The other week while visiting with a patient during one
of her appointments, she presented me with an article that her husband found in
a past edition of the Reader’s Digest.
It was a short snippet from an internist (MD) in Michigan stating that
he advised his patients that if they wanted to see a chiropractor that was fine
“but don’t let them touch your neck”. He
states that this was because he has had a “number of patients over the years
that have had strokes after chiropractic neck manipulations.”
I really found this amazing that he himself has seen “a
number” of such patients.
Can significant
complications occur? It seems that they can, according to case reviews.
Are they that common that one medical practitioner
should see “a number of them”?
Statistically, no!
Chiropractic adjustments (manipulation), even of the
neck, is an extremely safe procedure when performed by a highly trained
practitioner such as a doctor of chiropractic.
If it were not, malpractice liability premiums for doctors of
chiropractic would not be among the lowest of all diagnostic level health
providers.
This margin of safety is
maintained due to the history of past health and of the current complaint which
is done with each patient.
This is then
followed up with screening tests for possible complications and possibly
confirmatory x-ray or other special studies.
If the doctor of chiropractic practices “due diligence”, chiropractic
care is extremely safe.
It can be much
safer in fact than the use of
many over
the counter remedies and pain relievers.
A research paper published in 2001 in the Canadian Medical
Association Journal found 23 reported strokes over a 10 year period. This is only a one in 5.85-million risk that
a chiropractic neck adjustment will be associated with a subsequent stroke. Other studies have placed the risk at
1 in 500,000 to 1 in one million visits resulting in a serious event requiring
medical attention.
In contrast, a
statistical review in the March 2000 issue of the journal
Pain, authors
calculated that 1 in 1,200 patients taking
NSAIDs
(
Aspirin, Ibuprophen, Celebrex, Motrin,
Toradol, Relefen, Aleve, Lodene and others) for at least 2 months will die
from stomach and intestinal complications.
I often ask those inquiring about this subject if they know anyone,
personally, who has been hospitalized after receiving a “routine” medical
procedure or taking a prescribed medication.
The answer is almost 100% of the time YES.
In contrast I will ask them if they,
personally, know someone that has been hospitalized due to a chiropractic
adjustment.
The answer to that is almost
100% of the time NO.
In the February 2008 journal, Spine, 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 authors
also noted that neck manipulation “is unlikely to be a major cause” of these
rare stroke events. It is
doubtful whether a neck manipulation, as it is practiced by chiropractors,
would have the force to damage healthy arteries. This seems to be supported by
the significant number of patients who are treated without incident.
This issue tends to creep into the media from time to
time.
While it is an unfortunate
complication that can happen, a handful of case and retrospective studies
indicate that it is extremely rare and no more common that might be expected to
happen with everyday life activities.
Routine daily activities that can create
the situation which is proposed to cause strokes, such as sudden neck rotation
and extension, these include over the shoulder checking while driving, sports,
lifting, working overhead, falls, getting your hair washed at a salon, sneezing,
and coughing.
To put the above mentioned risks into perspective let’s
use the mid range number of 1 in 1,000,000 (that’s one million) figure. We should consider that a review of risks
which appeared in the September 1980 edition of JAMA found these “voluntary
risks” in everyday activities:
Activity Risk
of Death per Person per Year
Smoking: 20
cigarettes/day 1
in 200
Drinking: 1 bottle of
wine per day 1 in 13,300
Football (Soccer) 1
in 25,500
Automobile driving (UK) 1
in 5,900
Motorcycling 1 in 50
Rock climbing 1
in 7,150
Taking contraceptive
pills 1 in
5,000
Power boating
1 in 5,900
Skiing 1
in 430,000
Pregnancy (United
Kingdom) 1 in 4,350
Oh, returning to our
Michigan, internist friend! Extrapolating
from the above study finding 23 cases in ten years, adjusting for a complication
rate of 1 in 1,000,000, we could expect to see about 133 strokes per ten
years. This means that there would be
about 13 cases of stroke per year, nation wide.
This internist evidently is either an ambulance chaser for such cases,
practices in an area with some very sloppy chiropractors creating this “number
of cases” in his area or he is simply exaggerating the truth. But those are topics for other articles!
For your empowerment,
Dr. Heller
In their new book "Selling Sickness:" authors Ray Moynihan and Alan Cassels, MD examine the tendency of the healthcare industry to ignore lifestyle-based primary prevention, focused on the three pillars of
diet, exercise and stress management, and over the past generation, increase emphasis on mass screenings of
asymptomatic populations for early signs of disease, and for markers
(blood tests, radiologic findings) that might indicate an increased
likelihood of disease in the future, thereby finding new customers for their products and services.
