title: Chiropractic treatment vs self-management in patients with acute chest pain: a randomized controlled trial of patients without acute coronary syndrome.
abstract: OBJECTIVE
  The musculoskeletal system is a common but often overlooked cause of chest pain. The purpose of the present study is to evaluate the relative effectiveness of 2 treatment approaches for acute musculoskeletal chest pain: (1) chiropractic treatment that included spinal manipulation and (2) self-management as an example of minimal intervention.
  
  
  METHODS
  In a nonblinded, randomized, controlled trial set at an emergency cardiology department and 4 outpatient chiropractic clinics, 115 consecutive patients with acute chest pain and no clear medical diagnosis at initial presentation were included. After a baseline evaluation, patients with musculoskeletal chest pain were randomized to 4 weeks of chiropractic treatment or self-management, with posttreatment questionnaire follow-up 4 and 12 weeks later. Primary outcome measures were numeric change in pain intensity (11-point box numerical rating scale) and self-perceived change in pain (7-point ordinal scale).
  
  
  RESULTS
  Both groups experienced decreases in pain, self-perceived positive changes, and increases in Medical Outcomes Study Short Form 36-Item Health Survey scores. Observed between-group significant differences were in favor of chiropractic treatment at 4 weeks regarding the primary outcome of self-perceived change in chest pain and at 12 weeks with respect to the primary outcome of numeric change in pain intensity.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first randomized trial assessing chiropractic treatment vs minimal intervention in patients without acute coronary syndrome but with musculoskeletal chest pain. Results suggest that chiropractic treatment might be useful; but further research in relation to patient selection, standardization of interventions, and identification of potentially active ingredients is needed.
authors.affiliation: Researcher, Nordic Institute of Chiropractic and Clinical Biomechanics and Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Part of Clinical Locomotion Science, Odense, Denmark. m.jensen@nikkb.dk
authors.forename: Mette J
authors.initials: MJ
authors.lastname: Stochkendahl
authors.forename: Henrik W
authors.initials: HW
authors.lastname: Christensen
authors.forename: Werner
authors.initials: W
authors.lastname: Vach
authors.forename: Poul F
authors.initials: PF
authors.lastname: Høilund-Carlsen
authors.forename: Torben
authors.initials: T
authors.lastname: Haghfelt
authors.forename: Jan
authors.initials: J
authors.lastname: Hartvigsen
mesh_terms: D054058:Acute Coronary Syndrome; D059787:Acute Pain / Q000175:diagnosis / Q000628:therapy; D000328:Adult; D002637:Chest Pain / Q000175:diagnosis / Q000628:therapy*; D003718:Denmark; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000379:methods*; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000628:therapy*; D010147:Pain Measurement; D018570:Risk Assessment; D012648:Self Care / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome