Chiropractic for high blood pressure?

[OMGturt1es]

I see you continue to avoid identifying yourself, your profession, or your interest in this matter, other than being the manager of a biased EBM website. How cowardly of you.

Attack the argument, not the arguer.

1. People come to chiropractors because they suffer from neck pain, headaches or low back pain. They have been doing this in increasing numbers, even though folks like you try to paint my profession as a quasi-religion.

Consumers also buy Head On, select incandescent over CFL or LED bulbs, and purchase vehicles that are far larger than they really need. Consumer selection is not a reliable proxy for product utility.

A very recent meta-analysis by the Dutch Institute for Health Care Improvement, and published in the European Spine Journal reviewed 17 randomized controlled trials for pain treatments: NSAIDs (n = 4), antidepressants (n = 5), and opioids (n = 8). Amazingly, no studies were found for muscle relaxers. Their conclusions were that NSAIDs and opioids “seem to lead to a somewhat higher relief in pain on the short term, as compared to placebo” (or no treatment at all!), “in patients with non-specific chronic low back pain, and that both types of medication show more adverse effects than placebo”. (What an elegant understatement that is!). [1] Even the least-supportive studies on spinal manipulation found that chiropractic care is "at least" as effective as pain meds, while many others find that chiropractic care is orders of magnitude superior to "usual medical management". Our Blog (www dot chiro dot org) is loaded with such studies.

My understanding is that data generally indicate that all professions equally suck at treating lower back pain.

I'm currently down with a herniated disc. Position and posture definitely impact nerve irritability. It seems reasonable that chiropractors could develop treatments that may offer some benefit for these sorts of problems. But it does not appear they've yet done so. Taken as a whole, it appears, absent surgery, bed rest and natural healing are just as good as anything else. Surgery seems to be the only treatment that can actually beat bed rest, but then the recovery from surgery is often just about as long as natural healing, so surgery really a solution for those folks who aren't healing very quickly.

Finally... if chiropractic had ACTUALLY been PROVEN to be dangerous, why would our Malpractice Insurance rates be the LOWEST of any "healing" profession? Do you also claim to know more than the the Insurance Industry?

My insurance covers 100% physical therapy for my herniated disc. This is a treatment that appears to offer zero benefit over bed rest. I'm not convinced insurance companies are really following the journals.

My understanding is that potential chiropractic hazards (e.g., dissection) are still not well understood. Attribution is tricky. It doesn't appear there's enough data yet to prove or disprove risk. My guess is that if sufficient data accumulate to prove risk, and if lawyers are made aware, your rates will increase.

 

[Blue Wode]

People come to chiropractors because they suffer from neck pain, headaches or low back pain. They have been doing this in increasing numbers, even though folks like you try to paint my profession as a quasi-religion.

In increasing numbers? Are you sure about that? If the following is anything to go by, I don’t see how that’s possible:

“Although four possible scenarios were given by Dr. Bezold, it’s clear the worst case scenario, Scenario #2: Downward Spiral, is the most accurate now inasmuch he said 15% of DCs have quit the profession. Meanwhile, there has been a 39% drop in chiro education student enrollment from 1969-2002 and, while the use of CAM in general has increased, the largest decrease occurred for chiropractic (9.9% to 7.4%) according to the recent Eisenberg study. Indeed, there’s little to cheer about when faced with the hard facts about this profession.”

http://chirotalk.proboards.com/index.cgi?action=display&board=outlook&thread=804&page=1

FYI, Dr Bezold’s four scenarios were lifted from here (a non-skeptic site):

The Future of Chiropractic Revisited: 2005 to 2015 Report & Online Poll
http://www.altfutures.com/future-chiropractic-revisited-2005-2015

Much is made of DD Palmer's employment history, as though the fact that he had been a greengrocer automatically invalidated his ability to observe, think or create.

Whatever he was, DD Palmer certainly seemed to be inconsistent. For example, in his 1910 textbook, The Chiropractor’s Adjuster, he wrote:

“Harvey Lillard, a janitor, in the Ryan Block, where I had my office, had been so deaf for 17 years that he could not hear the racket of a wagon on the street or the ticking of a watch… I made inquiry as to the cause of his deafness and was informed that when he was exerting himself in a cramped, stooping position, he felt something give way in his back and immediately became deaf. An examination showed a vertebra racked form its normal position. I reasoned that if that vertebra was replaced, the man’s hearing should be restored. With the object in view, a half-hour’s talk persuaded Mr Lillard to allow me to replace it.”

If he was as deaf as claimed, don’t you wonder how Mr Lillard could have heard what DD Palmer said to him in that half-hour conversation?

If this same group of people were forced to seek "evidence-based" medical care for their complaints, here's what they would be offered:

non-steroid anti-inflammatory drugs (NSAIDs)
muscle relaxants
opioids
antidepressants, and eventual
spinal surgery

–snip-

…it has been shown that 16,500 NSAID-related deaths occur each year among arthritis patients alone. The numbers of all NSAID deaths would be overwhelming, yet the scope of this problem is generally under-appreciated in your beloved medical literature.

Re NSAIDs, for a true comparison with chiropractic spinal manipulation one would have to take into account the following:

1. No prospective randomized trial conclusively demonstrates that chiropractic management reduces the incidence of serious NSAID complications, such as fatal gastrointestinal bleeding.

2. NSAIDs taken at recommended doses for a short time are generally very low-risk for appropriately selected patients — particularly the relatively young not on corticosteriods, anticoagulants, alcohol or tobacco and without a history of ulcers or severe comorbid illness.

3. Many patients continue to take NSAIDs while undergoing spinal manipulation. Moreover, spinal manipulation can frequently cause an exacerbation of pain, which might cause some patients to increase or initiate NSAID therapy. [Ernst E. Prospective investigations into the safety of spinal manipulation. Journal of Pain and Symptom Management, 21(3): 238-242, March 2001]

4. Herbal recommendations seem to be common among DCs; some remedies have actions similar to NSAIDs, while others directly affect bleeding per se. A recent set of reports by the North American Spine Society includes an 18-page reference chart listing approximately 70 herbs with their uses, potential side effects, and (known) potential interactions.

5. While side effects of low-back manipulation appear to be very uncommon, some chiropractic back-pain patients also receive neck manipulation, which entails additional risks.

6. Manipulation is much more expensive than NSAID treatment. So if both are equally effective, manipulation would be much less cost-effective.

http://www.chirobase.org/18CND/03/03-03.html

It’s also worth remembering that packets of NSAIDs contain Patient Information Leaflets detailing risks. However, it is evident that not all chiropractors warn patients about the risks associated with their manipulative treatments.

I would also venture that because the number of people taking NSAIDs is bound to be much higher than those receiving spinal adjustments, then NSAIDs are likely to be far safer. In addition to that, NSAIDs have been proven to work and their adverse effects are recorded and acknowledged:

“It is, of course, important to present any risk-benefit assessment fairly and in the context of similar evaluations of alternative therapeutic options. One such option is drug therapy. The drugs in question—non-steroidal anti-inflammatory drugs (NSAIDs)—cause considerable problems, for example gastrointestinal and cardiovascular complications. Thus spinal manipulation could be preferable to drug therapy. But there are problems with this line of argument: the efficacy of NSAIDs is undoubted but that of spinal manipulation is not, and moreover, the adverse effects of NSAIDs are subject to post-marketing surveillance while those of spinal manipulation are not. Thus we are certain about the risks and benefits of the former and uncertain about those of the latter. Finally, it should be mentioned that other therapeutic options (e.g. exercise therapy or massage) have not been associated with significant risks at all.”

