User:PalMD/chiropractic

Chiropractic is the theory and practice of correction of "vertebral subluxation processes" to treat and cure disease. It was developed in the late 19th century, just before the development of modern medical education in the United States. It may be considered a pseudoscience, depending on how one choses to define this. For more on the history of chiropractic, see Wikipedia's article.

The lay public has many different perceptions of chiropractic, as there are few unified standards of practice. Patients seek out chiropractors for a variety of reasons, but mostly because they are suffering from back pain. Also, patients may feel that mainstream medicine has failed to adequately treat their pain. Another motivation to seek chiropractic care is that it is perceived as more "holistic" or "natural".

Chiropractic Theory
Most chiropractors subscribe to the theory of "vertebral subluxation". This differs from the medical definition considerably. An "orthopaedic subluxation" is a painful partial dislocation of a vertebral body. A "chiropractic subluxation" is an asymptomatic misalignment or a “vertebral subluxation complex” thought to be a cause of disease. Such a subluxation has never been proven to exist.

In July 1996, the Association of Chiropractic Colleges issued a consensus statement that “Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation. A subluxation is a complex of functional and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.” This hypothesis has never been tested, and ignores significant anatomical reality, such as the fact that much of the nervous system does not pass through the spine in any way. This especially applies to the autonomic nervous system that "influences organ system function".

Effectiveness of Chiropractic
There is evidence that chiropractic therapy is as effective as usual medical therapy in treating acute low back pain. Usual medical therapy includes back exercises and anti-inflammatory medications. Chiropractic was also found to be slightly more effective than simply handing a patient a book about back care. In some studies, chiropractic did cost more overall. Specifically, a study comparing outcomes of acute low back pain treated by orthopedic surgeons, primary care physicians (PCP), and chiropractors found similar outcomes, but less cost from PCPs.

While 50-60% of patients who seek chiropractic care do so for back or neck pain, a significant number are treated for other problems. There is no evidence to support the use of chiropractic in general medical conditions.

Potential Harms
There are many potential harms associated with chiropractic. These fall into three main categories:
 * Cost: chiropractic care costs more than usual care for low back pain
 * Overreach: many chiropractors claim to treat conditions for which they have no evidence of effectiveness. They may discourage conventional medical care as it is out of line with subluxation theory (and it would cut into their profits). Also, national health systems my route people to chiropractors to delay more effective, but expensive therapy that could be more appropriately treated by physicians.
 * Danger: rarely, chiropractic care can be actively dangerous, including causing stroke, carotid artery dissection, and vertebral artery dissection.

Summary
There is evidence that chiropractic can help alleviate symptoms of low back pain, neck pain, and tension headache. There is no evidence that it can help with any other medical problems and may in fact cause harm. The theory behind chiropractic, specifically subluxation theory, is scientifically unsound. It seems likely that much of the benefit of chiropractic comes from the "laying on of hands" and listening to the patient. There is no reason to believe this is any better than standard massage therapy, which may be considerably safer.

Given the non-scientific theories underlying chiropractic, and its poor results, it should be classified as a pseudoscience.