Below is an early review combining data from numerous studies. This looked to combine data and information from a variety of sources and treatment options for headaches and neck pain. These are very difficult studies to perform because you are readingand evaluating hundreds of studies. Those individual studies then need to be graded on some type of system to determine whetheror not they should be included within your review. When researcheguidelines are established the studies are evaluated for inclusion in the review study. Included studies are then used to aggregate information. Not all studies can provide data that can bepulled and utilized to produce a statistical significance. Muchof that has to do with how the individual studies were set up, data collected, sample size, and evaluation techniques.
This study did an excellent job of combining data and providing preliminary information for treatment and evaluation. It then helped lay the groundwork for more advanced studies to determine effectiveness and treatment recommendations in clinical settings.
Once again this study showed positive benefit of chiropractic and soft tissue treatments in headaches and neck pain. There is once again a difference between chronic and acute pain and treatment protocols. We see a difference in headache types. Weare limited in our ability in the study to compare it to pharmacologic effects, but it was shown to have the same if not betteroutcomes as compared to analgesic medications.
Studies like this are informative and helpful to give providers a betteridea on how we can manage your care. Information such as this helps researchers then determine better studies for the future toevaluate best practices and treatments.
Journalof Manipulative and Physiological Therapeutics
Volume 24, Issue 7 , Pages 457-466, September 2001
Efficacy of spinal manipulation for chronic headache: A systematic review
GertBronfort, DC, PhD, Willem J.J. Assendelft, MD, PhD, RoniEvans, DC, Mitchell Haas, DC, LexBouter, PhD
Chronic headache is a prevalent conditionwith substantial socioeconomic impact. Complementary or alternative therapies are increasingly being used by patients to treat headache pain, and spinal manipulative therapy (SMT) is among the most common of these.
To assess the efficacy/effectiveness of SMT for chronic headache through a systematicreview of randomized clinical trials.StudySelection: Randomized clinical trials on chronic headache (tension, migraine and cervicogenic) were included in the review if they compared SMT withother interventions or placebo. The trials had to have at least1 patient-rated outcome measure such as pain severity, frequency, duration, improvement, use of analgesics, disability, or quality of life. Studies were identified through a comprehensive search of MEDLINE (1966–1998) and EMBASE (1974–1998). Additionally,all available data from the Cumulative Index of Nursing and Allied Health Literature, the Chiropractic Research Archives Collection, and the Manual, Alternative, and Natural Therapies Information System were used, as well as material gathered through the citation tracking, and hand searching of non-indexed chiropractic, osteopathic, and manual medicine journals. Data Extraction: Information about outcome measures, interventions and effect sizes was used to evaluate treatment efficacy. Levels of evidence were determined by a classification system incorporating study validity and statistical significance of study results. Two authorsindependently extracted data and performed methodological scoring of selected trials. Data Synthesis: Nine trials involving 683patients with chronic headache were included. The methodological quality (validity) scores ranged from 21 to 87 (100-point scale). The trials were too heterogeneous in terms of patient clinical characteristic, control groups, and outcome measures to warrant statistical pooling. Based on predefined criteria, there is moderate evidence that SMT has short-term efficacy similar to amitriptyline in the prophylactic treatment of chronic tension-typeheadache and migraine. SMT does not appear to improve outcomes when added to soft-tissue massage for episodic tension-type headache. There is moderate evidence that SMT is more efficacious than massage for cervicogenicheadache. Sensitivity analyses showed that the results and the overall study conclusions remained the same even when substantial changes in the prespecifiedassumptions/rules regarding the evidence determination were applied.
SMT appears to have a better effect than massage for cervicogenicheadache. It also appears that SMT has an effect comparable to commonly used first-line prophylactic prescription medications for tension-type headache and migraine headache. Thisconclusion rests upon a few trials of adequate methodological quality. Before any firm conclusions can be drawn, further testing should be done in rigorously designed, executed, and analyzed trials with follow-up periods of sufficient length.
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© 2001 Published by Elsevier Inc. PubMed