keep coming back. The issue I have with them is that there never is curing anyone...it's all about required maintenance every month and scare tactics to keep the patients coming back.

 

Well, as non operative spine specialist, I can affirm that there are very, very few 'cures' for back pain. I tell my patients that we can't fix them. We can hopefully improve their pain, but it will never go away completely. Most patients, including disc herniations with radiculopathies, don't need surgeries, and my job is to only send the ones that REALLY need surgery to the surgeons.

 

Out of every 50 patients I see, I maybe send 1 to the spine surgeons.

[Nakasoner]

Proballr32. Sounds like a bad experience. How many chiro's have you worked with? I hope you are not painting an entire profession based on one chiro. It is true that there are many chiro's similar to the one you worked with. I can tell you I have seen many back surgeries gone wrong too, and some of them have been needless. I have been a PA in Spine Ortho, Pain Mgmt, and Gen Ortho and have privileges as 3 hospitals as a Ortho Surg PA.. I am about to start a new PA job as a neurosurg PA for the chief of neurosurg. I am also a chiropractor. My experience as a chiro has helped me tremendously in getting each of these jobs, but I did not fit your description of the chiro profession. It is true the stereotype does exist, but if you take time to ask around and dig deeper, you might be surprised to find a few good chiros here and there that do a fine job. There are certainly some idiot PA's out there too, and I would bet many patients refuse to see PA's because they are "not real doctors."

[rev ronin]

If I were going for spine manipulation, I would go to a DO who does OMM, not a chiropractor.

[Boatswain2PA]

I have very strong opinions on chiropractors (which means that, of course, I'm right! lol )

 

There are good and bad chiropractors.

 

The BAD ones are usually easy to spot. In the waiting room they have a wall full of "supplements" that cost 4-10 times what the same nutrients cost at Wal-Mart. When you go back to see the "doctor" (I refuse to call them that) then the first thing they do is take multiple x-rays of your spine. Then the "quactor" comes in and shows you your x-rays, and shows you how out of alignment your back is, and says it will take 2-3 visits a week for six months to get things back in alignment. Oh, and you also need to buy his special "naturally formulated" Vitamin D, Vitamin C, Costo-Chondroitin, etc, etc, etc, etc, etc, etc, etc, etc.

 

I have been to one shuckster like this years ago outside of Boston, and I have seen more than a few patients come in with their grocery sack full of "medicine" that they buy from a local shuckster. (Of course, these same folks probably don't pay for their ER visits, but can afford the couple hundred a month for chiro and "fruit-juice pills".)

 

Worse yet, I live in a state where chiropractors can do school physicals and DOT physicals (Yes, quacks with no real medical training are signing off on BP/Diabetes/etc on truckers pulling 80,000 pounds of freight down the highway).

 

The GOOD Chiropractors take me back into the room, lay me on their table, ask a few questions, start feeling around on me, maybe put some heat/tens/US on me for a few minutes, and then CRRAAACCCKKKK....I have gained an inch again and feel like a million bucks. I'm not exactly sure how they do what they do, but it works

 

I agree with Rev Ronin -- I would rather go to an OMM trained DO than a Chiropractor, and I have been fortunate enough to find one in my area that takes Tricare. I hope the DO's push these quacks out of business.

[True Anomaly]

If I were going for spine manipulation, I would go to a DO who does OMM, not a chiropractor.

 

Agreed....

[Nakasoner]

Tough to find osteopaths that manipulate anymore. The older I've met do manipulations as they were trained to manipulate and have some experience. The younger ones do surgery and Rx meds as that is where the money is to pay their student loans. I've never seen one do a manipulation. I see younger Osteopaths (less than 35 years old) in my rotations and they ask me tips on their manipulation as they didn't do much in Osteopathic College. I see the osteopaths in the OR though.

[browndog]

Patients should be warned about the possibility of stroke secondary to cervical spine manipulations. This is a documented risk.

[discogenic]

Patients should be warned about the possibility of stroke secondary to cervical spine manipulations. This is a documented risk.

 

The relationship between cervical manipulation and stroke isn't as clear as you'd think. The largest study to date, published in Spine a couple years ago, failed to show causal relationship. It's also been shown that there is no difference in risk between stroke sufferers having visited their PCP vs a chiro in the 24 hours prior to the event; prior to that study, the only metric that had been examined was the visit to the chiro and assumptions were always then made toward causality. The current thought is shifting toward the following: a patient suffers an early dissection, which produces pain and/or headache, which prompts the visit to the chiro, who treats the patient, who subsequently suffers a stroke. The manipulation could conceivably exacerbate/worsen the already-lesioned vessel, but evidence of causality is murky.