Background Concepts
Allopathic providers (medical doctors) are primarily chemical providers of care (pharmacology/drugs). Government gives drug companies patents for their products, allowing for hundreds of billions of dollars in profits. Government does not grant patents on natural products, even if they work great, which is one of the reasons we hear much less about these natural products.
Chiropractors are primarily mechanical providers of care (adjustments, exercise, tissue work, etc. The chiropractic approach was awarded the Nobel Prize in 2021 (1, 2).
Chiropractic education emphasizes mechanical care. Chiropractors are not trained in pharmacology and drugs are outside of their scope of license. Yet, the majority of chiropractic patients are taking medication or drugs for their symptoms prior to initiating chiropractic care.
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In 1990, a study was published in the British Medical Journal, titled (3):
Low Back Pain of Mechanical Origin:
Randomized Comparison of Chiropractic and Hospital Outpatient Treatment
This randomized trial involved 741 patients. The patients were followed for a period between 1–3 years. The authors concluded:
“Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain.”
“There is, therefore, economic support for use of chiropractic in low back pain, though the obvious clinical improvement in pain and disability attributable to chiropractic treatment is in itself an adequate reason for considering the use of chiropractic.”
“Chiropractic was particularly effective in those with fairly intractable pain-that is, those with a history of severe pain.”
“Patients treated by chiropractors were not only no worse off than those treated in hospital but almost certainly fared considerably better and that they maintained their improvement for at least two years.”
“The results leave little doubt that chiropractic is more effective than conventional hospital outpatient treatment.”
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The following month (July 1990), the journal Lancet published an editorial pertaining to the study (3), stating the following (4):
“Chiropractors and Low Back Pain”
“[The study (3)] showed a strong and clear advantage for patients with chiropractic.”
The advantage for chiropractic over conventional hospital treatment was “not a trivial amount” and “reflects the difference between having mild pain, the ability to lift heavy weights without extra pain, and the ability to sit for more than one hour, compared with moderate pain, the ability to lift heavy weights only if they are conveniently positioned, and being unable to sit for more than 30 minutes.”
“This highly significant difference occurred not only at 6 weeks, but also for 1, 2, and even (in 113 patients followed so far) 3 years after treatment.”
“Surprisingly, the difference was seen most strongly in patients with chronic symptoms.”
“Chiropractic treatment should be taken seriously by conventional medicine, which means both doctors and physiotherapists.”
The authors of the British Medical Journal study (3) note that if all back-pain patients without manipulation contraindications were referred for chiropractic instead of hospital treatment, there would be significant annual treatment cost reductions, a significant reduction in sickness days, and a significant savings in social security payments.
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The authors from the above study (3) presented a longer-term follow-up on their patient population. It was published in the British Medical Journal in 1995, and titled (5):
Randomised Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain:
Results from Extended Follow Up
In this 3-year follow-up study, the authors found:
“[The] Oswestry scores improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals.”
“The beneficial effect of chiropractic on pain was particularly clear.”
“[More subjects] rated chiropractic helpful at three years than hospital management.”
“[Improvements] were all significantly greater in those treated by chiropractic, including the changes early on-that is, at six weeks and six months.”
“The results of our trial show that chiropractic has a valuable part to play in the management of low back pain.”
This 1995 study confirms that the longer and more serious the low back pain, the more likely the patient was to benefit from chiropractic care.
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In 2002, a study was published in the Annals of Internal Medicine, titled (6):
Manual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain:
A Randomized Controlled Trial
The authors compared the effectiveness of manual therapy, physical therapy, and pharmacology provided by a general practitioner physician for the treatment of neck pain, assessing 183 patients. They concluded:
“Manual therapy scored consistently better than the other two interventions on most outcome measures.”
“In daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued [drug] care by a general practitioner.”
“Range of motion improved more markedly for those who received manual therapy or physical therapy than for those who received continued [physician drug] care.”
“Manual therapy seems to be a favorable treatment option for patients with neck pain.”
“Primary care physicians should consider manual therapy when treating patients with neck pain.”
In this study, the primary authors are physical therapists, and they found that manual manipulative therapy was superior to traditional physical therapy in the management of neck pain.
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In 2003, a study was published in the journal Spine, titled (7):
Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation
The authors randomized 115 patients suffering from chronic neck/back pain to three groups:
- Daily prescription Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
- Needle Acupuncture by a certified needle acupuncturist.
- Spinal manipulation by a licensed chiropractor. The manipulations were high-velocity, low-amplitude thrust spinal manipulation to a joint with reduced mobility.
