| Abstract/Notes |
Background: As standards for randomised, controlled, clinical trials in medicine evolve, there is debate about whether the RCT model of investigation is appropriate for chiropractic and other forms of so-called "complementary and alternative medicine." There may be some question as to whether the use of placebo interventions can be justified ethically and scientifically given that experimental treatments must eventually compete in a marketplace where there is often already a clinical alternative which is more effective than placebo. Beyond these concerns, design of an appropriate placebo for chiropractic trials is particularly problematic since the therapeutic component of overall chiropractic treatment may be difficult to isolate. Objective: To compare placebo interventions in current use in chiropractic clinical research with simple somatic stimuli that produce significant physiological effects in a selected group of patients (those suffering from dystonia). Methods: A literature search was made using MEDLINE, with the key words dystonia, sensory trick and geste antagoniste. Articles were reviewed for descriptions of these stimuli. The stimuli were compared, in terms of site and modality, with placebo interventions used in recent chiropractic clinical trials. Results: Stimuli used as placebo procedures in recent chiropractic clinical trials are quite similar, in terms of site and modality, to the "sensory tricks" that either cause substantial temporary relief, or, alternatively, provocation of symptoms in dystonic patients. Conclusions: Caution should be used in assuming that control (placebo) procedures used in chiropractic clinical trials-procedures that involve physical contact or positioning of patients-lack specific effects on neuromusculoskeletal symptomatology. This abstract is reproduced with the permission of the publisher; full text (print only) by subscription.
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