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Author Topic: chiropractic care really effective or placebo effect? Is it safe?  (Read 1506 times)
loco
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« on: May 20, 2008, 11:41:51 AM »

"manipulation of the neck has been associated with injury to the blood vessels supplying the brain. Rarely, neck manipulation may cause a stroke." - Mayo Clinic
http://www.mayoclinic.com/health/back-pain/SA00080
 
"Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation." -  Edzard Ernst, MD
http://jrsm.rsmjournals.com/cgi/content/full/100/7/330

Maintenance care in chiropractic - what do we know?
There is no evidence-based definition of maintenance care and the indications for and nature of its use remains to be clearly stated.

It is likely that many chiropractors believe in the usefulness of maintenance care but it seems to be less well accepted by their patients.

The prevalence with which maintenance care is used has not been established.
Efficacy and cost-effectiveness of maintenance care for various types of conditions are unknown.
http://chiroandosteo.com/content/pdf/1746-1340-16-3.pdf

Chiropractic and Scoliosis
..."Dr. Lantz and his colleagues are currently conducting a scoliosis research project to explore the effectiveness of chiropractic in the management of children ages 9-15 with mild to moderate scoliosis (less than 25" curve). This is the first clinical trial ever to look at the effect of chiropractic on scoliosis."...

..."Virtually no formal research exists documenting chiropractic's effectiveness in managing scoliosis. We are excited about the potential benefits of this study and we believe the scoliosis community is well served by a collaborative effort such as this. This is perhaps best expressed in their project grant application, "Given that chiropractic has long claimed success in treating patients with mild scoliosis, it seems reasonable and timely to validate the extent to which that claim is valid." ...

..."Virtually no formal research exists documenting chiropractic's effectiveness in managing scoliosis, although anecdotal reports abound. Several well-conducted case studies suggest that chiropractic is, indeed, effective in managing scoliotic curves, but the definitive studies are lacking. It is widely stated that chiropractic care is effective in alleviating the pain and discomfort associated with adult scoliosis, however, no studies to date have adequately documented this effect."... -
Charles A. Lantz, D.C., Ph.D. is Director of Research at the Life Chiropractic College West in San Lorenzo, California
http://www.scoliosis.org/resources/medicalupdates/chiropractic.php

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loco
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« Reply #1 on: May 23, 2008, 10:24:10 AM »

Deadly twist: Neck adjustments can be risky
Chiropractor's move can trigger strokes in healthy patients

MSNBC
June. 17, 2007

“An evaluation of chiropractic visits and other complementary treatments for lower-back pain conducted by Harvard Medical School in Boston found the therapies “did not result in clinically significant improvements in symptom relief or functional restoration.”…
 
…“Injuries that can occur on a chiropractor’s table include soft tissue damage, joint dislocations and bone fractures in the neck and back. The most common problem is disk injury in the neck or lower back, which can be extraordinarily painful. (In 1999, Karen Santorum, wife of former Pennsylvania Senator Rick Santorum, won $175,000 in court after suffering a herniated disk at the hands of a chiropractor.)”…

…“Wade S. Smith, M.D., director of the Neuro-vascular Service at the University of California at San Francisco, was the lead author of a 2003 study in the journal Neurology that confirmed the connection between cervical manipulation and stroke.”...

…”Brittmarie Harwe, 40, of Wethersfield, Connecticut, received an out-of-court settlement of $900,000 after a 1993 manipulation that permanently paralyzed one of her vocal cords and left her unable to swallow food; she nourishes herself through a stomach tube. In December 2006, Rachelle Smith, a 32-year-old mother of five in Olathe, Kansas, settled a case with her chiropractor for undisclosed damages and $70,000 in medical costs. She says that when she began to vomit after a neck adjustment — a sign of what would turn out to be a stroke — the chiropractor assured her that her body was simply “releasing toxins.”…

