Chiropractic

***Disclaimer: This blog is not meant to be used as legal or medical advice. It is written as my person perspective on how medical professionals could blend western medicine with other modalities***

How many of you have ever stretched your back or neck and had those spinal joints crack and pop?  Have you noticed how you feel afterward?  Today on The Integrated Pharmacist Podcast, we're talking about chiropractic therapy.  Literally translated "Done by Hand", this includes the physical manipulation of the body to promote health.  It focuses primarily on the spine as a key element to total-body health.  The main belief is that by realigning the vertebrae, the nerves are better able to function.  When nerves operate optimally, the body can better heal itself.  The communication channels for self healing are open.  When the vertebrae are misaligned, those nerves get pinched and become poor signal transmitters.  These misalignments are called subluxations.  There are two main philosophies of chiropractic practice: "straights" who rely solely on spinal manipulation, and "mixers" who add other modalities to their practice.
Although physical manipulation has existed for much longer, chiropractic as we know it was developed in 1895 by an American philosopher named Daniel David Palmer.  The philosopher studied science and metaphysics and attempted to combine the two when he developed his method of healing.  He theorized that disease came from the subluxations of the spine.  The history of chiropractic therapy is riddled with unregulated practice, confrontations from associations of medical doctors and doctors of osteopathy, and even arrests of chiropractic founders for malpractice and quackery.  By the 1950's the medical culture in western countries had doubled down on the scientific method with the discovery of penicillin and the polio vaccine.  Proponents of chiropractic began earnestly striving to understand and demonstrate the science behind chiropractic therapy, but it wasn't until the 1990's that enough clinical evidence had surfaced demonstrating that chiropractic therapy is useful for spine-related problems.  Today, many insurance plans include chiropractic visits for back pain, but not every chiropractor accepts insurance.  Studies indicate fewer costs and quicker recovery times when adding chiropractic care for back pain.  Regardless of these results, chiropractic therapy has seen less success as a profession than what might be expected.
Evidence for chiropractic therapy continues to progress.  I found the COCOA trial that compared how chiropractic therapy can be incorporated into standard western medicine.  This trial looked at 131 community-dwelling, ambulatory older adults with chronic lower back pain.  The participants were randomly assigned into 1 of 3 arms.  The first arm received standard medical care, the second arm received medical care plus chiropractic care, and the third arm received a collaborative experience of medical and chiropractic care.  The study was designed to look at the benefits of medical doctor coordination with chiropractors.  Although the trial reached their goal of participation and had minimal losses, results did not demonstrate better efficacy for joint therapies over the control.  However, patients in chiropractic arms did report higher levels of satisfaction in care.
There were some challenges with this trial.  Medical therapy was provided by residents while chiropractic care was provided by experienced professionals.  The difference in satisfaction between the control and chiropractic arms may have been based on the level of experience of clinicians rather than the addition of chiropractic therapy itself.  There may also be a bias among the participants to expect chiropractic care for lower back pain.  So naturally, they would be dissatisfied if they didn't receive it.  Another challenge was the study sample.  Apparently, older females tend to experience lower back pain more often, but are less likely to seek treatment or participate in experimental therapy - this study included primarily older white males. 
Regardless of these and other challenges, the reason I chose this trial was the emphasis on collaboration between medical and chiropractic modalities.  The facility used for this study was designed to allow good communication between the two groups.  Even in the arm of the trial that did not have specific collaborative care, the medical resident and chiropractor had easy access to patient information that approached collaboration in its knowledge-sharing capability.  What this trial tells me is that patients can receive high quality care using medical and chiropractic therapies, and collaboration between these modalities can enhance the patient's experience.  If these healthcare providers can learn to accept each other and work together, it's going to have a positive impact on the patient's experience.  The fact that this study was put together tells me that, generally speaking, traditional western medical practitioners still regard chiropractic therapy as fringe and unqualified even though there is demonstrated efficacy within the bounds of spinal health.  As a proponent of complementary medicine, I hope that the relationship between these two modalities continues to improve and that someday more people will have the enhanced satisfaction of having an open relationship between their primary and chiropractic care providers.
I absolutely recommend chiropractic care for back pain and some headaches.  With some insurances, a visit to the chiropractor may be completely covered.  Otherwise, a standard visit can cost between $20 and $200 depending on the kind of service and practice you're looking for.  Remember, a good chiropractor will not need you to come in for regular maintenance.  They should be able to fix the problem and be done within a few visits.  There is a large pool of evidence that speaks to the safety and efficacy of chiropractic care for back pain and headache.  However, I urge patients to research the qualifications of their chiropractor, especially if they fall into the category of mixer.  Be sure that whatever other modality they incorporate is also evidence-based and that they have some kind of certified training in that field.  For example, some mixer chiropractors want to discuss nutritional health, but may not have been trained as a nutritionist.  To learn more about chiropractic health, you can visit the American Chiropractic Association at www.acatoday.org.  The website includes references to a myriad of clinical trials in support of their practice.  You can also learn more from the International Chiropractors Association at www.chiropractic.org. 
I hope you have enjoyed today's episode of The Integrated Pharmacist.  If you did, please remember to subscribe, rate and review, and share this podcast with others who might be interested.  Thank you so much for listening and we'll see you next time on the Integrated Pharmacist Podcast!

Reference:

Goertz CM, Salsbury SA, Long CR, et al. Patient-centered professional practice models for managing low back pain in older adults: a pilot randomized controlled trial. BMC Geriatr. 2017;17(1):235. Published 2017 Oct 13. doi:10.1186/s12877-017-0624-z