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Chiropractic Benefits for Migraine Patients Likely Psychological: Control-group Study

November 2, 2016

By Mendy Hecht, Hamaspik Gazette

After One Year, Both Real, Sham Patients Report Less Migraines than Drug Patients

While believers have all but sworn by the benefits of chiropractic for decades, skeptics have remained, well, skeptical.

But a new study from Norway now lends weight to the notion that the spinal manipulation therapy, popular in several Gazette reader communities, works simply due to the psychological placebo effect—at least when it comes to treating chronic migraine headaches.

In the placebo effect, patients report feeling better because of treatment—whether or not anything actually gets better because of treatment.

In a three-month study of 104 patients suffering from migraines, the painful and debilitating headaches, patients were split into three groups.  One got real manual chiropractic adjustments, one got fake manual chiropractic adjustments, and one got conventional migraine medications.

After 12 weekly sessions, patients of both the real and fake chiropractic back adjustments reported the same reduction in “migraine days” per month as those taking medications. 

But in follow-ups 12 months after the start of the study, the real and fake chiropractic patients reported about 40 percent improvement in migraine symptoms over 12 months earlier, while the medication-only patients returned to the same level of symptoms at the start of the study.

Chiropractic has long been the subject of at least some controversy.  But the school of treatment, once dismissed by the medical establishment as outright quackery, has made significant inroads into the mainstream over the decades.

Subluxations, chiropractic jargon for displaced vertebrae in the spine, are the spine (no pun intended) of chiropractic theory.

Chiropractic maintains that minute displacements of the vertebrae impinge on signals from brain to body, and vice-versa, via the spinal cord, much as stepping on a garden hose limits water flow.  With spinal adjustments, chiropractic supposedly corrects subluxations of the vertebrae to reduce or remove specific symptoms and to improve overall health.

However, part of the reason for chiropractic’s arms-length treatment by (at least some of) mainstream medicine is that subluxations do not appear in x-rays.  That and other basics of chiropractic have made it difficult to subject the discipline to the rigors of scientific testing.

In ordinary situations, a new medical treatment—say, a new drug—would be scientifically tested by giving a real pill to one group of people and a fake (placebo) pill to another group (the “control” group).  If the “real” group improves compared to the “fake” group, it means that the pill works.

But in scientifically testing chiropractic, you can’t execute a fake spinal manipulation.

To address that issue, researcher Dr. Aleksander Chaibi of Akershus University Hospital in Norway—himself a physiotherapist, chiropractor and PhD candidate—developed a chiropractic “adjustment” that 80 percent of study participants eventually couldn’t tell was fake.  It involved pushing on the scapula shoulder bone and the far lower hip area to seem real.  However, according to the researchers, it did not directly move, adjust or otherwise affect the spine.

To make their placebo-controlled study even more realistic, Chaibi and colleagues had both real and sham sessions last 15 minutes each, with both groups getting the same structural and motion assessments before and after each session.  Participants also all kept a headache diary.

At the same time, the third group was getting just common medications normally prescribed for migraines.

The authors of the study, which was published recently in the European Journal of Neurology, suggest that the effect of chiropractic spinal manipulation therapy “is probably due to a placebo response.”

According to Dr. Chaibi, the one-year benefits reported by the fake chiropractic group could be attributed to the neurological benefits of physical touch—a benefit that he says exists with every manual contact, including simple handshakes.

“We do not believe that our placebo sham intervention by itself had any effect other than a placebo effect,” he told health news outlet MedPage Today, “particularly considering that all the placebo contacts were pre-defined and made outside the spinal column.”

But Dr. Chaibi also believes that because 15 percent of migraine patients do not respond to medications like NSAIDs or triptans, chiropractic care—even if the result of a placebo effect—may have a place in treating migraines.

Or, we might add, in treating all sorts of other ailments.