From the Guidelines
Chiropractic care is not recommended for the management of rheumatoid arthritis due to the lack of evidence and potential cervical spine complications. The most recent and highest quality study, published in 2023 in the journal Arthritis Care & Research 1, conditionally recommends against the use of chiropractic therapy for rheumatoid arthritis management, citing the absence of evidence and potential risks. This recommendation is based on the lack of studies that met the eligibility criteria, and the perceived burden and costs associated with chiropractic therapy. In contrast, some chiropractic treatments, such as spinal manipulation, have moderate evidence supporting their effectiveness for certain types of low back pain, as reported in earlier studies published in the Annals of Internal Medicine 1. However, the quality of evidence varies significantly depending on the specific condition being treated and the particular techniques used. Key points to consider when evaluating chiropractic care include:
- The lack of evidence supporting the use of chiropractic therapy for rheumatoid arthritis management
- The potential risks associated with chiropractic therapy, such as cervical spine complications
- The importance of seeking practitioners who emphasize evidence-based approaches and clearly communicate the limitations of treatment
- The need for patients to recognize when medical referrals are appropriate.
From the Research
Evidence for Chiropractic Care
- Chiropractic care is a popular alternative for back and neck pain, with efficacy comparable to usual care in randomized trials 2.
- Numerous studies and expert panel reviews have supported the use of chiropractic and manipulation for low back pain, neck pain, whiplash, and headaches 3.
- A systematic review of pragmatic studies found that chiropractic care for low back pain appears to be equally effective as physical therapy, with no reports of serious adverse events 4.
Clinical Practice Guidelines
- An evidence-based clinical practice guideline for chiropractic management of patients with chronic musculoskeletal pain recommends nonpharmacological treatments, including spinal manipulation/mobilization, exercise, and lifestyle modifications 5.
- A clinical practice guideline for chiropractic care for low back pain updated and combined previous guidelines, and found that doctors of chiropractic are well suited to diagnose, treat, co-manage, and manage the treatment of patients with low back pain disorders 6.
Economic Evaluation
- A systematic review of full economic evaluations of chiropractic care for low back pain found mixed evidence, with some studies suggesting that chiropractic care is more cost-effective than medical care, while others found equivalent costs 4.
- A study comparing the effectiveness of usual care with or without chiropractic care for patients with recurrent musculoskeletal back and neck pain found that chiropractic care did not increase costs, and provided an additional viable option for patients who prefer this type of care 2.
Patient Outcomes
- Satisfaction with chiropractic care for low back pain is typically good 3.
- Patients with chronic musculoskeletal pain who receive chiropractic care may experience improvements in pain severity, interference, and symptom bothersomeness 5.
- A study found that patients who received chiropractic care for low back pain had similar outcomes to those who received other types of care, including exercise therapy and medical care 4.