I would recommend reading the whole paper from which the above quote was lifted:
http://jrsm.rsmjournals.com/cgi/content/full/100/7/330

A most recent in-depth review, published in the Feb 15, 2008 Spine Journal was completed by members of the Spine Decade Task Force. It reviewed 10 years worth of hospital records, involving 100 million person-years. Those records revealed no increase in vertebral artery dissection risk with chiropractic, compared with medical management, and further stated that “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.”

The Spine review looked at the records of patients who were admitted for head and neck pain and compared medical visits with chiropractic visits to determine which group had the greatest number of strokes. It did not look at chiropractic patients who had a stroke as a result of neck manipulation who were treated for problems unrelated to head and neck pain, such as low-back pain and general health problems or for "maintenance care" on asymptomatic patients.

It’s worth noting that even the NICE guidelines for low back pain failed to consider that point, as Professor Edzard Ernst observed:

“So why were these risks not considered more seriously? The guideline gives the following reason: ‘The review focused on evidence relevant to the treatment of low back pain, hence cervical manipulation was outside our inclusion criteria’. It is true that serious complications occur mostly (not exclusively) after upper spinal manipulation. So the guideline authors felt that they could be excluded. This assumes that a patient with lower back pain will not receive manipulations of the upper spine. This is clearly not always the case.

Chiropractors view the spine as an entity. Where they diagnose ‘subluxations’, they will normally manipulate and ‘adjust’ them. And ‘subluxations’ will be diagnosed in the upper spine, even if the patient suffers from back pain. Thus many, if not most back pain patients receive upper spinal manipulations. It follows that the risks of this treatment should be included in any adequate risk assessment of spinal manipulation for back pain.”

Edzard Ernst, Int J Clin Pract (18th August 2009)
http://tinyurl.com/6b6nkzg

In relation to that, it’s interesting to read what Sharon Mathiason, a mother whose daughter died following chiropractic neck manipulation for a tailbone injury, had to say in a letter in which she questioned the integrity of the leader author of the Spine review, J. David Cassidy:

The Globe and Mail [a publication in which the review was featured] is also negligent in not identifying the principal author, David Cassidy, as a chiropractor, one who has been sued in Saskatchewan, in 1999, by his research assistant for falsifying data, and one whose work is stated in the New England Journal of Medicine as “all of the study’s authors conclusions are completely invalidated by their methods”.

More…
http://www.chirowatch.com/Chiro-strokes/gm080120stroke.html

Finally, returning to the topic of this thread, here’s what the veteran, evidence-based chiropractor, Samuel Homola, has to say about the blood pressure study:

"Members of the National Upper Cervical Chiropractic Association (NUCCA) specialize in adjustment of the atlas, using the procedure as an exclusive treatment for a great variety of ailments…The NUCCA approach to treating human ailments received unexpected support recently when a pilot study published in a legitimate medical journal suggested that correcting atlas misalignment would reduce early high blood pressure…The minor atlas subluxations routinely found by NUCCA chiropractors have not been proven to be significant. I would be surprised if a legitimate properly controlled study offered proof that upper neck manipulation would permanently lower blood pressure that has an organic origin. The claim by NUCCA practitioners that a painless slightly misaligned atlas is a cause of high blood pressure does not have enough supporting evidence to warrant the risk of manipulating the necks of patients suffering from high blood pressure, risking injury to vertebrobasilar arteries."

http://www.sciencebasedmedicine.org/index.php/the-problem-with-chiropractic-nucca/

End of discussion?

 

[DrFrankmeister]

Hi Sledge,

I get your point. However, it would be a shame to ignore all this valid information, just because I am suspicious of Blue Man's motivations. In my case they are transparent. I am a chiropractor, and have seen how what I do has helped thousands of patients. There's nothing unreasonable about my trying to coax him into putting his cards on the table.

 

[Blue Wode]

I am a chiropractor, and have seen how what I do has helped thousands of patients.

Have you ever considered that you might be misinterpreting what you're seeing? FYI, the late Barry Beyerstein, who was Professor of Psychology at Simon Fraser University in Vancouver, looked at the problem in his essay Social and judgmental biases that make inert treatments seem to work. These are the areas he covered:

Psychological reasons for the popularity of alternative therapies:

The will to believe

Logical errors and lack of a control group

Judgmental shortcomings


Social and cultural reasons for the popularity of unproven therapies:

The low level of scientific literacy among the public at large

An increase in anti-intellectualism and anti-scientific attitudes riding on the coat-tails of New Age mysticism

Vigorous marketing of extravagant claims by the “alternative” medical community

Inadequate media scrutiny and attacking critics

Increasing social malaise and mistrust of traditional authority figures-the anti-doctor backlash

Dislike of the delivery methods of scientific biomedicine

Safety and side effects

Psychological distortion of reality

Self-serving biases and demand characteristics


Why might therapists and their clients who rely on anecdotal evidence and uncontrolled observations erroneously conclude that inert therapies work?

The disease may have run its natural course

Many diseases are cyclical

Spontaneous remission

The placebo effect and the need for randomized, double blind assessments

Some allegedly cured symptoms were probably psychosomatic to begin with

Symptomatic relief versus cure

Many consumers of alternative therapies hedge their bets

Misdiagnosis (by self or by a physician)

Derivative benefits

Full article here:
http://www.sram.org/0302/bias.html

 

[DrFrankmeister]

In increasing numbers? Are you sure about that? If the following is anything to go by, I don’t see how that’s possible:

FYI, Dr Bezold’s four scenarios were lifted from here (a non-skeptic site):

The Future of Chiropractic Revisited: 2005 to 2015 Report & Online Poll

Blue Man,

These quotes are all self-referential, from "op-ed" web sites, not from peer-reviewed websites, so I don't see the point in them.


Whatever he was, DD Palmer certainly seemed to be inconsistent. For example, in his 1910 textbook, The Chiropractor’s Adjuster, he wrote:

If he was as deaf as claimed, don’t you wonder how Mr Lillard could have heard what DD Palmer said to him in that half-hour conversation?

Seriously? How does ANY deaf person communicate? The pay attention.

Re NSAIDs, for a true comparison with chiropractic spinal manipulation one would have to take into account the following:

Chiropractic by itself is not obligated to "reduce the incidence of serious NSAID complications". However, IF spinal manipulation reduces their pain levels, and the person discontinues NSAID use, that would lower their cumulative risk.

Your Point# 2 "NSAIDs taken at recommended doses for a short time are generally very low-risk for appropriately selected patients" sounds most impressive, but tell me...who is doing this selection when Patient Jones is purchasing his NSAIDS at the local drug store? That's magical thinking. Americans are famous for believing that is some is good, more is better. Very few people read the fine print because they hope (and believe) that adverse events happen to *others*.

Second, the chronic pain patients (which I see every day) are NOT taking them for short periods. And research clearly demonstrated:

1. osteoarthritis (OA) and rheumatoid arthritis (RA) patients are 2.5—5.5 times more likely than the general population to be hospitalized for NSAID-related GI events;

2. the absolute risk for serious NSAID-related GI toxicity remains constant and the cumulative risk increases over time;

3. there are no reliable warning signals- >80% of patients with serious GI complications had no prior GI symptoms;

4. independent risk factors for serious GI events were age, prednisone use, NSAID dose, disability level, and previous NSAID-induced GI symptoms; and

5. antacids and H2 antagonists do not prevent NSAID-induced gastric ulcers, and high-risk NSAID users who take gastro-protective drugs are more likely to have serious GI complications than patients not taking such medications.

It’s also worth remembering that packets of NSAIDs contain Patient Information Leaflets detailing risks. However, it is evident that not all chiropractors warn patients about the risks associated with their manipulative treatments.

Evident? I hear your OPINION, but I see no supporting documentation, and as far as a know, no one (DC or otherwise) has yet to explore that component of chiropractic case management.

I would also venture that because the number of people taking NSAIDs is bound to be much higher than those receiving spinal adjustments, then NSAIDs are likely to be far safer. In addition to that, NSAIDs have been proven to work and their adverse effects are recorded and acknowledged:

if "proven to work" is your only benchmark, then I'm sorry for your short-sightedness. This article:

"Recent Considerations in Nonsteroidal Anti–inflammatory Drug Gastropathy"
American Journal of Medicine 1998 (Jul 27); 105 (1B): 31S–38S

clearly documents the number of deaths occurring because of routine NSAIDs use.

This also raises a genuine scientific conundrum:
How can anything that kills that many people still be referred to as "evidence-based"?

I would recommend reading the whole paper from which the above quote was lifted:

As for reviewing Ernst's Adverse effects of spinal manipulation: a systematic review, the man selectively reviewed "32 case reports, four case series, two prospective series, three case-control studies and three surveys" and states that these case studies "suggested a causal relationship between spinal manipulation and the adverse effect".

Is that evidence? I thought this page was devoted to real evidence.

Stroke is a hot button issue, and it's one my profession agonized over for decades because we too thought that their *could* be a relationship. I have maintained a page for years on Chiro dot Org devoted to that topic, titled "Stroke and Chiropractic".

If I sneeze and there is a car accident across the street, where is the causality?

Do some patients have some level of discomfort in their early stages of care? Duh! Of course...if you finger was had a splinter in it, and it became infected (inflammation) and you dug it out with a pin, is it possible your finger might hurt worse for a short period of time? Of course. However, I never see this in my practice after the first 1 or 2 visits, and neither has peer-reviewed studies of adverse events in chiropractic practices.

The Spine review looked at the records of patients who were admitted for head and neck pain and compared medical visits with chiropractic visits to determine which group had the greatest number of strokes. It did not look at chiropractic patients who had a stroke as a result of neck manipulation who were treated for problems unrelated to head and neck pain, such as low-back pain and general health problems or for "maintenance care" on asymptomatic patients.

These distorted facts were addressed by the author in a Podcast interview, available on our website, titled "No Increased Risk of Stroke With Chiropractic"

It’s worth noting that even the NICE guidelines for low back pain failed to consider that point, as Professor Edzard Ernst observed:

I enjoyed Dr. Ernst's early work on CAM. However, he is a self-appointed head of a non-University publishing group, funded by one of England's tabloid owners. Hardly the credentials of credibility.

The rest of his commentary is a "red herring" since the Spine Journal review dealt with reported instances of stroke following manipulation (not the reason why someone sought care), as previous studies had also done. Again, CAUSALITY had not been demonstrated. There is no proof. Period.

In relation to that, it’s interesting to read what Sharon Mathiason, a mother whose daughter died following chiropractic neck manipulation for a tailbone injury, had to say in a letter in which she questioned the integrity of the leader author of the Spine review, J. David Cassidy:

Whoa! You slid from evidence to hearsay reportage from newspaper articles. Excuse me while I ignore your reliance on hearsay.

Finally, returning to the topic of this thread, here’s what the veteran, evidence-based chiropractor, Samuel Homola, has to say about the blood pressure study:

Again, you quote someone who is not a researcher...he's a professional critic, and he is NOT a practicing DC. He's spouting OPINION, while the topic here is evidence. However...

Homola's statement "The minor atlas subluxations routinely found by NUCCA chiropractors have not been proven to be significant" is contradicted by the findings of this study... that the correction of this "minor atlas subluxation" significantly lowered blood pressure, equal to the effect of 2 blood pressure medicines.

What is NOT known is the mechanism by which the blood pressure dropped. A NUCCA doctor would tell you it was a correction of the purported subluxation, wheras researcher Jim Deuchars has a different opinion. The truth is that none of us knows (yet). However...

As a practicing doctor (and a research fan), it is not important for me to know WHY my patients get well. I am just happy that they do. I leave uncovering the answers to the researchers.

End of discussion?

You betcha! You are very effective at promulgating information dredged up from anti-quack websites. I haven't read your own *evidence-based* website yet, so I am still unsure if you have actually done any unique reading and thinking o0f your own. So far, I am not very impressed.

 

[Blue Wode]

These quotes are all self-referential, from "op-ed" web sites, not from peer-reviewed websites, so I don't see the point in them.

Then please supply evidence from peer-reviewed websites to support your original assertion that “People come to chiropractors because they suffer from neck pain, headaches or low back pain. They have been doing this in increasing numbers”.

Whatever he was, DD Palmer certainly seemed to be inconsistent. For example, in his 1910 textbook, The Chiropractor’s Adjuster, he wrote:

Seriously? How does ANY deaf person communicate? The pay attention.

Get real. We’re talking about a half-hour conversation that took place in the days before hearing aids, and Harvey Lillard was at least 90% deaf:
http://www.chirobase.org/05RB/BCC/07.html

IF spinal manipulation reduces their pain levels, and the person discontinues NSAID use, that would lower their cumulative risk.

Then please provide evidence that conclusively demonstrates that chiropractic management reduces the incidence of serious NSAID complications, such as fatal gastrointestinal bleeding, and that it is more cost-effective than NSAIDS – all the while remembering that…

…the efficacy of NSAIDs is undoubted but that of spinal manipulation is not, and moreover, the adverse effects of NSAIDs are subject to post-marketing surveillance while those of spinal manipulation are not. Thus we are certain about the risks and benefits of the former and uncertain about those of the latter. Finally, it should be mentioned that other therapeutic options (e.g. exercise therapy or massage) have not been associated with significant risks at all.”

http://jrsm.rsmjournals.com/cgi/content/full/100/7/330

It’s also worth remembering that packets of NSAIDs contain Patient Information Leaflets detailing risks. However, it is evident that not all chiropractors warn patients about the risks associated with their manipulative treatments.

Evident? I hear your OPINION, but I see no supporting documentation, and as far as a know, no one (DC or otherwise) has yet to explore that component of chiropractic case management.

