Chiropractic and Stroke
Assault on Chiropractic
Recently the news has been covering the subject of risk of stroke from chiropractic adjustments. The sudden media interest stems from hearings that the Connecticut Board of Chiropractic Examiners held to address the question of mandatory informed consent that addresses the risk of stroke when a chiropractic physician performs a neck adjustment.
First a little background. Over the past few years a group calling themselves Victims of Chiropractic Abuse (VOCA) has been placing billboards and advertisements around the state asking if you’ve been injured by a chiropractor or warning that chiropractic adjustments cause strokes. In addition they have repeatedly attempted to pass informed consent legislation that singles out the chiropractic profession and stroke. After multiple Public Health Committee hearings, they have not been successful. Interestingly, this group never approached the Connecticut Chiropractic Association to discuss their concerns.
Last June the Connecticut Chiropractic Association (CCA) chose to file a petition with the Department of Public Health and the Chiropractic Board of Examiners asking for a Declaratory Ruling on the issue of informed consent for cervical spine manipulation and stroke. At the same time the CCA and VOCA signed an agreement to allow due process of the petition and hearings without either group having any direct contact with the board or the media. Apparently someone broke the agreement. Any guess who it was?
So what really is the risk from a cervical adjustment? The risk of stroke has been estimated at one in 4 – 5 million chiropractic neck adjustments. Other injuries? Well the odds of suffering a serious complication from a chiropractic neck treatment are about one in 2 million. These numbers are no exaggeration. In other words, the risk is remote.
A better risk indicator may be the cost of malpractice. The average malpractice
insurance rate for doctors of chiropractic across the country is
$1,500. For general physicians (MDs), rates range from $10,000 to
$20,000–depending on the area of the country. Here in Connecticut I pay about $2,000 through the Connecticut Medical Insurance Company.
In my opinion, VOCA and the recent media blitz intends to scare people away from chiropractic care and may in fact put them at much greater risk of injury from treatment like over-the-counter and prescription anti-inflammatory and pain medication. They have no intention of protecting the public and their agenda is to smear chiropractic. I also find it offensive that a group would call themselves Victims of Chiropractic Abuse. The many chiropractic physicians that I know are dedicated to their patients’ health care and take this responsibility very seriously. I know I do.
Check out CTChiro for the current research.
Back Surgery
Back Surgery Compared to Non-Surgical Treatment
People with severe back pain due to a ruptured disk usually recover
whether they have surgery or decide to wait it out, though an operation
brings immediate pain relief. And contrary to what many people are told
by their surgeons, avoiding surgery does not result in nerve damage.
These findings are from a large clinical trial published in November 2006 in
the Journal of the American Medical Association.
Many back surgeons criticized this trial before it began because
they were convinced of disk surgery’s benefit. Some refused to refer
their patients to a trial they saw as unethical because surgery would
be withheld from some study participants, a necessary component to a
study intended to randomly assign half to non-surgical treatment.
But the research team led by James N. Weinstein, DO, Dartmouth
Medical School, had these justifications for going ahead: 1) ruptured
disks are often seen on the CT or MRI scans of people without any back
symptoms and these scans also show that untreated ruptured disks can
regress in time; 2) the rate of disk surgery in some regions of the
U.S. is 15 times higher than that of other regions and other Western
countries, thus raising suspicion that many disk operations are
unnecessary.
The clinical trial went forward despite surgeons’ objections, and
2,000 people were treated at one of 13 U.S. spine clinics. All had
scan-confirmed disk herniation and the persistent back and leg pain of
sciatica for at least six weeks. Some of the participants agreed to be
assigned randomly to receive either back surgery or non-surgical
therapy (physical therapy and counseling and anti-inflammatory
painkillers). Other participants, however, wanted to choose their own
treatment, and they formed the basis of a separate trial called an
observational study.
The results did not identify one treatment as superior to the other
because so many study participants “crossed-over.” Only 50% of the
people assigned to undergo surgery actually had the operation, and 30%
of those assigned to non-surgical therapies decided to have the
operation.
A co-author of the observational study Richard A. Deyo, MD,
Professor of Medicine and of Health Services, University of Washington,
Seattle, was asked for the take-home message of both trials. “Most
people got better, regardless of whether they had surgery. Surgery
typically offered faster relief, but by two to four years, people are
the same whether or not they had surgery,” he responded in a telephone
interview. Surgery can be avoided, if the pain is tolerable and the
patient is “risk averse,” he explained, referring to the small but
definite risks of surgery, such as nerve injury, scarring, and
anesthesia mishaps.
The risks of surgery, though small, are greater than any risk of the
wait-and-see approach, he continued. “Many people have the impression
they will become paralyzed or [suffer] permanent muscle weakness if
they delay, but patients needn’t worry.”
Will the new findings reverse back surgeons’ opinions? “This study
replicates a trial done in Norway 30 years ago with much the same
results,” said Dr. Deyo, noting that many American back surgeons could
be unaware of this trial. “It might bring some surgeons up to date,” he
said, answering the question of whether the findings will reduce the
country’s high number of herniated disk operations, estimated to be
300,000 yearly.
“But it’s spinal fusion surgery that is now the most controversial,”
said Dr. Deyo, referring to another back surgery now done in excess.
“It has exploded [in growth] over the last decade, and there is no
evidence for it.” There are huge financial interests involved in terms
of equipment, hospitals, and physicians, explained Dr. Deyo, and the
circumstances for which the operation may be warranted, such as
spondylolisthesis (vertebrae out of alignment), spinal fracture, and
cancer metastasis to the spine—are all uncommon.
Center for Medical Consumers
High Dose Fish Oil for Back and Neck Pain
Alternative to NSAIDs
Investigators at the University of Pittsburgh have treated chronic pain patients with high doses of omega-3 fatty acids – the ingredient found in many cold-water fish species such as salmon. The researchers say their findings suggest that this could be the answer to the adverse effects seen with non-steroidal anti-inflammatory drugs (NSAIDs), including cyclooxygenase (COX)-2 inhibitors, which have been associated with potentially catastrophic adverse effects.
Patients who took high doses of omega-3 oils were impressed enough with the outcomes that they chose to continue using the oils and fore go the use of NSAIDs. The 250 study patients suffered from chronic neck or back pain but
were not surgical candidates, and they had been using daily doses of NSAIDs.
This research was published in the medical journal Surgical Neurology in April 2006. Comments from the abstract include:
- Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain.
- The use of NSAIDs are associated with “extreme complications, including gastric ulcers, bleeding, myocardial infarction, and even deaths.”
- An alternative treatment with fewer side effects that also reduces the inflammatory response and thereby reduces pain is believed to be omega-3 EFAs found in fish oil.
- At an average of 75 days on fish oil, 59% discontinued taking their prescription NSAIDs for pain and 88% stated they would continue to take the fish oil.
- There were no significant side effects reported.
- “Our results mirror other controlled studies that compared ibuprofen and omega-3 EFAs demonstrating equivalent effect in reducing arthritic pain.”
- Omega-3 EFA fish oil supplements appear to be a safer alternative to NSAIDs for treatment of nonsurgical neck or back pain.
We use a concentrated Omega-3 from Pure Encapsulations that provides a much higher dosage with less risk of burping.
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