Ignite Creation Date:
2024-05-05 @ 11:25 AM
Last Modification Date:
2024-10-26 @ 9:07 AM
Study NCT ID:
NCT00030004
Status:
TERMINATED
Last Update Posted:
2006-08-18
First Post:
2002-01-29
Brief Title:
Pilot Study of Spinal Manipulation for Chronic Neck Pain
Sponsor:
National Center for Complementary and Integrative Health NCCIH
Organization:
National Center for Complementary and Integrative Health NCCIH
Study Overview
Official Title:
Pilot Study of Spinal Manipulation for Chronic Neck Pain
Status:
TERMINATED
Status Verified Date:
2006-07
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
This study is designed to determine whether a medicine that can produce temporary amnesia midazolam can be used to block the memory of treatment with spinal manipulation This is important since any study that is designed to determine whether spinal manipulation is effective would be better if patients were not aware of whether or not they were treated This would allow a true assessment of treatment effects without the complication of a strong placebo effect that manipulative treatment may produce
Detailed Description:
There has been growing recognition of the high frequency with which Americans utilize complementary and alternative health care providers and that annually about 10 of the population is treated by a chiropractor While chiropractors employ several types of treatment spinal manipulation is the most important and unique of these therapies Over 90 of the spinal manipulations performed in the US are done by chiropractors with most of the remainder performed by osteopathic physicians The annual number of chiropractic visits in the US has been estimated at approximately 100 per 100 person-years
Spinal manipulation and chiropractic have been controversial at least partially due to a paucity of clinical scientific evidence of benefit For example reviews of the literature on randomized clinical trials RCTs of manipulative treatment for back pain have variably found evidence of benefit or insufficient evidence of benefit A review of the existing clinical trials of spinal manipulation for neck pain concluded that most of the five existing RCTs were of relatively poor quality and that despite some evidence for very short-term benefit studies of higher quality will be needed in order to determine whether there is clinical benefit for this condition This issue is important since neck pain is the second most common reason for presentation to chiropractors
There are several difficulties in researching the effects of spinal manipulation Most of the conditions that are treated ie back and neck pain do not have a well-defined pathophysiology Therefore it is not possible to study treatment by evaluating the effects of treatment on physiological variables The lack of a proven pathophysiology also leads to heterogeneous study populations with large variability in response to treatment This makes it necessary to use large experimental populations in order to detect any effects of treatment There is heavy reliance on subjective outcome measures in neck and back pain research making these clinical trials particularly sensitive to placebo or nonspecific effects The use of blinded subjects is the accepted method of dealing with these issues but blinding is particularly difficult to achieve when investigating physical interventions particularly those where the therapist cant be blinded as to whether she is delivering an actual or sham treatment
The present proposal is in response to a request for applications for pilot studies to establish the methodological feasibility and strengthen the scientific rationale for proceeding to full-scale RCTs on the use of chiropractic or osteopathy to manage or treat musculoskeletal injuries and disorders One of the stated goals of this request for applications is to refine the control strategy for studies of manipulative therapy The proposed study will examine whether an amnestic agent midazolam can be used to blind subjects to their experimental group in a double-blind pilot RCT This proposal is similar to a study by Sloop et al who used diazepam to produce amnesia in a study of spinal manipulation for chronic neck pain The present study will utilize an agent with more specific amnestic effects and will also address several methodological problems with their study If successful the methods employed in this pilot study may permit a high degree of blinding in full scale RCTs of spinal manipulation
Spinal manipulation and chiropractic have been controversial at least partially due to a paucity of clinical scientific evidence of benefit For example reviews of the literature on randomized clinical trials RCTs of manipulative treatment for back pain have variably found evidence of benefit or insufficient evidence of benefit A review of the existing clinical trials of spinal manipulation for neck pain concluded that most of the five existing RCTs were of relatively poor quality and that despite some evidence for very short-term benefit studies of higher quality will be needed in order to determine whether there is clinical benefit for this condition This issue is important since neck pain is the second most common reason for presentation to chiropractors
There are several difficulties in researching the effects of spinal manipulation Most of the conditions that are treated ie back and neck pain do not have a well-defined pathophysiology Therefore it is not possible to study treatment by evaluating the effects of treatment on physiological variables The lack of a proven pathophysiology also leads to heterogeneous study populations with large variability in response to treatment This makes it necessary to use large experimental populations in order to detect any effects of treatment There is heavy reliance on subjective outcome measures in neck and back pain research making these clinical trials particularly sensitive to placebo or nonspecific effects The use of blinded subjects is the accepted method of dealing with these issues but blinding is particularly difficult to achieve when investigating physical interventions particularly those where the therapist cant be blinded as to whether she is delivering an actual or sham treatment
The present proposal is in response to a request for applications for pilot studies to establish the methodological feasibility and strengthen the scientific rationale for proceeding to full-scale RCTs on the use of chiropractic or osteopathy to manage or treat musculoskeletal injuries and disorders One of the stated goals of this request for applications is to refine the control strategy for studies of manipulative therapy The proposed study will examine whether an amnestic agent midazolam can be used to blind subjects to their experimental group in a double-blind pilot RCT This proposal is similar to a study by Sloop et al who used diazepam to produce amnesia in a study of spinal manipulation for chronic neck pain The present study will utilize an agent with more specific amnestic effects and will also address several methodological problems with their study If successful the methods employed in this pilot study may permit a high degree of blinding in full scale RCTs of spinal manipulation
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None