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Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials

PainSci » bibliography » Haller et al 2019
Tags: controversy, debunkery

One article on PainSci cites Haller 2019: Does Craniosacral Therapy Work?

PainSci commentary on Haller 2019: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This is a pseudoscientific review of other pseudoscience, with a completely untrustworthy positive conclusion that “significant and robust effects of CST on pain and function.” They “reviewed” ten extremely low quality studies. Jonathan Jarry writes, “If you don’t look up these individual trials, you won’t know just how bad they are.” One was not even a trial of CST, or published; two were actually negative; five had such glaring design flaws that they never should have been considered; another superficially adequate trial was so underpowered that the results had “error bars so large you could drive an entire cohort of participants through them.” Only a single study of the ten had the outward appearance of a trial worth reviewing, but a serious design flaw is apparent with even a little digging.

It is easy to find faults in scientific papers. Even good ones have major limitations. But it’s a matter of degree, and this is one of the most dramatic examples of “garbage in, garbage out” I have ever seen. There isn’t enough data here to review in any way, let alone meaningful statistical pooling (meta-analysis). And while it isn’t technically “evidence of absence” — there’s almost no actual “evidence” involved at all — the complete failure to produce credible positive evidence, despite a dramatic bias in favour of CST, is a kind of conclusion in itself.

See Jarry’s more detailed analysis: Even the Best Scientific Studies Can Lie.

~ Paul Ingraham

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: To systematically assess the evidence of Craniosacral Therapy (CST) for the treatment of chronic pain.

METHODS: PubMed, Central, Scopus, PsycInfo and Cinahl were searched up to August 2018. Randomized controlled trials (RCTs) assessing the effects of CST in chronic pain patients were eligible. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for pain intensity and functional disability (primary outcomes) using Hedges' correction for small samples. Secondary outcomes included physical/mental quality of life, global improvement, and safety. Risk of bias was assessed using the Cochrane tool.

RESULTS: Ten RCTs of 681 patients with neck and back pain, migraine, headache, fibromyalgia, epicondylitis, and pelvic girdle pain were included. CST showed greater post intervention effects on: pain intensity (SMD = -0.32, 95%CI = [- 0.61,-0.02]) and disability (SMD = -0.58, 95%CI = [- 0.92,-0.24]) compared to treatment as usual; on pain intensity (SMD = -0.63, 95%CI = [- 0.90,-0.37]) and disability (SMD = -0.54, 95%CI = [- 0.81,-0.28]) compared to manual/non-manual sham; and on pain intensity (SMD = -0.53, 95%CI = [- 0.89,-0.16]) and disability (SMD = -0.58, 95%CI = [- 0.95,-0.21]) compared to active manual treatments. At six months, CST showed greater effects on pain intensity (SMD = -0.59, 95%CI = [- 0.99,-0.19]) and disability (SMD = -0.53, 95%CI = [- 0.87,-0.19]) versus sham. Secondary outcomes were all significantly more improved in CST patients than in other groups, except for six-month mental quality of life versus sham. Sensitivity analyses revealed robust effects of CST against most risk of bias domains. Five of the 10 RCTs reported safety data. No serious adverse events occurred. Minor adverse events were equally distributed between the groups.

DISCUSSION: In patients with chronic pain, this meta-analysis suggests significant and robust effects of CST on pain and function lasting up to six months. More RCTs strictly following CONSORT are needed to further corroborate the effects and safety of CST on chronic pain.

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