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Craniosacral therapy versus light touch

PainSci » bibliography » Haller et al 2016
Tags: treatment, massage, controversy, manual therapy, debunkery

One article on PainSci cites Haller 2016: Does Craniosacral Therapy Work?

PainSci notes on Haller 2016:

This study reports that craniosacral therapy is an effective treatment for chronic neck pain, compared to “light touch,” in a few dozen patients.

Before I comment on the scientific value of this paper, I’d like to point out that it’s poorly written. It’s a mess. Just sayin’.

And the scientific value is probably nil. It’s in that awkward grey zone between good science and overt pseudoscience. The abstract begins with a glaringly disingenuous exaggeration of the scientific context — there is no credible “growing evidence” that craniosacral therapy works! Making such a claim betrays a strong bias that is clear throughout the paper, numerous examples of highly motivated reasoning and ideological dedication to CST. This experiment was obviously conducted by researchers fishing for confirmation that CST works, the kind of research that finds what it’s looking for and that more objective researchers never seem to be able to replicate.

The results were technically positive and statistically significant, but also clinically unremarkable and attributable to many possible confounding factors rather than “because CST works.” Even if the results could be accepted at face value, it wouldn’t validate the mechanisms of CST, which are just as dubious as ever. And we know that statistical significance validity, poor at the best of times, is even worse when testing highly implausible claims (see Pandolfi 2014). Either CST only appeared to outperform a sham, thanks to bias-powered mistakes, or it outperformed it only because the CST treatment ritual had more robust nonspecific effects.

And yet even if the results could be trusted, they would be underwhelming, and the authors themselves concede that "the effect sizes are comparable to those of neck pain guideline treatments" and "they "found comparable effects in blinded patients with respect to sham." This is what we see with essentially all passive interventions: a modest and transient effect at best, likely attributable to a combination of p-hacking and non-specific effects common to virtually any pleasant therapeutic interaction.

The authors believe (because of course they do) that the effect they measured "more than likely cannot be explained exclusively by nonspecific treatment effects," and it’s largely based on the premise that the signal is legit in the first place … a benefit of the doubt I am not willing to extend to an obviously biased test of a highly implausible treatment.

This study will be undoubtedly be touted by CST practitioners as proof that CST works, but it is no such thing without replication that it will almost certainly never get. Remember, there are lots of “positive” studies of homeopathy and acupuncture too … and we know how much that means.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVES: With growing evidence for Craniosacral Therapy (CST) effectiveness for pain management, the question about CST efficacy remained unclear. This study therefore aimed at investigating CST in comparison to sham treatment in chronic non-specific neck pain patients.

METHODS: 54 blinded patients were randomized to either 8 weekly units of CST or light touch sham treatment. Outcomes were assessed before and after treatment (week 8) and a further 3 months later (week 20). The primary outcome was pain intensity on a visual analogue scale; secondary outcomes included pain on movement, pressure pain sensitivity, functional disability, health-related quality of life, well-being, anxiety, depression, stress perception, pain acceptance, body awareness, patients' global impression of improvement and safety.

RESULTS: In comparison to sham, CST patients reported significant and clinically relevant effects on pain intensity at week 8 (-21▒mm; 95%-CI: [-32.6|-9.4]; P=0.001; d=1.02) as well as at week 20 (-16.8▒mm; 95%-CI: [-27.5|-6.1]; P=0.003; d=0.88). Minimal clinically important differences in pain intensity at week 20 were reported by 78% of the CST patients, while 48% even had substantial clinical benefit. Significant differences at week 8 and 20 were also found for pain on movement, functional disability, physical quality of life and patients' global improvement. Pressure pain sensitivity and body awareness were significantly improved only at week 8; anxiety only at week 20. No serious adverse events were reported.

DISCUSSION: CST was both specifically effective and safe in reducing neck pain intensity and may improve functional disability and quality of life up to 3 months post intervention.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights: