Monday, June 1, 2009

Chiropractors claim wrist action, but evidence states no happy ending.

I'm talking about Carpal Tunnel Syndrome(CTS) of course.

CTS is a relatively common ailment, which causes a pins and needles sensation in the fingers and hands. The NHS website linked to above, estimates that almost 5% of women and 3% of men have CTS. Most cases of CTS develop in people who are between 45-64 years of age. People with mild to moderate symptoms usually respond well to non-surgical treatment, such as wrist splints and corticosteroids injections. However, more severe cases usually require surgery to reduce the pressure on the median nerve. Left untreated, CTS may lead to permanent nerve damage.

So this is a common problem, ranging from very mild to severe, but at the painful end of the scale, surgery is the only option. As with menstrual pain, the parameters are nicely set for quack therapies to offer hope of relief.

Also like menstrual problems, the Cochrane Collaboration, an international not-for-profit and independent organization, dedicated to making up-to-date, accurate information about the effects of healthcare readily available worldwide, has published a review on Carpal Tunnel Syndrome. In this case, it has looked at all the non-surgical therapies that have been discussed in the scientific literature, analysed the data and come up with some evidence-based conclusions:
Trials of magnet therapy, laser acupuncture, exercise or chiropractic care did not demonstrate symptom benefit when compared to placebo (or control).
So the evidence gathered so far seems to be fairly clear and there is no reason why any self-respecting chiropractor would advertise that they could help CTS - it would be surely foolish?

Surprisingly (or perhaps not), the deja vu continues - CTS, like menstrual problems, is a prime complaint for alternative medicine; Like menstrual problems, it has a Cochrane Review which concludes that, based on published evidence, chiropractic is no better than placebo or control; and lastly and incredibly, like menstrual problems, appears on numerous chiropractic websites as a condition that they are able to successfully treat.

For instance, see Dr (not medical) Chris Pickard of the Pain Relief Centres in Finchley and Hatfield, discussing carpal tunnel syndrome:
Dr (not medical) Chris doesn't seem to have read the evidence, but no doubt he has his 'own evidence' (anecdotes) as do homeopaths, faith healers, pendulum swingers, astrologers, mediums and any other branch of quackery and pseudoscience you can think of. (Incidentally, I haven't looked into Cold Laser treatment mentioned in the video, except to say that a review in 2007 said there was 'conflicting evidence' as to its effectiveness). I like the ice-cream van near the end of the video.

Glasgow Chiropractic, (once again) claim:
[if] it is definitely carpal tunnel syndrome [...] a chiropractor can help greatly.
Not according to the evidence, they can't.

Roundhay Chiropractic in Leeds claims
carpal tunnel syndrome [-] Chiropractic can help you recover quicker and with less pain.
The evidence suggests not.

Other offenders include The Healing Clinic in York, Health Hydro (Swindon Borough Council website, if you're interested in complaining) in Swindon, the Chiropractice in Cardiff, the Chiropractic Clinic in Chester, and of course the Pain Relief Centre in Finchley, which boasts Chris Pickard from the above video.

There are plenty more Chiropractors out there offering this quack treatment, despite the clear, available evidence that it is of no value over placebo or control. I have no idea whether these places are aware of the available evidence - if they are, then they are knowingly misleading and fraudulent (bogus, if you will), if they aren't, then their professional knowledge is questionable - would you want to be treated by someone who offers useless treatments, demonstrating their ignorance in their supposedly specialised field?

Needless to say, the GCC will be made aware of this situation - will they just get a slap on the wrist?

BPSDB

13 comments:

  1. The GCC code states:

    "D2 Chiropractors must maintain and improve their professional
    knowledge, skills and performance.

    "Specifically chiropractors:
    D2.1 must meet any requirements for Continuing Professional Development set out by the GCC."

    Sadly the CPD focuses mainly on learning within Chiropractic; they're hardly encouraged to look at Cochrane reviews, but are encouraged to "learn" from their own experiences.