The subjects were assessed initially and then again at 2, 5, and 9 weeks after the beginning of treatment. The authors note:
“Gastrointestinal toxicity induced by NSAIDs is one of the most common serious adverse drug events in the industrialized world.”
“The consistency of the results provides evidence that in patients with chronic spinal pain, [chiropractic spinal] manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication.”
“The highest proportion of asymptomatic patients before or at the week 9 assessment was found in the [chiropractic spinal] manipulation group (27.3%) followed by the acupuncture group (9.4%) and the medication group (5%).”
“Manipulation yielded the best results over all the main outcome measures.”
“The results of this efficacy study suggest that [chiropractic] spinal manipulation, if not contraindicated, may be superior to needle acupuncture or medication for the successful treatment of patients with chronic spinal pain syndrome.”
“In summary, the significance of the study is that for chronic spinal pain syndromes, it appears that [chiropractic] spinal manipulation provided the best overall short-term results, despite the fact that the spinal manipulation group had experienced the longest pretreatment duration of pain.”
The chiropractic spinal manipulation group showed significantly greater improvement in subjective complaints, functional abilities, objective range of spinal motion, and in general health status, than acupuncture and medication groups. The chiropractic patients recorded no adverse events to treatment.
The long-term outcomes from this study were published in 2005 in the Journal of Manipulative and Physiological Therapeutics, titled (8):
Long-Term Follow-up of a Randomized Clinical Trial Assessing the Efficacy of Medication, Acupuncture, and Spinal Manipulation for Chronic Mechanical Spinal Pain Syndromes
The authors note:
“The overall results of this extended follow-up efficacy study appear to favor the application of manipulation.”
“Spinal manipulation appeared to provide the highest satisfaction.”
“In patients with chronic spinal pain syndromes, [chiropractic] spinal manipulation, may be the only treatment modality of the assessed regimens that provides broad and significant long- term benefit.”
“Patients who have chronic mechanical spinal pain syndromes and received spinal manipulation gained significant broad-based beneficial short-term and long-term outcomes.”
The authors were particularly negative on the results offered by medications for the management of chronic spinal pain, noting that “medication did not achieve an improvement in chronic spinal pain.”
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The first randomized controlled trial to evaluate opioids for chronic pain was published in 2018; it was published in the Journal of the American Medical Association, titled (9):
Effect of Opioid vs Non-opioid Medications on Pain-Related Function in Patients with Chronic Back Pain or Hip or Knee Osteoarthritis Pain
This study involved 234 subjects. The authors state:
“Rising rates of opioid overdose deaths have raised questions about prescribing opioids for chronic pain management.”
“Because of the risk for serious harm without sufficient evidence for benefits, current guidelines discourage opioid prescribing for chronic pain.”
“Studies have found that treatment with long-term opioid therapy is associated with poor pain outcomes, greater functional impairment, and lower return to work rates.”
“Treatment with opioids was not superior to treatment with non-opioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”
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In 2018, a study was published in The Journal of Alternative and Complementary Medicine, titled (10):
Association Between Utilization of Chiropractic Services for Treatment of Low-Back Pain and Use of Prescription Opioids
The authors analyzed the health insurance claims of 6,868 low back pain subjects, noting:
“There is little evidence that opioids improve chronic pain, function, or quality of life.”
“The adjusted likelihood of filling a prescription for an opioid analgesic was 55% lower for recipients of services provided by doctors of chiropractic compared with non-recipients.”
“Pain management services provided by doctors of chiropractic may allow patients to use lower or less frequent doses of opioids, leading to lower costs and reduced risk of adverse effects.”
“Pain relief resulting from services delivered by doctors of chiropractic may allow patients to use lower or less frequent doses of opioids, leading to reduced risk of adverse effects.”
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In 2018, the journal Pain Medicine published a study titled (11):
Opioid Use Among Veterans of Recent Wars Receiving Veterans Affairs [VA] Chiropractic Care
The authors note:
“Apart from the potential to reduce pain and improve function in patients with musculoskeletal conditions, chiropractic care may have an impact on opioid use in such patients.”
“Chiropractic care is more likely to be a replacement for, rather than an addition to, opioid therapy for chronic musculoskeletal pain conditions in the VA.”
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In 2019, a study was published in the journal BMJ Open titled (12):
Observational Retrospective Study of the Initial Healthcare Provider for New-onset Low Back Pain with Early and Long-term Opioid Use
The authors examined the association of initial conservative therapy provider treatment (chiropractors, acupuncturists, physical therapists) on opioid use in a national sample (216,504) of individuals with a new-onset low back pain. The most frequent initial conservative provider seen was a chiropractor. The authors note:
“For early opioid use, patients initially visiting chiropractors had 90% decreased odds [of early opioid use].”
