FDA shouldn't recommend "chiropracty" for pain

FDA shouldn't recommend "chiropracty" for pain

The FDA recently issued draft revisions to its Blueprint for Prescriber Education for Extended-Release and Long-Acting Opioids. The proposed revisions say that nonpharmacologic therapies can include physical rehabilitative approaches, like physical therapy, and "complementary therapies" like "chiropracty."

What the FDA apparently doesn't realize is that the only evidence-based therapy for pain offered by chiropractors isn't "complementary" at all. Spinal manipulation -- the application of a controlled force to a joint of the spine -- has weak evidence of efficacy for certain types of back pain. It is performed by chiropractors as well as physical therapists, doctors of osteopathy, and MDs. While spinal manipulation may be used by chiropractors in treating patients, it is not a synonym for "chiropracty."

"Chiropracty," or the more common term, "chiropractic," is based on the notion that misalignments ("subluxations") of the spinal bones, or vertebrae, cause ill health and disease and that detecting and correcting them can relieve symptoms and improve overall health. This is not only the definition of chiropractic accepted by the Association of Chiropractic Colleges, it is a common definition of chiropractic practice under state law. There is no scientific evidence that these chiropractic subluxations exist or that their purported "detection" or "correction" is beneficial to health. Yet, chiropractors use a broad spectrum of methods that purport to diagnose and treat subluxations and claim such treatments benefit the patient's health.

A more recent trend in chiropractic is the chiropractic "primary care physician," who diagnoses and treats a wide variety of conditions and diseases using dubious diagnostic methods and equally dubious treatments, like dietary supplements. This vision – the "DC as PCP" – is actively promoted by the largest chiropractic industry trade group, the American Chiropractic Association.

So, in recommending "chiropracty" for pain, the FDA is subjecting patients to a confusing and contradictory group of healthcare practitioners. At the chiropractor's office, the patient could

  • Receive an evidence-based recommendation (however weak) of spinal manipulation for low-back pain.
  • Be subjected to a diagnosis of "subluxations" for a myriad of health care problems, and signed up for a series of "adjustments" to treat those problems.
  • Conned into thinking the chiropractor is capable of acting as the patient's primary care physician.

The FDA's recommendation of "Physical rehabilitative approaches – e.g., physical therapy, occupational therapy," adequately encompasses the use of spinal manipulative therapy as an evidence-based approach to pain. Adding "chiropracty" merely subjects patients to an array of pseudoscience that won't help their pain and may well drain their wallets with ineffective treatments. It is perhaps unfair to lead patients away from evidence-based chiropractors who might offer them relief via the evidence-based use of spinal manipulation. But that is the fault of chiropractors themselves, who have never had the courage to kick the quacks out of their ranks.

[The FDA also recommended acupuncture as a "complementary" therapy for pain. Fellow SFSBM Board member Steve Novella, MD, shot down that recommendation nicely in a recent post on his Neurologica blog.]

Points of Interest 05/16/2017
Points of Interest 05/14/2017