Check the evidence on treating neck pain
The article "Consider safety of chiropractors' vigorous neck manipulations" by Susan Berger in the Jan. 20 edition describes disturbing patient stories that would concern anyone considering chiropractic care. But since similar stories can be told by patients having adverse events from any medication, surgical procedure, or other intervention used in treating neck pain, examining the evidence becomes crucial.
The literature used to support the story appears designed to arrive at a predetermined conclusion. The writer states that evidence of chiropractic manipulation for neck pain is inconclusive. Yet several recent studies, systematic literature reviews and the most extensive multidisciplinary panel to develop guidelines for the treatment of neck pain show spinal manipulation is an effective treatment, particularly when manipulation is combined with other treatments given by chiropractic physicians such as massage, exercise and proper instructions for home care.
The current best evidence indicates manipulation is much safer than medications or surgery used in treating neck pain. In addition, the association between spinal manipulation and stroke has been found to be generally coincidental rather than causal. The largest population-based study included all VBA strokes in Ontario, Canada, over nine years. It found no evidence of excess risk of VBA stroke associated with chiropractic care. The prevailing hypothesis is that patients with vertebral artery dissections often have initial symptoms that cause them to seek care from a chiropractic or medical physician. The stroke is independent of their visit. This study provides higher quality evidence than previous case reports, case series, and physician surveys frequently referenced when discussing spinal manipulation.
We appreciate the Daily Herald's interest and agree that individuals be fully informed on this issue. Those who assess the evidence will likely conclude that the benefits of manipulation significantly outweigh the risks.
Gregory D. Cramer, DC, Ph.D.
Batavia
Dean L. Smith, DC, Ph.D.
Oxford, Ohio
Jerrilyn A. Cambron, DC, MPH, Ph.D.
Lombard