“Initial visits to chiropractors or physical therapists are associated with substantially decreased early and long-term use of opioids.”
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In 2020, a study was published in the journal Pain Medicine titled (13):
Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain
The authors are from Yale School of Medicine. This meta-analysis used 62,624 patients from 6 chiropractic studies. The authors note:
“Chiropractors predominantly manage spinal conditions, with back conditions being the most common reason to seek chiropractic care.”
“The main finding of the review was that all included studies demonstrated a negative association between use of chiropractic care and opioid prescription receipt.”
“Chiropractic users had 64% lower odds of receiving an opioid prescription than nonusers.”
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In 2020, a study was published in the journal Pain Medicine titled (14):
Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain
The objective of this study was to evaluate the impact of chiropractic utilization upon use of prescription opioids among 101,221 patients with spinal pain. The authors note:
“Among patients with spinal pain disorders, for recipients of chiropractic care, the risk of filling a prescription for an opioid analgesic over a six-year period was reduced by half, as compared with non-recipients.”
“[There is] accumulating evidence for increased utilization of chiropractic services as an upstream strategy for reducing dependence upon prescription opioid medications.”
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In 2022, a study was published in the Journal of Chiropractic Medicine, titled (15):
Associations Between Early Chiropractic Care and Physical Therapy on Subsequent Opioid Use Among Persons with Low Back Pain
This study assessed 40,929 patients with low back pain, noting:
“The use of chiropractic care within 30 days of LBP diagnosis was associated with diminished use of opioids in the short term and, in particular, the long term, in which the risk of long-term opioid use was almost cut in half.”
“Chiropractic care was associated with substantial reduction in likelihood of any opioid use and long-term opioid use [by 44%].”
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In 2022, a study was published in the journal Chiropractic & Manual Therapies, titled (16):
Association Between Chiropractic Care and Use of Prescription Opioids Among Older Medicare Beneficiaries with Spinal Pain
This retrospective observational study examined 55,949 Medicare beneficiaries diagnosed with spinal pain. The authors noted:
“The adjusted risk of filling an opioid prescription within 365 days of first office visit was 56% lower among [chiropractic] recipients as compared to nonrecipients.”
Among early recipients of chiropractic care, the reduction of filling an opioid prescription was 62% lower as compared to non-recipients.
“Among older Medicare beneficiaries with spinal pain, use of chiropractic care is associated with significantly lower risk of filling an opioid prescription.”
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In 2022, a study was published in the journal BMJ Open, titled (17):
Association Between Chiropractic Spinal Manipulative Therapy and Benzodiazepine Prescription in Patients with Radicular Low Back Pain
Benzodiazepines (BZDs) are a class of medication that are increasingly prescribed for patients with low back pain (LBP) and radicular low back pain (rLBP). This study assessed 9,206 patients in each cohort. Outcomes were measured at 3, 6, and 12 months, and the authors note:
“Although BZDs are increasingly prescribed for LBP, there is no strong evidence supporting their use for this condition.”
“Systematic reviews have found evidence supporting [SMT] treatment for acute, chronic and radicular LBP, while documenting its safety.”
“This study identified a significant reduction in odds of BZD prescription over 3-month, 6-month and 12-month follow-up windows in adults initiating care for rLBP with CSMT.”
“These findings suggest that receiving CSMT for newly diagnosed rLBP is associated with reduced odds of receiving a benzodiazepine prescription during follow-up.”
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In 2023, a study was published in the journal BMJ Open, titled (18):
Association Between Chiropractic Spinal Manipulation and Gabapentin Prescription in Adults with Radicular Low Back Pain
This study examined the association between chiropractic spinal manipulative therapy (CSMT) and the likelihood of gabapentin prescription among patients with radicular low back pain (rLBP). Both cohorts assessed 1,635 patients. The authors note:
The odds of gabapentin prescription over the 1-year follow-up were significantly lower in the CSMT cohort compared with the cohort receiving usual medical care, by 47%.
“These real-world findings support our hypothesis that adults initially receiving CSMT for rLBP have reduced odds of receiving a gabapentin prescription over a 1-year follow-up period.”
“Our findings are consistent with some authors’ recommendations that patients with LBP/rLBP should initiate treatment with non-pharmacological providers such as chiropractors.”
