Here we go again.
A medical association has seen the need to warn the public about the risks of chiropractic care. The American Heart Association and American Stroke Association just released a “scientific statement” that chiropractic treatment is associated with stroke.
So what are the risks? First, a little background. There is a rare type of stroke that involves the arteries that course along the back of the neck to the brain, called the vertebrobasilar arteries, or VBA. If these arteries are damaged, they can interfere with blood supply to the brain, eventually leading to a stroke. Unlike most other strokes, this is usually a prolonged process, which can take a few weeks or more. While the process is unfolding, the person typically complains of neck pain and headache. This is before the blood supply to the brain is affected.
A large study was done in Ontario to determine if chiropractic care causes VBA strokes. They reviewed the medical records of 9 million residents, over the past 12 years, looking for cases of VBA stroke. They identified 818 total. That means such strokes happen about 7.5 times per million people, per year. Most people recover fully; only about 5 percent of cases are fatal.
To assess the risk of stroke from chiropractic treatment, the researchers then reviewed the records to see in how many of these cases an individual saw a doctor of chiropractic in the month before the stroke was diagnosed. The numbers are revealing: only 4 percent — about 36 people out of 818 — who had a VBA stroke had seen a chiropractor in the previous month. However, 51 percent had seen a medical provider in that time. The diagnosis for the vast majority of all these patients was neck pain and headache.
The researchers concluded that the chiropractic treatment did not cause the strokes, since the risk of having a VBA stroke was the same whether the patient saw a medical or a chiropractic doctor. The patients called the doctors’ offices for the neck pain caused by the artery damage, often weeks before blood flow to the brain was affected. Whether the patient saw a medical doctor or a chiropractic doctor did not affect the outcome; the process had already been set in motion. The manipulation typically done by the doctor of chiropractic, which was blamed by the medical associations for causing these strokes, seems not to be a factor.
I can understand why there might be concern about neck manipulation; I still recall the noise that came from my neck the first time I was treated. But that doesn’t mean it is a dangerous treatment, and the numbers support this.
Despite the noise, it does not take a lot of force to treat the neck, and these forces are not great enough to damage the arteries. Also, this treatment is very effective for neck pain and headache; it certainly was for me. The true cause of VBA stroke is most likely the same process that affects the arteries to the heart: the development of plaques and hardening of the walls of the artery.
Next, let’s compare the safety record of neck manipulation to medical care for neck pain and headache. The most common medical treatment for pain is a class of drugs called NSAIDs; these are anti-inflammatory medications including Aleve, Motrin, Advil, ibuprofen, or aspirin. These drugs have very serious, and common, side effects. One review of NSAIDs found that long-term use caused life-threatening bleeding in 1.5 percent of users.
All NSAIDs increase the risk of stroke, with ibuprofen being the worst, tripling your risk. They are also associated with heart problems, including atrial fibrillation, dementia, kidney damage, and raising blood pressure.
A very conservative estimate found that NSAIDs are responsible for 16,500 deaths per year, and this figure includes only deaths from gastrointestinal complications. According to the authors, if all NSAIDs-related deaths were included, the numbers would be “overwhelming.”
Despite these dangers, over 100 million NSAIDs prescriptions are written in the U.S. every year.
Of course, the risks from NSAIDs pale in comparison to the opiate drugs such as OxyContin, which are also used for pain. These drugs are fueling a deadly wave of drug addiction throughout our country and deaths are skyrocketing. According to the CDC, overdose deaths rose from 4,000 in 1999 to 16,650 in 2010, and show no signs of letting up.
Statistically, chiropractic treatment is far less likely to cause problems than any medication. Also, a side benefit of neck manipulation is reducing the need for these painkillers. The majority of my patients are taking NSAIDs when they start care, and some are on opioids; many have been on them for years. Most are able to greatly reduce or eliminate the use of these drugs after a course of chiropractic care.
So I am releasing my own “scientific statement”: If you suffer from neck pain and/or headache, call a doctor of chiropractic first. We are trained to evaluate patients for VBA stroke and other serious conditions. The treatments we provide are not only very effective, they are literally thousands of times safer than the drugs prescribed by medical providers.
If you are still concerned about having your neck treated manually, then be sure to talk to your doctor of chiropractic about it. I’m sure they will be able to offer an alternative style of manipulation for you.
Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at firstname.lastname@example.org.