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Is there any evidence that supports the work of chiropractors, i.e., alignment of the spinal column, for muscle spasm, chronic back pain, or other condition? Although I don’t recommend it, many of my patients say a “bear hug” from a friend is a less expensive way to get the same relief.
—Ferdinand M. Rivera, MD, Salinas, P.R.

There are some data that chiropractic manipulation may be moderately effective for patients with uncomplicated low back pain. However, a recent meta-analysis of randomized controlled trials concluded that there is no evidence that chiropractic manipulation was any more efficacious than other standard treatments (Ann Intern Med. 2003;138:898-906). The data supporting the use of spinal manipulation for neck pain or headache is more limited than for low back pain, and a majority of the published studies had significant methodologic limitations. A recent Cochrane review found that spinal manipulation for neck pain was not efficacious on its own but was moderately effective when used in conjunction with exercise for patients without radicular findings (Spine. 2004;29:1541-1548). There are currently no convincing data to support the use of spinal manipulation fornonmusculoskeletal conditions. In contrast, spinal manipulation can have notable associated adverse events, including disk herniation, cauda equina syndrome, and vertebrobasilar accidents, which have been reported to occur in up to one case per 400,000 manipulations (Am J Med. 2002;112:566-571). All that being said, I would advise against any attempts to manipulate the spine by a well-meaning but untrained friend, bear hug or otherwise.
—Daniel G. Tobin, MD (109-3)

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