on 2/5/02 2:11 pm, Stephen M. Perle, D.C. at [log in to unmask] wrote:
> So from my personal experience let's look at a low back pain patient where
> the literature is much more equivocal. The patient barely walks into my
> office. ..........They saw their M.D. and had
> both Rx NSAIDs and muscle relaxers which have had absolutely no effect. ......
I examine the patient and give them one manipulative thrust
> and concurrent with the thrust they are instantly pain free. (BTW this is
> an example of a relatively common occurrence) If this is a placebo, why
> didn't the medication work as a placebo?
>
Stephen M Perle has raised an important point which in the spirit of
scientific inquiry should be addressed.
Many manipulative therapists report similar stories yet several systematic
reviews of manipulation of neck and back have not come out in favour of the
intervention. This mis-match between experience and trials should make us
think about the relevance of the design of trials to practice. We should
frame a new question (in good EBP style) *Do some patients with neck and
back disorders respond instantly to true manipulation compared to sham
manipulation in recovery from pain and immobilisation* The outcome looked at
here would be instant relief not relief at two four or sixteen weeks.
If the answer were yes, then other research questions would follow (does
physical sign X differentiate patients who respond instantly to
manipulation from...etc) I remember a generation ago osteopaths (maybe some
still do) argued that the osteopathic lesion could be identified by changes
in skin adjacent to the lesion - this could be one such sign ripe for study.
Musculoskeletal medicine (chiropractic or physiotherapy) is not beyond
scientific inquiry and I plead with the list to approach the questions in
that spirit. No place for defensiveness (m/s practitioners claiming that
their field is different and beyond RCTs) or mockery from orthododox
practitioners. I will now vacate the pulpit:-)
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