I think you need to get up to speed with the data:

"A recent article by researchers from the Anglo-European College of Chiropractic in Bournemouth started with the telling statement that "the risk associated with cervical manipulation is controversial". This is certainly true…The Bournemouth team sent questionnaires about risk-related issues to 200 randomly selected UK chiropractors and received 92 responses. Their results show, among other things, that "only 45% indicated they always discuss [the risks of cervical manipulation] with patients ... " In plain language, this means that the majority of UK chiropractors seem to violate the most basic ethical standards in healthcare. If we assume that the 92 responders were from the more ethical end of the chiropractic spectrum, it might even be the vast majority of UK chiropractors who are violating the axiom of informed consent.”
http://www.ebm-first.com/chiropract...-duty-to-tell-their-patients-about-risks.html

"Results from this survey suggest a patient's autonomy and right to self-determination may be compromised when seeking chiropractic care. Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk."
http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

"In this recent investigation which focused on approaches to consent of a small sample of practicing UK chiropractors, only 23% reported that they always discussed serious risk with their patients, and over one third did not advise patients of alternative available treatments."
http://www.ncbi.nlm.nih.gov/pubmed/15726031?dopt=Abstract

I would recommend reading the whole paper from which the above quote was lifted:

As for reviewing Ernst's Adverse effects of spinal manipulation: a systematic review, the man selectively reviewed "32 case reports, four case series, two prospective series, three case-control studies and three surveys" and states that these case studies "suggested a causal relationship between spinal manipulation and the adverse effect".

Is that evidence? I thought this page was devoted to real evidence.

Professor Ernst cites more than enough evidence to compel chiropractors to adopt a cautious attitude towards neck manipulation. IMO, it is wholly unethical that many chiropractors condemn the accumulating evidence for neck manipulation causing stroke as anecdotal when, in many cases, it’s exactly that sort of evidence that they rely on to promote their services – i.e. many chiropractors, as well as their regulators and professional associations, seem to find it acceptable to promote anecdotal or weak evidence where it supports chiropractic treatment, but where similar, or more robust, evidence suggests that serious complications (e.g. stroke) can result from it, they are known to be quick to dismiss it. Indeed, it’s interesting to note that the same concern was highlighted in paragraph 146 (p.55) of the Statement of Claim filed by tetraplegic Canadian chiropractic victim, Sandra Nette, in her multi-million dollar lawsuit:

“Incredibly, and, acting in bad faith, the College [Alberta College and Association of Chiropractors] attacked the new and surprisingly high number of vascular accidents associated with chiropractic services that were published medical literature and reported in the media by demanding a level of evidence it has never demanded of itself. It maintained that the causal link between strokes and chiropractic adjustment remained unproven.”

http://www.casewatch.org/mal/nette/claim.pdf

If I sneeze and there is a car accident across the street, where is the causality?

Once again, get real. We’re talking about plausibility.

The Spine review looked at the records of patients who were admitted for head and neck pain and compared medical visits with chiropractic visits to determine which group had the greatest number of strokes. It did not look at chiropractic patients who had a stroke as a result of neck manipulation who were treated for problems unrelated to head and neck pain, such as low-back pain and general health problems or for "maintenance care" on asymptomatic patients.

These distorted facts were addressed by the author in a Podcast interview, available on our website, titled "No Increased Risk of Stroke With Chiropractic"

Then in the interests of public debate please reproduce those rebuttals here.

It’s worth noting that even the NICE guidelines for low back pain failed to consider that point, as Professor Edzard Ernst observed:

I enjoyed Dr. Ernst's early work on CAM. However, he is a self-appointed head of a non-University publishing group, funded by one of England's tabloid owners. Hardly the credentials of credibility.

Irrelevant. Please deal with the evidence on the table.

The rest of his commentary is a "red herring" since the Spine Journal review dealt with reported instances of stroke following manipulation (not the reason why someone sought care)

No, the Spine paper specifically pulled the records of patients who were admitted for head and neck pain and compared medical visits with chiropractic visits to detemine which group had the greatest number of strokes, and, as a result, demonstrated that patients suffering from head and neck pain were no more likely to suffer a stroke following a visit to a chiropractor than they were following a visit to a family medical physician.

In relation to that, it’s interesting to read what Sharon Mathiason, a mother whose daughter died following chiropractic neck manipulation for a tailbone injury, had to say in a letter in which she questioned the integrity of the leader author of the Spine review, J. David Cassidy:

Whoa! You slid from evidence to hearsay reportage from newspaper articles. Excuse me while I ignore your reliance on hearsay.

Then please produce evidence that counters Sharon Mathiason’s claims.

Homola's statement "The minor atlas subluxations routinely found by NUCCA chiropractors have not been proven to be significant" is contradicted by the findings of this study... that the correction of this "minor atlas subluxation" significantly lowered blood pressure, equal to the effect of 2 blood pressure medicines.

What is NOT known is the mechanism by which the blood pressure dropped. A NUCCA doctor would tell you it was a correction of the purported subluxation, wheras researcher Jim Deuchars has a different opinion. The truth is that none of us knows (yet). However...

As a practicing doctor (and a research fan), it is not important for me to know WHY my patients get well. I am just happy that they do. I leave uncovering the answers to the researchers.

So you charge your patients a fee as if the evidence exists? IMO that is not ethical when the only evidence for chiropractic lies in the treatment of a sub-group of low back pain sufferers - and even then it's no better than cheaper, more convenient and safer options.

End of discussion?

You betcha! You are very effective at promulgating information dredged up from anti-quack websites. I haven't read your own *evidence-based* website yet, so I am still unsure if you have actually done any unique reading and thinking o0f your own. So far, I am not very impressed.

I follow what the science tells me. Sadly, I get the impression that you do not.

 

[Sledge]

I get your point.

There's nothing unreasonable about my trying to coax him into putting his cards on the table.

Pick one.

 

[DrFrankmeister]

Then please supply evidence from peer-reviewed websites to support your original assertion that “People come to chiropractors because they suffer from neck pain, headaches or low back pain. They have been doing this in increasing numbers”.

What's the point? It's evident what your *opinion* is, and I see no reason to discuss it further with someone who already has their mind set in stone. Also, it's not an important point. You will agree that LOTS of people seek care from DCs...in fact, that seems to be what motivates you to make the astounding number of postings you make all over the Net.

I believe we will all be better off if I present literature demonstrating how and why chiropractic is effective, superior to medical care FOR THE SAME CONDITION, and is vastly superior to pain medication. After all, that is the real issue at hand.

Get real. We’re talking about a half-hour conversation that took place in the days before hearing aids, and Harvey Lillard was at least 90% deaf

Thanks for the invitation, and the acknowledgement that Harvey Lillard WAS deaf before DD Palmer adjusted him.

Perhaps I have you confused with one of your forefathers, who maintain that Harvey was NOT deaf.

I have not seen the source you mention, but I suspect it would have taken LONGER to get his ideas across to a deaf person that it would have with you or I.

Then please provide evidence that conclusively demonstrates that chiropractic management reduces the incidence of serious NSAID complications, such as fatal gastrointestinal bleeding, and that it is more cost-effective than NSAIDS – all the while remembering that…

Finally, we get to the meat of the matter. First off, I am hamstrung because I am not (yet) permitted to post links (urls) to my materials, and that puts the onus on anyone who wants to review these materials to have to do the leg-work for themselves.

HOWEVER, it is easy to locate these materials on GOOGLE by putting quotation marks around the titles of these articles, when you paste them into the search box. I hope that you will, because the following materials are quite revealing.

