NCCAM Publishes Chiropractic Consumer Fact Sheet

The National Center for Complementary and Alternative Medicine (NCCAM) has published a new report for consumers: About Chiropractic and Its Use in Treating Low-Back Pain. Containing more than 30 references and appendices, along with links to other NCCAM documents, the report provides an extensive view of the chiropractic profession, including its history; use by the American public; and current research projects being conducted.

The report is divided into 11 sections, along with a "Key Points" segment that provides a brief overview. Each section asks a specific question related to the practice of chiropractic; answers are supported with references from government reports and scientific studies. Among the topics covered:

• who uses chiropractic, and what types of health problems are treated;
• chiropractic training;
• side-effects reported when using chiropractic care to treat low-back pain;
• health insurance and payments for chiropractic treatment; and
• possible controversies associated with chiropractic.

Of particular interest are the sections related to scientific research into the use of chiropractic for low back pain and general research on chiropractic. The first section features the results of 11 trials on chiropractic treatment for back pain. (Detailed findings from these trials can be found in the two appendices at the end of the report.)

Doctors of chiropractic may be disappointed to learn that the authors of the report consider the evidence for the effectiveness of chiropractic care in treating back pain "weak and less than convincing," and that the studies "have been of uneven quality and insufficient to allow firm conclusions."

However, they are quick to add that while "many clinical trials of chiropractic analyze the effects of chiropractic manipulation alone, chiropractic practice includes more than manipulation. Results of a trial performed in one setting ... may not completely apply in other settings."

The report's authors also note that the NCCAM has funded a great deal of research on chiropractic. Among the projects recently supported by NCCAM are studies that compared treatments for acute back pain; measured the effects of chiropractic positioning and adjustments on the lumbar spine; evaluated how the speed of a spinal adjustment affects muscles and nerves; and assessed the effectiveness of chiropractic adjustments for a variety of conditions, including neck pain, chronic pain and temporomandibular disorders.

The report includes links to several resources, including the NCCAM Clearinghouse (which provides general information on complementary and alternative medicine); the Agency for Healthcare Research and Quality (which published a report on chiropractic training, practice and research in 1998, and a guideline on the treatment of acute low back problems in 1994); and ClinicalTrials.gov (a government database of information on clinical trials being conducted primarily in North America).

Overall, About Chiropractic and Its Use in Treating Low-Back Pain is a fairly concise, easy-to-read publication that may be of use to DCs interested in providing general information on chiropractic to their patients. However, several statements made by the document's authors seem to lack the appropriate context, which may prove confusing to the public, and potentially damaging to the profession:

• The authors' statement, "Research studies of chiropractic treatment for low-back pain have been of uneven quality and insufficient to allow firm conclusions," fails to note that this is true with regard to a large number of research trials.
• With regard to the risks associated with spinal manipulation, they note: "The risk of experiencing complications from chiropractic adjustment of the low back appears to be very low. However, the risk appears to be higher for adjustment of the neck," but fail to mention that in either instance, the risks are significantly lower than those associated with numerous common medical treatments.
• The authors also state: "The rate of serious complications from chiropractic has been debated. There have been no organized prospective studies on the number of serious complications." However, they do not include any disclaimer that such studies, while desirable, are often extremely difficult to launch successfully.
• Chiropractic education is described, in part, as a "4-year academic program consisting of both classroom and clinical instruction"; what is not included is any reference to the fact that in most chiropractic colleges, completion of a pre-med training program is prerequisite.

About Chiropractic and Its Use in Treating Low-Back Pain is a public domain document (meaning anyone can print and distribute copies), available online at www.nccam.nih.gov/health/chiropractic/index.htm.