Chiropractic
Safety
Study: Chiropractic Does Not Increase
Risk of Stroke
A new study finds there is no
evidence of excess risk of stroke following chiropractic spinal manipulation,
according to a February 2008 report in the journal Spine.
In the study, researchers noted that patients are no more likely to suffer a
stroke following chiropractic treatment than they would after visiting their
family doctor’s office.
The study goes on to say that any
observed association between a vertebrobasilar
artery (VBA) stroke and chiropractic manipulation is likely due to patients
with an undiagnosed vertebral artery dissection seeking care for neck pain and
headache before their stroke.
“This may prove to be one of the
most important and significant studies in the profession’s history,” said ACA
President Glenn Manceaux, DC. “The results of this
study confirm that chiropractic manipulation is a safe and appropriate course
of treatment.”
The issue of stroke being
associated with a chiropractic neck adjustment focuses around the very
rare occurrence of a tear to the vertebral artery as it passes through the
sides of the upper cervical vertebrae and into the base of the skull. An injury
to the arterial wall may lead to formation of a blood clot, which can break
free and travel upward until it lodges in one of the smaller blood vessels in
the base of the brain, blocking circulation.
There are many reports in the
literature of cervical artery dissections (CADs)
occurring after everyday activities that most people would consider
non-traumatic, such as turning the head when driving, having your hair washed
at a beauty salon, or sleeping on your stomach.
A research paper published in
2001 in the Canadian Medical Association Journal found there is only a
one-in-5.85-million risk that a chiropractic neck adjustment will be associated
with a subsequent CAD and stroke.
In this new study, the Canadian
team looked at nine years of data in
According to the study’s authors, “Because the association between
chiropractic visits and VBA stroke is not greater than the association between
PCP visits and VBA stroke, there is no excess risk of VBA stroke from
chiropractic care.” (SEE STUDY BELOW)
Chiropractic:
Safer Than Common Pain Medications, Studies Show
Recent news reports on the risks of chiropractic cervical manipulation, or neck
adjustments, have needlessly alarmed patients about one of the most safe and
effective treatments in health care today, according to the American
Chiropractic Association (ACA).
The ACA believes that patients have the right to know about the health risks
associated with any type of treatment, including chiropractic. However, health
care consumers should be aware that the risks associated with chiropractic
treatment are "infinitesimally low," according to Dr. William J. Lauretti, an ACA member and chiropractic researcher from
Despite statistics from dozens of studies demonstrating the safety of
chiropractic treatments, recent news reports have alleged that chiropractic
neck adjustments can frequently damage arteries in the neck that carry blood to
the brain, possibly leading to a stroke. However, according to a study by the
Rand Corporation, a serious adverse reaction from cervical manipulation occurs
less than once in 1 million treatments. The study also showed that on the
rare occasion of an adverse reaction, it is often the result of the procedure
being performed by a health professional (M.D., P.T.) who is inexperienced or inadequately
trained in spinal manipulation, rather than by a licensed doctor of
chiropractic. Other scientific textbooks and reports have estimated the
risk to be even more minute -- as low as one in 10
million treatments.
During their five-year post-graduate education, doctors of chiropractic are
alerted to possible risk factors and taught when to modify their technique or
refer a patient for other specialty care. Risk management is also a frequent
topic in the continuing education seminars that most states require practicing
chiropractors to attend annually.
"Chiropractic researchers have published dozens of studies in recent years
that will help chiropractors identify the rare patients who have risk
factors," notes Dr. Lauretti. "Studies
recently published in the chiropractic literature have found that the risks
associated with chiropractic treatments are less than or similar to the risks
associated with other conservative treatments often used for similar
conditions, such as common prescription and non-prescription medications. Other
recently published and ongoing studies are testing the validity of
pre-treatment screening tests, and devising strategies for even further
minimizing the risks of chiropractic neck treatments." Dr. Lauretti adds that he performs neck adjustments on patients
"thousands of times a year" in his practice, and also performs them
on his wife and other loved ones. He also frequently receives neck adjustments
himself.
When compared to the number of illnesses and deaths that will occur this year
from the use of prescription and over-the-counter drugs, the number of serious
complications from chiropractic treatment is extremely low. A study
published in the April 15, 1998 issue of the Journal of the American Medical
Association found that more than 2 million Americans become seriously ill every
year from reactions to drugs that were correctly prescribed and taken; 106,000
Americans die annually from those side effects.
Complications from non-steroidal anti-inflammatory drugs (NSAIDs)
-- a group that includes prescription and non-prescription pain medications
such as aspirin and ibuprofen -- are responsible for 16,500 deaths each year,
according to the New England Journal of Medicine. To put this in perspective,
approximately 16,500 people died of AIDS in the
In addition, a more recent study conducted by the
"The time has come for the medical community and the media to focus their
efforts on warning patients about common procedures with very real risks
associated with them -- such as the inappropriate use of drugs and
surgery," said Dr. Lauretti. "Chiropractic
has been proven to be a safe and effective non-drug, non-surgical treatment for
a variety of conditions, and tens of millions of satisfied chiropractic
patients will attest to this fact."