This first section will address the evidence that spinal manipulation is AT LEAST as effective as pain medication for reduction of neuro-musculo-skeletal (NMS) pain.

Later sections will document that manipulation is MORE THAN an expensive aspirin (which wears off quickly). I think any reasonable person (evidence-based addict or not) would agree that any treatment (and I am referring to chiropractic care) that provided SIGNIFICANT PAIN RELIEF for weeks or months is CERTAINLY preferable to taking pain pills, with their documented risks, including death.

1. Chronic Pain in Persons With Neuromuscular Disease
Archives of Physical Medicine & Rehabilitation 2005 (Jun); 86 (6): 1155–1163 ~ FULL TEXT

The first study I’d like to draw your attention to is a paper published in the Archives of Physical Medicine & Rehabilitation (2005). Although this study is not specific to neck pain per-se, the results, published by several M.D.s and a Ph.D. from the Department of Rehabilitation Medicine at the University of Washington School of Medicine is still most interesting.

Questionnaires were given to several hundred recruited patients who experienced severe neuro-musculo-skeletal (NMS) pain. The researchers used a broad selection of assessment tools, including Pain presence or absence, pain severity, pain quality (Neuropathic Pain Scale), pain interference (Brief Pain Inventory), pain site, quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]), and the form of pain treatment used by the patient. Very extensive!

The following table tabulates the type of treatment each patient used, followed by the average pain relief they experienced from that treatment. It’s rated on a classical 1-10 scale, with 1 meaning little or no relief, and 10 suggesting complete pain relief. The results are quite staggering:

Pain treatment -------------- Average Pain Relief
Chiropractic manipulation --------- 7.33 ±3.78
Nerve blocks --------------------- 6.75 ±4.76
Narcotics ------------------------ 6.37 ±2.74
Muscle relaxants ----------------- 5.78 ±2.88
Massage ------------------------ 5.48 ±2.73
Acupuncture -------------------- 5.29 ±3.22
Ibuprofen, aspirin ---------------- 5.22 ±2.83
Physical therapy ------------ ---- 4.45 ±2.66
Acetaminophen ------------ ----- 4.11 ±2.93

It may be hard for organized medicine to swallow, but this study revealed that chiropractic care was more effective for pain relief than nerve blocks, opioid analgesics , muscle relaxants, physical therapy, or acetaminophen (in that order). That’s pretty powerful stuff, isn’t it?

I have great respect for these authors because, even though the results were not very complementary to standard medical treatment (pain pills, muscle relaxants and physical therapy), they published the article anyway. Who’s to say how many other similar studies may never have made it to publication because they contained comparable findings?


2. Upper Cervical Manipulation Combined with Mobilization for the Treatment of Atlantoaxial Osteoarthritis: A Report of 10 Cases
J Manipulative Physiol Ther. 2011 (Feb); 34 (2): 131-137

This new case series, managed by the Department of Orthopedics, in the General Military Hospital of Beijing, China, involved 10 patients with idiopathic degenerative and posttraumatic atlantoaxial osteoarthritis. They were treated with upper cervical chiropractic adjusting, in combination with mobilization device therapy.

Outcome measures included self-reported pain using a numeric pain scale (NPS) (1-10, with 0 is no pain and 10 is the worst possible pain), physical examination findings, and radiologic changes.

The reported results were quite impressive:

• Pre to post pain findings included a reduction of pain from 8.6 to 2.6

• Rotation of C1 upon C2 increased from 28° to 52°, effectively doubling upper cervical range of motion.

• Restoration of joint space was observed in 6 patients

• Clinical improvement was rated as “good” to “excellent” by 80% of these patients!

3. Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence
Journal of Occupational and Environmental Medicine 2011 (Apr); 53 (4): 396–404

This study is unique in that it was conducted by the Center for Disability Research at the Liberty Mutual Research Institute for Safety and the University of Massachusetts Lowell, Hopkinton, Mass; and the Center for Health Economics & Science Policy at United BioSource Corporation, London, United Kingdom.

Their objective was to compare the occurrences of repeated disability episodes between types of health care providers, who treat claimants with new episodes of work-related low back pain (LBP). They followed 894 patients over 1-year, using workers’ compensation claims data.

By controlling for demographics and severity, they determined the hazard ratio (HR) for disability recurrence between 3 types of providers:
-- Physical Therapists (PT),
-- Physicians (MD), and
-- Chiropractors (DC).

The disability recurrence rates were:

• For PTs: HR = 2.0

• For MDs: HR = 1.6

• For DCs: HR = 1.0

Statistically, this means you are twice as likely to end up disabled if you got your care from a PT, rather than from a DC.

You’re also 60% more likely to be disabled if you choose an MD to manage your care, rather than a DC. Isn't that an eye-opener?

The authors concluded: “In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than with chiropractic services or no treatment.”

<HR>

Because I can't provide links to these materials, it is way too time consuming, pasting all this in here. Please consider reviewing the numerous articles on our blog at Chiro dot Org

Professor Ernst cites more than enough evidence to compel chiropractors to adopt a cautious attitude towards neck manipulation. IMO, it is wholly unethical that many chiropractors condemn the accumulating evidence for neck manipulation causing stroke as anecdotal when, in many cases, it’s exactly that sort of evidence that they rely on to promote their services – i.e. many chiropractors, as well as their regulators and professional associations, seem to find it acceptable to promote anecdotal or weak evidence where it supports chiropractic treatment, but where similar, or more robust, evidence suggests that serious complications (e.g. stroke) can result from it, they are known to be quick to dismiss it.

Blue Man, you make false statements when you say: "it is wholly unethical that many chiropractors condemn the accumulating evidence for neck manipulation causing stroke" BECAUSE there is NO EVIDENCE. Evidence is when you can prove something causes something else.

Have you heard of Salon Stroke, or Bow Hunter's Stroke? It is well-known that people have strokes following such trivial events as backing their car out of the driveway, or after sneezing.

To put it bluntly...if Salon owners had to carry malpractice insurance, and someone (like you) started making *big noises* in the media about the terrible dangers of having your hair washed at the Salon, don't you think there would be LOTS litigation? But...would that PROVE that Salons cause stroke? Deep pockets draw them like flies, and bottom-feeders are happy to take their case, for the usual 40% share of the take.

Litigation is not PROOF of causation, so your endless mention of another court case is STILL NOT PROOF OF CAUSATION.

So...why you choose to focus on chiropractors when there are plenty of documented cases of stroke following hair-washing? Inquiring minds want to know? If you are really so outraged at the fact that people get strokes, why don't you review stroke in general, rather than focusing solely on chiropractors? Something about your specific focus smells funny to me.

I think you need to get up to speed with the data:

Quote:
"A recent article by researchers from the Anglo-European College of Chiropractic in Bournemouth started with the telling statement that "the risk associated with cervical manipulation is controversial". This is certainly true…The Bournemouth team sent questionnaires about risk-related issues to 200 randomly selected UK chiropractors and received 92 responses. Their results show, among other things, that "only 45% indicated they always discuss [the risks of cervical manipulation] with patients ... " In plain language, this means that the majority of UK chiropractors seem to violate the most basic ethical standards in healthcare. If we assume that the 92 responders were from the more ethical end of the chiropractic spectrum, it might even be the vast majority of UK chiropractors who are violating the axiom of informed

A review of virtually ALL the stroke literature on my "Stroke and Chiropractic" page suggests that the odds of anyone having a stroke following chiropractic care is between 1:500,000 to 0:5,000,000, depending on which author you choose to quote.