…“The expectation of benefit is almost negligible. The risk, though small, is very real,” says Dr. Stewart, one of whose patients had part of her brain removed after a cervical manipulation mangled both of her vertebral arteries. “You can’t predict who this will happen to, and for that reason alone, it just shouldn’t be done.”…

MORE:
http://www.msnbc.msn.com/id/18871755/
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« Reply #2 on: May 27, 2008, 06:45:18 PM »

Great forum where honest, former chiropractors and soon-to-be former chiropractors post.

http://chirotalk.proboards3.com/?board=careerchange&action=display&thread=1765&page=17
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« Reply #3 on: May 29, 2008, 11:41:25 AM »

I think Chirotalk has skewed opinions.  They're usually people who are disgruntled by their college or they were not successful in business or subscribed to a philosophy which is antiquated.   I even got sucked into reading this in my second year.  but I equate this to fear-mongering on the less-knowledgable.  Even patients who have become disgruntled with their own situations.  It offers advice and discussion that is otherwise not verified.

I don't believe the spinal adjustment is for everyone, obviously there are screens and due diligences that every doctor must observe.    Doctors must be aware of signs and symptoms of a stroke in progress (like dizziness, slurred speech, blurred vision, etc..)   There are always a wide spectrum of competencies in every profession:  Teachers, Lawyers, Doctors of Medicine, and Doctors Of chiropractic, etc.... 

The above mentioned papers cite research, yes, but take a close look at the populations they included in the study..  and take a look at the quality of study.   The inclusion/exclusion criteria is not very strong.   A paper only needed to be before 2000 to be included.  That's basically 7 year old research at the time of publication.  No real disqualifiers of any papers.  Furthermore, they did not critique the quality of research the papers presented in the review.  They also included manipulations done by NON-CHIROPRACTORS..  so basically people who have taken a weekend course and call themselves manipulators, as opposed to the 4 years post graduate study and constant training and evaluation and that chiropractors had gone through in Chiropractic College.

but let's also not forget that the numbers of adverse effects to Spinal Manipulation are essentially DROWNED out by the thousands of failed surgeries that must be repeated, or deaths on operating tables that happen every year.  The risk of having a stroke from seeing a chiropractor is virtually the same as that of seeing a family doctor.   Here's the source and abstract:

Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study.
Cassidy, J David DC, PhD, DrMedSc; Boyle, Eleanor PhD; Cote, Pierre DC, PhD; He, Yaohua MD, PhD; Hogg-Johnson, Sheilah PhD ; Silver, Frank L. MD, FRCPC; Bondy, Susan J. PhD

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 Ontario hospitals from April 1, 1993 to March 31, 2002. Four controls were age and gender matched to each case. Case and control exposures to chiropractors and PCPs were determined from health billing records in the year before the stroke date. In the case-crossover analysis, cases acted as their own controls.

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.


I'll just leave you with one final thought....
How many people have had spine surgery on the wrong spinal segment?   How many people have had knee surgery or hand surgery on the wrong side?  How many people have had to go back for more surgery after having surgery for something that could have been solved with simple rehab?

I encourage everyone to search reputable sources, and not just discussion boards..  because who really is an expert?  Not me, and not anyone else on this thread either.

Here's one conclusion from a paper in Spine, 33(2) 194-198.
Conclusion. There is a high prevalence of wrong level surgery among spine surgeons; 1 of every 2 spine surgeons may perform a wrong level surgery during his or her career. Although all spine surgeons surveyed report using at least 1 preventive action, the following measures are highly recommended but inconsistently adopted: direct preoperative communication with the patient by the surgeon, marking of the intended site, and the use of intraoperative verification radiograph.

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« Reply #4 on: May 29, 2008, 11:48:49 AM »

sorry..  the reference for the abstract is

SPINE, 33(4S) Supplement : 15 February 2008, pp S176-S183


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« Reply #5 on: July 15, 2008, 03:13:18 PM »

Yes it is effective.
Yes it is safe.
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