By Amy Norton
TUESDAY, October 11, 2016 (HealthDay News) – People with migraines sometimes seek help from a chiropractor, but a small study suggests that any pain relief they get could be a placebo effect.
When researchers turned a real manipulation of chiropractic versus a “bogus” version, they found that both were equally likely to relieve patients’ migraine pain.
On the other hand, both tactics worked better than the patient’s usual pain reliever drugs.
Pain management experts stressed that solid conclusions should not be drawn from a small study.
But they also said the results raise some interesting questions: What exactly causes and relieves migraine pain? And even if a therapy with a placebo effect works, what then?
“Ultimately, on average, the patients got better,” said Dr. William Lauretti, Associate Professor at New York Chiropractic College in Seneca Falls, NY
Traditionally, doctors have “looked down” on the placebo effect – a phenomenon that makes people feel better after taking sugar pills or other improper therapy.
However, many studies of pain management – testing anything from drugs to acupuncture – have found that people who receive sham therapy often get relief.
“The mind has something powerful,” said Lauretti. So it makes sense to actually use that power as long as the approach is safe, he added.
Lauretti, who was not involved in the study, is also a spokesperson for the American Chiropractic Association.
Dr. Houman Danesh heads the Integrative Pain Management Department at Mount Sinai Hospital in New York City.
He agreed that the placebo effect “should not be avoided”.
“We really don’t fully understand what a migraine is or what the placebo effect is,” said Danesh, who was not involved in the study.
Safe and effective pain relief is critical for any patient – whether or not it is partially mental, Danesh added.
Even so, Lauretti stressed that the new study does not prove that there is no real effect of manipulating chiropractic on migraine pain.
“You want to be careful about generalizing the results of a small study,” he said.
According to the US National Institutes of Health, about 12 percent of Americans suffer from migraines. The headache typically causes severe throbbing pain on one side of the head and sensitivity to light and sound. Many people also experience nausea.
Doctors prescribe various drugs that either treat acute migraine attacks or help prevent them.
For the new study, researchers at Akershus University Hospital in Norway recruited 104 patients with at least one migraine per month.
The researchers randomly assigned each patient to one of three groups: one who received true chiropractic manipulation of the spine; one that has received a mock version; and one who stuck to her usual pain reliever medication.
The sham version involved pressure on the shoulder and glutes, but no manipulation of the spine. Patients in both the real and mock groups attended 12 sessions for three months.
After three months, patients in all three study groups reported pain reduction on average.
But a year later, only the two chiropractic groups felt even better. On average, they reported four “migraine days” per month – from six to eight at the start of the study.
In contrast, patients who stayed on their medication regressed back to where they started.
So, what’s up? It is unclear. However, the sham chiropractic care is unlikely to have had any real physiological effect on patients’ migraines, said Aleksander Chaibi, chiropractor and lead researcher on the study.
“All placebo contacts were made outside of the spine,” he noted.
At the same time, Chaibi said, studies of pain medication typically also see high response rates to the placebo.
For Danesh, the results underscore the importance of providing patients with a range of options for migraine relief. Some people, he said, want to reduce their drug use or avoid drugs, so they try low-risk alternatives like acupuncture or chiropractic.
These patients could try these therapies alone or with medication, Danesh said.
“It doesn’t have to be ‘this’ or ‘that’,” he said. “People should be able to try different options, most of which are safe.”
Lauretti pointed out that manipulation in chiropractic can have side effects, such as temporary pain and, ironically, headache.
Chaibi made another point: in the “real world,” chiropractic manipulation for migraines is often used in combination with other tactics such as exercise and physical therapy, and advice on diet and lifestyle changes to limit migraine triggers.
These combination approaches could be more effective than manipulating the spine alone, Chaibi said.
The study was published in the online October 2nd edition of the European Journal of Neurology.