Personally, I will never get to adjust a half-million people, and the odds of my ever being involved as a litigant because someone had a stroke proximal to visiting me in my office is effectively ZERO. I have been in practice 16 years so far.

So, why should I quote unfounded speculation to patients as fact?

Perhaps you need to review these articles:

Inappropriate Use of the Title Chiropractor and the Term Chiropractic Manipulation in the Peer-reviewed Biomedical Literature
Chiropractic & Osteopathy 2006 (Aug 22); 14 (1): 16 ~ FULL TEXT

Misuse of the Literature by Medical Authors in Discussing Spinal Manipulative Therapy Injury
J Manipulative Physiol Ther 1995 (May); 18 (4): 203–210

because both these articles clearly document that MANY of the articles citing stroke-following-manipulation by a DC turn out to be following manipulation by untrained providers like MDs, PTs and even Barbers.

The most obnoxious example is this article:

Vertebral Artery Dissections After Chiropractic Neck Manipulation in Germany Over Three Years
J Neurol. 2006 Jun; 253 (6): 724-30. Epub 2006 Mar 6.

The abstract of this article blatantly conceals the facts stated within the body of the paper when it states that “we describe 36 patients with vertebral artery dissections and prior chiropractic neck manipulation”.

When I read that sentence, I am led to believe that “real-live chiropractors” (meaning licensed Doctors of Chiropractic, who received their training at a CCE/WCCE accredited schools) were the ones to provide the “chiropractic neck manipulation”. Unfortunately, that couldn't be further from the truth! Look at the table from this article:

The Debilitating Maneuver Was Conducted By:

Orthopedic Surgeons n=18 (50%)
Physiotherapists n= 5 (14%)
Chiropractors n= 4 (11%)
GP (Medical Doctors) n= 2 (6%)
Neurologist n= 1 (3%)
Homeopath n= 1 (3%)
"Unknown" n= 3 (9%)
Total Injuries n= 36 (100%)

So, in Germany at least, it appears that Orthopedic Surgeons are killing people with chiropractic, followed closely by PTs.

Where is your outrage, Blue Man?

And what angers me is that people like you cite mis-information articles like this to their unsuspecting readers ALL THE TIME

I have repeatedly asked what your training was, what your stake is, and why you continue to peddle drivel and innuendo-as-fact on lists like this. This is NOT AN ATTACK.

That's a genuine and fair question, posed by one of the doctors you gleefully suggest is "wholly unethical".

Originally Posted by DrFrankmeister View Post
If I sneeze and there is a car accident across the street, where is the causality?

Once again, get real. We’re talking about plausibility.

Ahhh...now you have devolved from *evidence* to mere *plausibility*.

Well, 2 can play that game.

1. It's *plausible* that MARKET SHARE is the cause for publishing mis-leasing articles like Vertebral Artery Dissections After Chiropractic Neck Manipulation in Germany Over Three Years
J Neurol. 2006 Jun; 253 (6): 724-30. Epub 2006 Mar 6.

• Managed Care has decimated medical incomes.

• Organized Medicine has a long history of trying to destroy ANY profession they consider as poaching on their turf.

• They were found guilty TWICE of lying, and attempting to destroy my profession for solely financial reasons.

2. It's *plausible* that Organized Medicine learned their lesson in Federal Court, and now financially supports lackeys and incompetent failed doctors to continue undermining alt-med in general and chiropractic in particular on websites just like yours, Blue Man.

So, for transparency sake, why don't you tell us a little about yourself. The choice is, of course, completely up to you, but I say your CREDIBILITY is on the line, and side-stepping this issue will cost you *believers* in the long run.

 

[autumn1971]

Ooh! Colored and bolded! It must be true!

Also, how does one join "Organized Medicine," and do they get a free jacket?
And, no, you say that "2 can play" the game of going from evidence to plausibility, but you never started with any evidence, you are simply going from unsubstantiated claims to yelling.

 

[DrFrankmeister]

First, one cannot manually re-align a single vertebra (or, even, multiple vertebrae short of breaking the customers back). Second, as suggested above, one cannot measure such a tiny correction. Third, one does not measure lateral displacements (as claimed in the original paper) in terms of "degrees." Finally, Bakriss is an idiot (formerly a scientist) for associating himself with such a crappy paper in a bottom-feeding magazine.

Aside from that, it is important news.

JJM

Early chiropractic theory posited the idea of mis-alignment causing pressure on a nerve (what I refer to as the BOOP, or bone-out-of-place theory) as being primary to the development of a subluxation.

I attended Palmer College of Chiropractic from 1990 to 1994, and I assure that this is NOT what I was taught, or what is taken as anything other than a simple analogy for explaining how inflammation of the nerve roots produces radiculopathy.

The more recent definitions of sublxation (as a "complex") take into account the impact of "loss-of-function" or "joint play" on the health of the tissues within the joint complex, and how that inflammation leads to radicular findings and less frequently loss of muscle tone, strength and coordination of those muscles.

You *might* be aware of how many sport teams have a chiropractor on call or staff to help them maintain their game. It's th e same with Olympic athletes.

Whatever a subluxation is, or whatever any scientist may choose to call it, there is no denying that chiropractic spinal adjusting (aka manipulation) is helpful in improving joint function, and as the joint health improves, the symptoms of rubor, dolor, and functiolatia all improve.

 

[DrFrankmeister]

Ooh! Colored and bolded! It must be true!

Also, how does one join "Organized Medicine," and do they get a free jacket?
And, no, you say that "2 can play" the game of going from evidence to plausibility, but you never started with any evidence, you are simply going from unsubstantiated claims to yelling.

Yes, that's absolutely true...if it's in Blue, it's true, and if it's in Red, you better write your mom about it.

I am outside of Chicago, where the AMA headquarters is, and their multi-floor building contains thousands of employees, who issue a average of 5000 press releases PER WEEK. If that isn't organized, I don't know what is.

I's unclear what evidence you say I didn't provide. If you were referring solely to the plausibility section, you may refer to the:

The Chiropractic Antitrust Suit
Wilk, et al vs. the AMA, et al

at Chiro dot Org/Wilk

I forgot that all the participants aren't well-versed in this amazing Court Case. It was a humiliating David vs. Goliath defeat for Organized Medicine.

And no, you don't "get a coat", you have to earn one.

 

[DrFrankmeister]

I think this was a specific claim about the Atlas vertebra only. Apparently this is the specialty of a sub-discipline within chiropractic. They are claiming an actual, conventional, appears on x-rays, you can measure it type misalignment. Normally it is left ambiguous whether, by subluxations, chiropractic is talking about an actual, but undetectable, misalignment or a metaphysical concept.

The study claims to be measuring the misalignment. Of course if they can't actually measure any such thing then that's the study debunked.

NUCCA is one of 10 (or more) "upper cervical specific" techniques that all evolved from Palmer's (original) 1920's shift from whole-spine to upper cervical adjusting.

The differences between the various named techniques (Toggle, Blair, Grostic, NUCCA, Atlas Orthogonal, just to name a few) revolve around their methods of x-ray analysis and their methods of adjusting. The differences include various improvements in application of the adjustive force in a specific vectored direction, by use of hand or instrument adjusting (my personal favorite).

