19 Apr Latest Research on Risk of Stroke and Manipulation
THE LATEST RESEARCH …In a recent Cochrane review for mechanical neck disorders, manipulation made it into the highest level of evidence. No medical interventions achieved this level of evidence. CMT: safe and effective. Use of prescription drugs: much less safe and proven to be ineffective for managing spinal pain. In the Rand study, it was found that the risk for severe complication from CMT, which would include Vertebrobasilar artery dissection(VAD) and/or stroke, some of which are self-limiting and some of which are not, or are fatal, is about one in 400,000 to one in a million. Based on these figures, we could expect about 83-250 serious complications from cervical CMT(chiropractic manipulative therapy) in the U.S. each year. Placing public health issues in contrast, one of the most common treatments medical providers use to treat neck pain is NSAIDs. According to government statistics, 33,000 people die each year of complications from taking NSAIDs.4 A JAMA study reported that about 106,000 died in the year 1994 from adverse drug reactions(ADR),5 while 2.5 million suffered drug-induced diseases. A new study by Cassidy et. Al, which was part of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders project, is now the definitive study on the subject of stroke risk and cervical manipulation. This study looked at all the residents of Ontario, Canada over a 9-year period (1993-2002). This represents the equivalent of 109 million person-years of observation. Their design looked at not only visitations to chiropractic physicians in the period preceding the stroke, but also visits to their primary care physician (PCP). The idea in this design is that a PCP, in their work up of patients, is unlikely to subject them to a maneuver that might produce a stroke. They concluded that the odds ratio (statistic of probability) was about the same for both groups. They concluded that patients with a VBA stroke are likely to consult with their PCP or chiropractic physician because of their symptoms, meaning the stroke incident was already underway. Meanwhile, practitioners of CMT should remain highly vigilant concerning the possibility of VAD. These patients may present with neck pain and/or headaches-usually one sided and described as a quality and severity of pain the patient has never experienced in the past. REFERENCES 1. Coulter ID, Hurwitz EL, Adams AH, Meekr WC, Hansen DT, Mootz RD, Aker PD, Genovese BJ, Shelkelle PG. The appropriateness of manipulation and mobilization of the cervical spine. 1 ed. Santa monica: The RAND Corporation; 1996. 2. Croft A. Stroke risk from CMT? Is the pressure finally off? Florida Chiropractic Association Journal. July/August/September 2008. 3. Cassidy JD, Boyle E, Cote P, He Y, Hogg-Johnson S, Silver F, Bondy S. Risk of vertebrobasilar stroke and chiropractic care: Results of a populationbased-control and cross-over study. Spine. 2008; 33(45):S176-183 4. Wolf SMea. Worst Pills, Best Pills. A Consumer’s Guide to Avoiding Drug-Induced Death & Illness. New York: Simon & Schuster, Inc. 2005 5. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998;279(15):1200-5. 6. Cassidy JD, Boyle E, Cote P, He Y, Hogg-Johnson S, Silver F, Bondy S. Risk of vertebrobasilar stroke and chiropractic care: Results of a populationbased-control and cross-over study. J Manipulative Physiol Ther.2009 Feb;32(2 Suppl):S201-8.