SOURCE American Chiropractic Association
Medline
Articles on Chiropractic Safety
Supplementary Research Studies
Spine. 33(4S) Neck
Pain Task Force Supplement:S176-S183,
Cassidy, J David
DC, PhD, DrMedSc *+++; Boyle, Eleanor PhD *;
Abstract:
Study Design. Population-based, case-control and
case-crossover study.
Objective. To investigate associations between
chiropractic visits and vertebrobasilar artery (VBA)
stroke and to contrast this with primary care physician (PCP) visits and VBA
stroke.
Summary
of Background Data. Chiropractic
care is popular for neck pain and headache, but may increase the risk for VBA
dissection and stroke. Neck pain and headache are common symptoms of VBA
dissection, which commonly precedes VBA stroke.
Methods. Cases included eligible incident VBA strokes admitted
to
Results. There were 818 VBA strokes hospitalized in a
population of more than 100 million person-years. In those aged <45 years,
cases were about three times more likely to see a chiropractor or a PCP before
their stroke than controls. Results were similar in the case control and case
crossover analyses. There was no increased association between chiropractic
visits and VBA stroke in those older than 45 years. Positive associations were
found between PCP visits and VBA stroke in all age groups. Practitioner visits
billed for headache and neck complaints were highly associated with subsequent
VBA stroke.
Conclusion. VBA stroke
is a very rare event in the population. The increased risks of VBA stroke
associated with chiropractic and PCP visits is likely due to patients with
headache and neck pain from VBA dissection seeking care before their stroke. We
found no evidence of excess risk of VBA stroke associated chiropractic care
compared to primary care.
·
Inappropriate use of the title chiropractor and term
chiropractic manipulation in the peer-reviewed biomedical literature.
Wenban AB. Chiropr Osteopat. 2006
Aug 22;14(1):16 [Epub ahead
of print]
ABSTRACT: BACKGROUND: The misuse of the title chiropractor and term chiropractic manipulation, in relation to injury associated with cervical spine manipulation, have previously been reported in the peer-reviewed literature. The objectives of this study were to - 1) Prospectively monitor the peer-reviewed literature for papers reporting an association between chiropractic, or chiropractic manipulation, and injury; 2) Contact lead authors of papers that report such an association in order to determine the basis upon which the title chiropractor and/or term chiropractic manipulation was used; 3) Document the outcome of submission of letters to the editors of journals wherein the title chiropractor, and/or term chiropractic manipulation, had been misused and resulted in the over-reporting of chiropractic induced injury. METHODS: One electronic database (PubMed) was monitored prospectively, via monthly PubMed searches, during a 12 month period (June 2003 to May 2004). Once relevant papers were located, they were reviewed. If the qualifications and/or profession of the care provider/s were not apparent, an attempt was made to confirm them via direct e-mail communication with the principal researcher of each respective paper. A letter was then sent to the editor of each involved journal. RESULTS: A total of twenty four different cases, spread across six separate publications, were located via the monthly PubMed searches. All twenty four cases took place in one of two European countries. The six publications consisted of four case reports, each containing one patient, one case series, involving twenty relevant cases, and a secondary report that pertained to one of the four case reports. In each of the six publications the authors suggest the care provider was a chiropractor and that each patient received chiropractic manipulation of the cervical spine prior to developing symptoms suggestive of traumatic injury. Regarding two of the four case reports contact with the principal researcher revealed that the care provider was not a chiropractor, as defined by the World Federation of Chiropractic. The authors of the other two case reports did not respond to my communications. Regarding the case series, which involved twenty relevant cases, the principal researcher conceded that the term chiropractor had been inappropriately used and that his case series did not relate to chiropractors who had undergone appropriate formal training. The author of the secondary report, a British Medical Journal editor, conceded that he had misused the title chiropractor. Letters to editors were accepted and published by all four journals to which they were sent. To date one of the four journals has published a correction. CONCLUSIONS: The results of this year-long prospective review suggests that the words chiropractor and chiropractic manipulation are often used inappropriately by European biomedical researchers when reporting apparent associations between cervical spine manipulation and symptoms suggestive of traumatic injury. Furthermore, in those cases reported here, the spurious use of terminology seems to have passed through the peer-review process without correction. Additionally, these findings provide further preliminary evidence, beyond that already provided by Terrett, that the inappropriate use of the title chiropractor and term chiropractic manipulation may be a significant source of over-reporting of the link between the care provided by chiropractors and injury. Finally, editors of peer-reviewed journals were amenable to publishing letters to editors, and to a lesser extent corrections, when authors had inappropriately used the title chiropractor and/or term chiropractic manipulation.