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From cradle to grave?

There is no conclusive evidence that chiropractic maintenance therapy works, says Professor Edzard Ernst

In 1926, BJ Palmer, the son of the founding father of chiropractic, wrote: ‘patients should never be told that they are well, only that they are getting better. If a patient asks if chiropractic treatments are to be continued for life, the answer should be: No, only as long as you want to stay healthy.'

Since then chiropractic has changed, but the notion that regular chiropractic treatments maintain patients at their optimal level and prevent illness is still a widespread concept in chiropractic.

Thousands of websites promote it. Many chiropractors would like to see maintenance care for each patient from the cradle to the grave.

This, of course, begs the question whether or not maintenance care is effective. A recent systematic review [1] found only one pilot study addressing this question. In this trial, 29 back pain sufferers were randomised to receiving either nine months of maintenance therapy or to having no such treatment.

The results failed to show any differences in pain at follow-up. Since then no further studies have emerged. This means that no conclusive research on the effectiveness of chiropractic maintenance treatment currently exists.

We should put all of this in the context of the risks and costs of this approach. Several prospective studies have shown that around half of all chiropractic patients suffer adverse effects, mostly pain, after chiropractic treatments. These adverse effects are usually mild to moderate and normally lasts 24 to 48 hours. Not even chiropractors deny their existence. However, several hundred cases of serious complications, including dozens of fatalities, have also been reported and there is a heated debate whether they are caused by chiropractic or not. Most of them are due to vertebral artery dissection after upper spinal manipulation. Numerous deaths are on record [2] – and that perhaps gives the concept ‘from cradle to grave' an entirely different connotation.

Professor Edzard Ernst is professor of complementary medicine at the Peninsula Medical School, University of Exeter

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