Because (at minimum) more than 50% of ALL chiropractors graduated from either Palmer or Life College, and because both schools taught upper cervical "specific", then upper cervical adjusting is NOT a rare curiosity, but is something regularly practiced by a majority of DCs.

AND, to date no head-to-head comparison of any of these techniques has been made.

Palmer College is currently comparing 3 different UC techniques for their impact on blood pressure. But until then, claims made by NUCCA doctors that only NUCCA can reduce blood pressure is unfounded. There have been case reports noting BP reductions in the literature for over 40 years, utilizing numerous UC techniques.

 

[DrFrankmeister]

Yeah, this is about a sub-group (NUCCA nuts) of chiros. Imagine how bad a group must be to be considered quacks by fellow quacks, as they are.

JJM

Shame on you! I don't know any DCs who consider NUCCA doctors to be quacks, and since I suspect you are not a doctor yourself, your disrespectful comment is out of line, and is not a valid form of critical thinking.

I'd like to quote one of our formost authors (Meridel I. Gatterman, MA, DC, MEd)

A subluxation syndrome has been defined as an aggregate of signs and symptoms that relate to pathophysiology or dysfunction of spinal and pelvic motion segments or to peripheral joints. [3] While the signs and symptoms characteristic of subluxation syndromes are not always due to a subluxation, when they are, the condition commonly is responsive to adjustive and manipulative procedures.

It is important the examination of patients be inclusive of the clinical indicators that identify subluxations. The components of the PARTS exam, developed by Bergmann [4] and included in the Medicare Benefit Policy Manual that covers medical and other health services, [5] commonly is used to identify subluxations.​

3. Gatterman MI, Hansen D.
Development of chiropractic nomenclature through consensus.
J Manipulative Physiol Ther, 1994;17(5):302.

4. Bergmann TF.
Chiropractic Spinal Examination. In: The Chiropractic Neurological Examination, Ferezy JS, Ed. Gaithersburg Md.: Aspen Publications, 1992.

5. Covered Medical and Other Health Services Medicare Benefit Policy Manual, Chapter 15.

 

[DrFrankmeister]

Worse than that, they're the imaginings of an Iowa grocer and fish peddler who dabbled in phrenology, the occult, animal magnetism and the like.

Joe,

In a county that elected a second-tier actor as President for 2 terms, and another actor as Governor of California, who are you to deny that this IS the land of opportunity?

One of my favorite methods for treating disc derangements in my patients, known as McKenzie Technique, was "discovered" by accident by a New Zealand Physical Therapist.

Now I am a Doctor...so should I look down my nose at McKenzie because it was developed by a non-doctor?

 

[DrFrankmeister]

Do you understand what a "Pilot Study" is and how those are very often showing nothing but selection bias?

I didn't think so.

But all over the place you can find Chiros prescribing this to patients as though the matter were proven.

Many drugs tested in as few patients seemed wonderful until the study was expanded and the effect disappeared.

Sad thing is, this is the best evidence they have for ANY of their claims.

Ben

I disagree.

First off, chiropractors have observed BP reduction in patients for decades after adjusting their upper cervical (C1 or C2) spines. I have seen it repeatedly in my practice for 16 years. So, you are wrong...this is not some new phenomena chiropractors are jumping on...this is something DCs have been doing since the late 1920s.

What is sad is the legacy of the AMAs anti-trust activities against my profession. By their own edicts, the AMA (aka Organized Medicine):

• Made it impossible for any MD to teach or research with a DC, even if they wanted to

• Made it impossible for a DC to send a patient for an MRI or other special study

Then they turn around and state that our schools were inferior because they had no MDs on staff, and because we couldn't order special studies for our patients.

I can find you studies of similar magnitude that show you that sugar pills can have similar results.

Yes, the placebo effect (now more accurately described as the "non-specific effects" of care) DOES have a dramatic impact on care. So what? The sense of hope and trust in a doctor is just such an effect, and there's no question that it contributes to overall satisfaction and progress.

I'd like to share a quote from a friend of mine:

<><><><><><><><><><><><><><><><><><><><><><><><><><>

"A patient finally went to a chiropractor for her back pain after finding no relief with the orthopedist. After three adjustments and a week of no symptoms, she had a follow-up visit with her M.D.

Upon learning about the success of the D.C., the orthopedist stated, "That was just the placebo effect."

The patient responded, "If it works so well, why didn't you use it?"

–– Attributed to Robert Mootz, D.C.

<><><><><><><><><><><><><><><><><><><><><><><><><><>

If you have a smart answer for the patient in this example, I am all ears.

 

[DrFrankmeister]

Sample size far too small to be representative.

Very small magnitude of the measured effect. (Not clinically significant.)

Magnitude consistent with placebo studies.

Study not replicated with a large enough cohort (n > 1000) by others.

Other studies that show no effect whatsoever.

Ben

Your first point about sample size is wrong, because ALL the participants had high blood pressure, the sole reason for the study. It is true that a larger study has more power, but then again, most of the drugs that have been recalled recently were tested in large trials, and where did that lead?

Your second point is moot. When they compared the EFFECT of UC adjusting and the 2-drug effects, by STANDARD MEASUREMENT of blood pressure, the chiropractic group had:

• lower blood pressure, and

• the effect persisted for 8 weeks.

Excuse me if I find your lack of enthusiasm for those results to be bizarre.

As for your last point... show me the study you claim demonstrated "no effect whatsoever".

 

[TubbaBlubba]

"Dr" Frank, this isn't your blog. It would be nice if you used the multi-quote feature.

 

[DrFrankmeister]

Well said.

I would add the known fact that the chiropractic theory of subluxations is known to be false, so there is no reason to think this approach should work. I realize that's not a comment on the study results, but it points out that the claim is extraordinary, so we need evidence that is more substantial, not marginal.

Joe,

The *theory* of subluxation has been evolving for 115 years.

You stretch things when you claim that it is a "known fact that the chiropractic theory of subluxations is known to be false"

There are some DCs, MD and etc who lament that it hasn't been proved, and that is true.

There are some SKEPTICS who quote earlier versions (the BOOP THEORY I mentioned earlier) as though they were still current thinking...this is a weak straw-man tactic. No DC I am aware of still believes this antiquated theory, any more than MDs still bleed their patients.

In reality, there is pretty good science supporting the contention that fixations of spinal joints causes:

• degenerative changes [1]

• radiculopathy [2]

• and that spinal adjusting does in fact improve joint function [3]

and equally impressive data demonstrating that chiropractic care is orders of magnitude more effective than "standard medical care" for low back pain [4-7] This selection of citations is far from exhaustive. You can review more of them at these pag es:

Low Back Pain and Chiropractic

Chiropractic and Chronic Neck Pain



REFERENCES:

1. Chiropractic and Degenerative Joint Disease

2. The Radiculopathy Page

3. Upper Cervical Manipulation Combined with Mobilization for the Treatment of Atlantoaxial Osteoarthritis: A Report of 10 Cases
J Manipulative Physiol Ther. 2011 (Feb); 34 (2): 131-137

4. A Nonsurgical Approach to the Management of Patients With Lumbar Radiculopathy Secondary to Herniated Disk: A Prospective Observational Cohort Study With Follow-Up
J Manipulative Physiol Ther 2009 (Nov); 32 (9): 723–733

5. Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence
Journal of Occupational and Environmental Medicine 2011 (Apr); 53 (4): 396–404

6. Chiropractic Treatment of Workers’ Compensation Claimants in the State of Texas
Chirrg Blog ~ February 24th, 2011

7. Cost of Care for Common Back Pain Conditions Initiated With Chiropractic Doctor vs Medical Doctor/Doctor of Osteopathy as First Physician: Experience of One Tennessee-Based General Health Insurer
J Manipulative Physiol Ther 2010 (Nov); 33 (9): 640–643

 

[DrFrankmeister]

"Dr" Frank, this isn't your blog. It would be nice if you used the multi-quote feature.

