Research & Studies

There is mounting evidence of the effectiveness of manipulation in the treatment of patients with CHRONIC HEADACHES. Recent research has looked at the role that chiropractic treatment can play in management of patients with chronic headaches:

In the first study reviewed here, 218 patients diagnosed with chronic migraine were randomized to receive either cervical manipulation, amitriptyline (a tricyclic antidepressant that is commonly used for migraine prophylaxis) or a combination of both manipulation and amitriptyline. The results showed that there were clinically important improvements in all three groups over time. During the treatment phase, there were no statistically significant differences in the three groups, but a difference was seen in the follow up period. They found that there was a statistically significant difference favoring the cervical manipulation group compared to the others. The side effects were much greater in the amitriptyline group, with 58% reporting side effects and 10% having to drop out because of them. There were minimal and mild side effects of manipulation, and no one had to drop out because of them.

The second study is a prospective, uncontrolled clinical trial of twelve months duration. The trial consisted of 3 stages: a two month pre-treatment observation stage, a two month treatment stage, and a two month post-treatment follow up stage. The initial 32 participants showed statistically significant improvement in migraine frequency, intensity, disability and medication use, when compared to initial baseline levels. At six month follow-up, there was continued statistically significant improvement.

The third study was a randomized, controlled trial (RCT) performed by the same group as the second. Here, 83 subjects were randomized to receive either manipulation over 2 months, with a maximum of 16 treatments, or detuned interferential over the same time period. They found that the average response in the treatment group showed statistically significant improvement in frequency, duration and medication use as compared to the control group. They express the results in other terms by saying that 22% of the treatment group reported greater than 90% reduction of their migraine and a further 49% reported significant improvement in the morbidity of each episode. Only 4.1% of participants reported that their migraine episodes were worse after the 2 months of treatment, but this was not sustained at the 2 month follow up.

A study conducted in Sweden has determined that 1 in 4 chiropractic patients experiences some form of “positive nonmusculoskeletal side effect” after spinal manipulative therapy. In addition, the percentage of patients who experience positive side effects increases with the number of spinal regions adjusted. This study was done with 1,504 valid patient questionaires. At least one positive side effect was reported by 23% of the respondents. Most felt benefits such as easier to breathe, improved digestive function, circulation, clearer and sharper vision, changes in heart rhythm and blood pressure. The authors of this research study believe that these results are exciting and additional research is needed.

The authors concluded that, “manipulative intervention followed by a general lumbar range of motion regimen (as opposed to an extension- or flexion- oriented program without manipulation) may be the key to rapid improvement in patients with low back symptoms”

In 1985, the University of Saskatchewan conducted a study of 283 patients “who had not responded to previous conservative or operative treatment” and who were initially classified as totally disabled. The study revealed that “81% became symptom free or achieved a state of mild intermittent pain with no work restrictions” after daily spinal manipulations were administered.

Journal of American Health Policy, stated that, “chiropractic users tend to have substantially lower total health care costs,” and “chiropractic care reduces the use of both physician and hospital care.”

A 1992 study conducted by L.G. Schifrin, Ph.D., provided an economic assessment of mandated health insurance coverage for chiropractic treatment within the Commonwealth of Virginia. As reported by the College of William and Mary, and the Medical College of Virginia, the study indicated that chiropractic provides therapeutic benefits at economical costs. The report also recommended that chiropractic be a widely available form of health care.

A study conducted by T.W. Meade, a medical doctor, and reported in the June 2, 1990, British Medical Journal concluded after two years of patient monitoring, “for patients with low-back pain in whom manipulation is not contraindicated, chiropractic almost certainly confers worthwhile, long-tem benefit in comparison with hospital outpatient management.”

A 1991 demographic poll conducted by the Gallup Organization revealed that 90% of chiropractic patients felt their treatment was effective; more than 80% were satisfied with that treatment; and nearly 75% felt most of their expectations had been met during their chiropractic visits

A 1978 study conducted by J.S. Wight, D.C., and reported in the ACA Journal of Chiropractic, indicated that 74.6% of patients with recurring headaches, including migraines, were either cured or experienced reduced headache symptomatology after receiving chiropractic manipulation

Following a 1993 study, researchers J. David Cassidy, D.C., Hayno Thiel, D.C., M.S., and W. Kirkaldy Willis, M.D., of the Back Pain Clinic at the Royal University Hospital in Saskatchewan concluded that “the treatment of lumbar intervertebral disk herniation by side posture manipulation is both safe and effective.”

A study by Miron Stano, Ph.D., reported in June 1993 Journal of Manipulative and Physiological Therapeutics involved 395,641 patients with neuromusculoskeletal conditions. Results over a two-year period showed that patients who received chiropractic care incurred significantly lower health care costs than did patients treated solely by medical or osteopathic physicians.

A 1991 report on a workers’ compensation study conducted in Oregon by Joanne Nyiendo, Ph.D., concluded that the median time loss days (per case) for comparable injuries was 9.0 for patients receiving treatment by a doctor of chiropractic and 11.5 for treatment by a medical doctor.

A 1992 article in the Journal of Family Practice reported a study by D.C. Cherkin, Ph.D., which compared patients of family physicians and of chiropractors. The article stated “the number of days of disability for patients seen by family physicians was significantly higher (mean 39.7) than for patients managed by chiropractors (mean 10.8).” A related editorial in the same issue referred to risks of complications from lumbar manipulation as being “very low.”

A workers’ compensation study conducted in Utah by Kelly B. Jarvis, D.C., Reed B. Phillips, D.C., Ph.D., and Elliot K. Morris, JD, MBA, compared the cost of chiropractic care to the costs of medical care for conditions with identical diagnostic codes. Results were reported in the 1991 Journal of Occupational Medicine. The study indicated that costs were significantly higher for medical claims than for chiropractic claims; in addition, the number of work days lost was nearly ten times higher for those who received medical care instead of chiropractic care.

In 1989, a survey administered by Daniel C. Cherkin, Ph.D., and Frederick A. MacCornack, Ph.D., concluded that patients receiving care from health maintenance organizations (HMOs) within the state of Washington were three times as likely to report satisfaction with care from chiropractors as they were with care from other physicians. The patients were also more likely to believe that their chiropractor was concerned about them.