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In 2024, a study was published in the journal Health Science Reports, titled (19):
Association Between Spinal Manipulation, Butalbital Prescription, and Medication Overuse Headache in Adults with Tension‐Type Headache:
Retrospective Cohort Study
Butalbital is a barbiturate that is commonly used to treat tension headaches. It works by depressing the central nervous system. This study is a retrospective cohort of 3,116 subjects (in each cohort) spanning 11 years. The authors note:
“Butalbital is an acute headache medication commonly prescribed for tension‐type headache (TTH), although discouraged by guidelines due to a risk of medication overuse headache (MOH).”
“Patients may develop MOH, described as a worsening of the primary headache after overuse or discontinuation of acute headache medication, and occurring at least 15 days per month.”
“Adults receiving initial SMT for TTH have a significantly reduced likelihood of butalbital prescription compared to matched controls not receiving SMT through 2 years’ follow‐up, as well as a reduced likelihood of MOH.”
“These findings suggest there is potential usefulness of SMT in managing TTH extending beyond improvement in headache frequency or intensity, and reinforce guidelines recommending SMT for TTH patients.”
SUMMARY AND CONCLUSIONS
This review looked at a range of clinical syndromes, including low back pain, low back radicular pain, neck pain, tension headaches, and medication overuse headaches. It also looked at a range pf pharmacological products that are commonly prescribed for these clinical syndromes, including non-steroidal anti-inflammatory drugs, opioids, Benzodiazepine, Gabapentin, and Butalbital.
The trend for these publications is that commonly prescribed drugs for musculoskeletal complaints have many concerns. They are not very effective and they are associated with multiple serious side-effects in a linear fashion (the more one takes the greater the risks of suffering side-effects).
In contrast, these publications show that chiropractic care for these musculoskeletal complaints are very effective, have high levels of patient satisfaction, routinely outperform the drugs assessed in randomized clinical trials, and carry none of the risks associated with the drugs.
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- Lisi AJ, Corcoran KL, DeRycke EC, Bastian LA, Becker WC and 11 more; Opioid Use Among Veterans of Recent Wars Receiving Veterans Affairs Chiropractic Care; Pain Medicine; September 1, 2018; Vol. 19; Supplemental; pp. S54–S60.
- Kazis LE, Ameli O, Rothendler J, Garrity B, Cabral H, McDonough C, Carey K, Stein M, Sanghavi D, Elton D, Fritz J, Saper R; Observational Retrospective Study of the Initial Healthcare Provider for New-onset Low Back Pain with Early and Long-term Opioid Use; BMJ Open; September 2019; Vol. 9; No. 9; e028633.
- Corcoran KL, Bastian LA, Gunderson CG, Steffens C, Brackett A, Lisi AJ; Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis; Pain Medicine; February 1, 2020; Vol. 21; No. 2; pp. e139-e145.
- Whedon JM, Toler AWJ, Kazal LA, Bezdjian S, Goehl JM, Greenstein J; Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain; Pain Medicine; December 25, 2020; Vol. 21; No. 12; pp. 3567-3573.
- Acharya M, Chopram D, Smith AM, Fritz JM, Martin BC; Associations Between Early Chiropractic Care and Physical Therapy on Subsequent Opioid Use Among Persons with Low Back Pain in Arkansas; Journal of Chiropractic Medicine; June 2022; Vol. 21; pp. 67-76.
- Whedon JM, Uptmor S, Toler AJW, Bezdjian S, MacKenzie TA, Kazal LA; Association Between Chiropractic Care and Use of Prescription Opioids Among Older Medicare Beneficiaries with Spinal Pain: A Retrospective Observational Study; Chiropractic & Manual Therapies; January 31, 2022; Vol. 30; No. 1.
- Trager RJ, Cupler ZA, DeLano KJ, Perez JA, Dusek JA; Association Between Chiropractic Spinal Manipulative Therapy and Benzodiazepine Prescription in Patients with Radicular Low Back Pain: A Retrospective Cohort Study Using Real-world Data from the USA; BMJ Open; June 13, 2022; Vol. 12; No. 6; Article e058769.
- Trager RJ, Cupler ZA, Srinivasan R, Casselberry RM, Perez JA, Dusek JA; Association Between Chiropractic Spinal Manipulation and Gabapentin Prescription in Adults with Radicular Low Back Pain: Retrospective Cohort Study Using US Data; BMJ Open; July 21, 2023; Vol. 13; No. 7; e073258.
- Robert J. Trager RJ, Timothy J. Williamson TJ, Pratheek S. Makineni PS, Lindsay H. Morris LH; Association Between Spinal Manipulation, Butalbital Prescription, and Medication Overuse Headache in Adults with Tension‐Type Headache: Retrospective Cohort Study; Health Science Reports; November 29, 2024; Vol. 7; No. 12; Article e70218.