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Insights into the role of chiropractic care in relieving pain indicate that it may be a safer alternative for many sufferers than commonly used medications, according to the New Zealand Chiropractors’ Association.

Back pain is amongst one of the most common symptoms prompting patients to seek chiropractic care. Treatments for acute back pain include analgesics, muscle relaxants, exercises, physical therapy, heat, spinal manipulative therapy (SMT) and others. But recent studies suggest an association between even small doses of over the counter analgesics and heart attacks^[1] and there is widespread concern about deaths from the use of opioids^[2].

Now a major review has indicated that chiropractic care may be as effective as these commonly used medications to relieve pain, with less risk of side effects, and the added benefit of improving function, not only symptom relief.

Dr Cassandra Fairest, chiropractor and spokesperson for the New Zealand Chiropractors’ Association explains: `In a study just published, American researchers conducted a review and meta-analysis of previous studies to assess the effectiveness and any potential harm associated with manual spinal adjustments, compared with other non-manipulative therapies for adults with acute (six weeks or less) low back pain^[3]. The authors write that the size of the benefit of SMT for acute low back pain is similar to the relief obtained from the use of nonsteroidal anti-inflammatory drugs, according to the Cochrane review on this topic. But chiropractic care has none of the risks associated with medications.’

Of 26 eligible randomized clinical trials (RCTs) identified, 15 RCTs (1,711 patients) provided moderate-quality evidence that SMT has a statistically significant association with improvements in pain. Twelve RCTs (1,381 patients) produced moderate-quality evidence that SMT has a statistically significant association with improvements in function. No RCT reported any serious adverse event.

Dr Fairest says: `Chiropractic adjustments are known to result in clinical improvements in spinal function and reduction of both acute and chronic low back and neck pain. However, the mechanisms responsible for the restoration of function and relief of pain after manipulative care are not widely understood. We have yet to fully understand the neurophysiological mechanisms responsible for such clinical improvements after spinal manipulation of any kind, although ongoing work by Dr Heidi Haavik and colleagues at the Centre for Chiropractic Research at the New Zealand College of Chiropractic^[4] has demonstrated that chiropractic care can induce changes in various aspects of central nervous system (CNS) functioning, including alterations in reflex excitability, sensory processing and motor control.’

^[1] Bally M, Dendukuri N, Rich B, et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ. 2017;357:j1909

^[2] www.bmj.com

^[3] jamanetwork.com

^[4] www.jmptonline.org

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