Spinal manipulation vs. @entity3659 for the treatment of chronic XXXX : a randomized clinical trial.

@entity1 @entity3659 @entity2133 @entity1017 @entity158 @entity2701 @entity10
OBJECTIVE: To compare the effectiveness of spinal manipulation and pharmaceutical treatment ( @entity3659 ) for chronic @entity2701 . DESIGN: Randomized controlled trial using two parallel groups. The study consisted of a 2-wk baseline period, a 6-wk treatment period and a 4-wk posttreatment, follow-up period. SETTING: Chiropractic college outpatient clinic. @entity1 : One hundred and fifty @entity1 between the ages of 18 and 70 with a diagnosis of @entity2701 of at least 3 months' duration at a frequency of at least once per wk. INTERVENTIONS: 6 wk of spinal manipulative therapy provided by chiropractors or 6 wk of @entity3659 treatment managed by a medical physician. MAIN OUTCOME MEASURES: Change in @entity1 -reported daily @entity10 intensity, weekly @entity10 frequency, over-the-counter medication usage and functional health status (SF-36). RESULTS: A total of 448 @entity1 responded to the recruitment advertisements; 298 were excluded during the screening process. Of the 150 @entity1 who were enrolled in the study, 24 (16%) dropped out: 5 (6.6%) from the spinal manipulative therapy and 19 (27.1%) from the @entity3659 therapy group. During the treatment period, both groups improved at very similar rates in all primary outcomes. In relation to baseline values at 4 wk after cessation of treatment, the spinal manipulation group showed a reduction of 32% in @entity10 intensity, 42% in @entity10 frequency, 30% in over-the-counter medication usage and an improvement of 16% in functional health status. By comparison, the @entity3659 therapy group showed no improvement or a slight worsening from baseline values in the same four major outcome measures. Controlling for baseline differences, all group differences at 4 wk after cessation of therapy were considered to be clinically important and were statistically significant. Of the @entity1 who finished the study, 46 (82.1%) in the @entity3659 therapy group reported side effects that included drowsiness, @entity2133 and @entity1017 . Three @entity1 (4.3%) in the spinal manipulation group reported neck soreness and stiffness. CONCLUSIONS: The results of this study show that spinal manipulative therapy is an effective treatment for @entity2701 headaches. @entity3659 therapy was slightly more effective in reducing @entity158 at the end of the treatment period but was associated with more side effects. Four weeks after the cessation of treatment, however, the @entity1 who received spinal manipulative therapy experienced a sustained therapeutic benefit in all major outcomes in contrast to the @entity1 that received @entity3659 therapy, who reverted to baseline values. The sustained therapeutic benefit associated with spinal manipulation seemed to result in a decreased need for over-the-counter medication. There is a need to assess the effectiveness of spinal manipulative therapy beyond four weeks and to compare spinal manipulative therapy to an appropriate placebo such as sham manipulation in future clinical trials.