    ReplyDelete
  2. Of the 300 chiroquacktor websites I'm investigating, 20% make claims about carpal tunnel syndrome or RSI.

    ReplyDelete
  3. This is incorrect - you state that the "Cochrane Review ... concludes that, based on published evidence, chiropractic is no better than placebo", yet the chiropractic trial was against conservative medicine as a control, and not placebo. The report states that: "Limited evidence also suggests that chiropractic and medical treatment provide similar short-term improvement in mental distress, vibrometry, hand function and health-related quality of life." This isn't the same as stating that chiropractic offers no benefit to patients.

    ReplyDelete
  4. - indeed, it should say 'placebo or control' - now fixed, thanks.

    'The limited evidence' statement is due to that particular part being heavily biased towards one paper (Davis 1998). Even so, the improvement was short term, leading the athors to conclude that chiropractic 'did not offer significant benefit'.

    And that's the rub.

    T

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  5. Yep, can't argue with that :). Thx.

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  6. At one point you type 'CPS' instead of 'CTS'. I can see why you might have been thinking of the Crown Prosecution Service.....incidentally, I looked up 'complementary medicine' in my local Yellow Pages recently. It lay between 'Compensation Claims' and 'Compost'. Srsly.

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  7. "CPS, like menstrual problems, is a prime complaint for alternative medicine"

    Heh....would that it were!

    Cheers AVP (now fixed)

    T

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  8. Hi its Dr (not medical) Chris here. All I can tell you is that since I have combined chiropractic, soft tissue work, cold laser and specific exercises all together I have had 100% success in reducing CTS symptoms, even on people that have already had failed surgery for it. Yes you only have my word for it, yes it is only on a small number of people so far. Thanks for noticing the ice cream van - I liked it too.

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  9. Hi Chris,

    Thanks for your comment and anecdotes - I'm sure you'll agree that 'reducing symptoms' isn't much of a commendation!

    I'm sure you'll publish your findings in a reputable peer-reviewed journal and prove me wrong.

    T

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  10. There are also interstitial entrapments via muscle and/or sinew that occur between the joints as readily as within the joints.
    I also submit the underlying cause of these two similar symptom sets, part of CTS, is the same and akin to the dis-ease as most know as "The Divers Benz"; One being the acute form called the Benz and one being the chronic form (i.e. pathologic form) manifesting itself as CTS as well as other syndromes (like “Thoracic Outlet Syndrome” or “Piriformis Syndrome”).
    ~Signed,
    The Super-ChiroQuacker
    (aka chiro-quack-tic magician of many successful former CTS sufferers)

    ReplyDelete
  11. Chiroquacker break my neck
    Chiroquacker burn in heck (Hell)
    Chiroquacker Liar Liar
    Hope you burn in Satan's fire
    Chiroquacker you're a QUACK
    Medical knowledge is what you lack
    You lied on my records to justify your action
    Your soul burning in Hell will by my satisfaction..!!!
    If you lost your hands tomorrow
    I would not feel any sorrow
    Cracking bones is pretty insane
    Chiropractor/Chiroquacker one and the same..!!!!

    ReplyDelete
  12. The most IGNORANT thing I've ever done was go to a Chiropractor/Chiroquacker..!!!
    Before you go to one of these QUACKS, bring up Chiropractic Malpractice and read all the information..!!! 7 years ago I was permenently damaged by a Chiropractor/Chiroquacker. I live in pain everyday because of this Jack Ass Chiroquacker's action. I had the quacker's office send my records to several Lawyers and no one wanted to take my case even though my REAL Dr. was willing to go to court with me. Later I found out that the records the lawyers received were completely fabricated. The chiroquacker had lied on my records to justify his actions. If reading this keeps even one person from going to one of these quacks, then it is worthwhile..!!!

    ReplyDelete
  13. Chiropractor negligence can take many forms. As a fully qualified medical practitioner, a chiropractor can detect, diagnose and treat medical conditions in their patients

    ReplyDelete

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