The Study: Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial.
a. The authors wished to study the effect of chiropractic spinal manipulation on migraineurs.
b. The length of the study was 17 months and involved 104 subjects who suffered with at least one migraine headache a month.
c. It was a randomized controlled trial which was done in Norway.
d. The treatment was chiropractic manipulative therapy and there was a sham treatment included in the study (placebo group) which was a push type of sham treatment at the edge of the scapula and/or in addition to the same type of sham treatment in the gluteal area.
e. There was also a control group which continued with their treatment by the use of medication.
f. The total study consisted of a one month run in period that was followed by a three month period of treatment followed by outcome assessment at the end of the treatment period and at 3, 6 and finally 12 month follow ups.
g. The treatment group received Gonstead spinal manipulative therapy which “was directed to spinal biomechanical dysfunction (full spine approach) as diagnosed by standard chiropractic tests at each individual treatment session.”
h. It should be noted that prior to the start of the manipulative studies a chiropractor performed what was described as a “physical assessment including meticulous spinal column investigation”.
i. They also note that both the placebo group and the chiropractic manipulation group received full spine radiographs.
j. There were 12 treatment sessions.
k. The authors felt that they had succeeded in blinding the patients as to who did receive the manipulations and who was in the placebo group and noted that “all previous manual-therapy RCTs on headaches lack placebo.”
l. The results were that all three groups (manipulation, medication and placebo) had a significant reduction in migraine days from baseline to post-treatment. But at the follow ups the control (medication) group, was the only group which returned to baseline.
m. However, the reduction continued in both the placebo and manipulation groups at all the follow ups.
n. “Adverse events were few, mild and transient.”
o. The authors concluded, “The effect of CSMT observed in our study is probably due to a placebo response.”
The authors felt that they had succeeded in blinding the subjects who received the sham manipulations and this they felt was important. The noted that both the chiropractic spinal manipulation therapy (CMST) and the placebo (the group that received the sham manipulations) group had sustained improvement in their headaches. They concluded that the improvement in the headaches in the manipulation group was a result of a placebo effect.
Now I hope you read this one carefully and I hope that I have been clear when I reviewed the article. Science in Brief has covered many articles that showed improvement by the use of chiropractic manipulations (adjustments). I also feel that it is important to include studies in which chiropractic shows less than stellar results. The authors make the very logical conclusion that since the placebo group and the manipulation group had the same type of improvements that the improvement was likely a result of placebo effect in this study. That does not mean in other studies the results were also from placebo effect but they point out that “that all previous manual-therapy RCTs on headaches lack placebo” which is a very strong point. So what does this mean? This is only one study and as self-serving researchers (like myself) always say, more research is needed. Results, especially unexpected results, always need to be further tested by other studies.
But write this down and pin it on your wall, “If chiropractic bases its usefulness solely on symptom relief, it is on a slippery slope. Structure and the laws of physics are important.” Structure and gravity affect everything from sky scrapers to ants, the cosmos and yes, even the human spine, which is not a magical entity absolved from the effects of the laws of physics. So when your chiropractic friends dismiss the importance of structure and biomechanics, maybe it’s time to add some new friends. May I suggest a few engineers.
Reviewer: Roger Coleman DC
Editor’s Comments: Dr. Coleman is right on here. We simply must base our profession on something more than just symptomatic relief. Detection and correction of biomechanical inefficiencies is central to what chiropractic has always been about. Palmer’s outdated theories of subluxation as a single level lesion (Yep…I said it.) and the woefully incomplete “new paradigm” of the seventies which refocused our profession on vertebral motion instead of misalignment, chiropractic has always been a profession concerned with the relationship between normal structure and normal function. These studies which look at various symptomatic issues are fine as far as they go but as a profession we simply must get the profession as a whole back onto a more substantive track if we hope to survive into the future.
One more comment, although this article doesn’t favor this particular application of chiropractic methods, it’s very interesting that both the placebo and manipulation groups both did better in the long run than the medication group which returned to baseline. Now that’s very interesting.
Editor: Mark R. Payne DC
Reference: Chaibi A, Knackstedt H, Tuchin PJ, Russell MB. Chiropractic spinal manipulative therapy for cervicogenic headache: a single-blinded, placebo, randomized controlled trial. BMC Res Notes. 2017;10:143-53.
Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/28738895