John K Maltby, DC, Donald D. Harrison, Ph.D, DC, MSE, Deed Harrison, DC, Joseph Betz BS, DC, Joseph R. Ferrantelli BS, DC, Gerard W. Clum, DC
Journal of Vertebral Subluxation Research ~ August 21, 2008 ~ Pages 1-12
Objective: To determine the validity of claims that headaches, neck pain, and upper back pain should resolve in 6 to 12 visits with Spinal Manipulative Therapy (SMT) or Mobilization and to derive an evidence-based Frequency and Duration program for these conditions.
Methods: Searches were performed in PubMed, CINAHL, Mantis, and the Index of Chiropractic Literature (ICL) for Randomized Clinical Trials (RCTs) on headaches, neck pain, and upper back pain for which the treatment was SMT and/or Mobilization. From these headaches, neck pain, and upper back pain RCTs, pain data, the number of subjects and the number of visits were analyzed.
Results: Fifty-four RCTs with SMT and/or Mobilization as the treatment for headaches, neck pain, cervicobrachial pain and/or upper back pain were located. Seven of these were follow-up studies, which resulted in 47 RCTs to be analyzed. The total NRS data indicated only a 46.5% improvement in 7.7 average visits. Using a constant linear extrapolation of dose response in these studies, a mean of 17 visits was needed to resolve headaches, neck pain and upper back pain. Using an initial examination visit, linearly extrapolated visits, once per week stabilization care for 4 weeks, and 2 follow-up examination visits, a provided 24 visits were needed to document, stabilize, and resolve the average headache, neck pain, cervicobrachial pain, and/or upper back pain case.
Conclusion: Pain data from RCTs did not support claims of restricting Chiropractic care to 6-12 visits for headaches, neck pain, cervicobrachial pain, and/or upper back pain. In fact, assuming a constant linear dosage response, the data indicated a minimum of 24 visits on average would be needed to document, resolve, and stabilize these conditions.
Key Words: Chiropractic, headaches, neck pain, upper back pain, spinal manipulation, spinal manipulative therapy, mobilization, randomized clinical trials, frequency, duration