TB,

I have no idea what a multi-quote is, I am just learning the ropes here.

As I understand it, this is a public blog, and because it is discussing my profession, and no other doctor is here to address the snide remarks (most of which I ignored), I am taking that role on.

I have helped maintain The Chiropractic Resource Organization website since 1996. We are an all-volunteer, non-commercial information website.

We donate more than half our yearly income back to chiropractic research, because we know how much more work needs to be done. And, I am a full-time practicing doctor...but over 15 years I have gathered a formidable collection of research articles for my profession to review.

So, when someone wonders about what research is out there, or why there is a dearth of research, someone needs to advise them that a significant portion of our research was (1) paid for from our own pockets, (2) and produced by field doctors with no specialized training in research methods.

It's only the last 10 years that the Federal government has finally accepted grant requests from DCs. And it's amazing the volume of studies and papers have been published since then.

I don't claim we have a ton of research to support what we do. YET.

It's only a matter of time until we have the infrastructure necessary to detail in depth what it is that's wrong with our patients (what we call a subluxation for lack of a better word) and how and why it is that they get better when we adjust them.

 

[Blue Wode]

Then please supply evidence from peer-reviewed websites to support your original assertion that “People come to chiropractors because they suffer from neck pain, headaches or low back pain. They have been doing this in increasing numbers”.

What's the point? It's evident what your *opinion* is, and I see no reason to discuss it further with someone who already has their mind set in stone. Also, it's not an important point. You will agree that LOTS of people seek care from DCs...in fact, that seems to be what motivates you to make the astounding number of postings you make all over the Net.

I take that to mean that you’re unable to produce any evidence in response to my request.

Get real. We’re talking about a half-hour conversation that took place in the days before hearing aids, and Harvey Lillard was at least 90% deaf

Thanks for the invitation, and the acknowledgement that Harvey Lillard WAS deaf before DD Palmer adjusted him.

Perhaps I have you confused with one of your forefathers, who maintain that Harvey was NOT deaf.

I have not seen the source you mention, but I suspect it would have taken LONGER to get his ideas across to a deaf person that it would have with you or I.

I’ll give you the benefit of the doubt then, but please supply robust data showing how many people have been cured of deafness through chiropractic treatment in the 100+ years that have passed since that famed adjustment administered to Harvey Lillard.

Chronic Pain in Persons With Neuromuscular Disease
Archives of Physical Medicine & Rehabilitation 2005 (Jun); 86 (6): 1155–1163 ~ FULL TEXT

-snip-

The following table tabulates the type of treatment each patient used, followed by the average pain relief they experienced from that treatment. It’s rated on a classical 1-10 scale, with 1 meaning little or no relief, and 10 suggesting complete pain relief. The results are quite staggering:

Pain treatment -------------- Average Pain Relief
Chiropractic manipulation --------- 7.33 ±3.78
Nerve blocks --------------------- 6.75 ±4.76
Narcotics ------------------------ 6.37 ±2.74
Muscle relaxants ----------------- 5.78 ±2.88
Massage ------------------------ 5.48 ±2.73
Acupuncture -------------------- 5.29 ±3.22
Ibuprofen, aspirin ---------------- 5.22 ±2.83
Physical therapy ------------ ---- 4.45 ±2.66
Acetaminophen ------------ ----- 4.11 ±2.93

It may be hard for organized medicine to swallow, but this study revealed that chiropractic care was more effective for pain relief than nerve blocks, opioid analgesics , muscle relaxants, physical therapy, or acetaminophen (in that order). That’s pretty powerful stuff, isn’t it?

Please note what the results of that study actually say:

"…we found no significant differences between the study participants and the US norms on the SF-36 role-emotional or mental health scales. A number of pain treatments were used by the study sample, but no treatment appeared to be effective for all participants, and some of the treatments reported as most effective (eg, chiropractic care) were used by very few participants."

http://www.ncbi.nlm.nih.gov/pubmed/15954054

Not quite so convincing taken in context, is it?

Upper Cervical Manipulation Combined with Mobilization for the Treatment of Atlantoaxial Osteoarthritis: A Report of 10 Cases
J Manipulative Physiol Ther. 2011 (Feb); 34 (2): 131-137

This new case series, managed by the Department of Orthopedics, in the General Military Hospital of Beijing, China, involved 10 patients with idiopathic degenerative and posttraumatic atlantoaxial osteoarthritis. They were treated with upper cervical chiropractic adjusting, in combination with mobilization device therapy.

Outcome measures included self-reported pain using a numeric pain scale (NPS) (1-10, with 0 is no pain and 10 is the worst possible pain), physical examination findings, and radiologic changes.

The reported results were quite impressive:
• Pre to post pain findings included a reduction of pain from 8.6 to 2.6
• Rotation of C1 upon C2 increased from 28° to 52°, effectively doubling upper cervical range of motion.
• Restoration of joint space was observed in 6 patients
• Clinical improvement was rated as “good” to “excellent” by 80% of these patients!

I think it’s a little premature to get excited about a study involving just 10 patients.

Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence
Journal of Occupational and Environmental Medicine 2011 (Apr); 53 (4): 396–404

-snip-

The disability recurrence rates were:
• For PTs: HR = 2.0
• For MDs: HR = 1.6
• For DCs: HR = 1.0

Statistically, this means you are twice as likely to end up disabled if you got your care from a PT, rather than from a DC.

You’re also 60% more likely to be disabled if you choose an MD to manage your care, rather than a DC. Isn't that an eye-opener?

Not really. There are still many questions that need to be answered in relation to chiropractic maintenance care:

"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. Therefore, our conclusion is identical to that of a similar review published in 1996, namely that maintenance care is not well researched and that it needs to be investigated from several angles before the method is subjected to a multi-centre trial."

http://chiromt.com/content/16/1/3

Note: Maintenance care is not well researched and needs to be "investigated from several angels before the method is subjected to a multi-centre trial". So, very early days.

Blue Man, you make false statements when you say: "it is wholly unethical that many chiropractors condemn the accumulating evidence for neck manipulation causing stroke" BECAUSE there is NO EVIDENCE. Evidence is when you can prove something causes something else.

Here are a selection of links that would suggest otherwise:

The death certificate of 39-year-old John Hoffman whose stroke occurred around 3 hours after having a neck adjustment at his chiropractor’s office. He died 6 days later. [Possibly slow to load.] http://www.chiropracticstroke.com/pdf/Hoffman Death Certificate.pdf

A case report of a healthy pregnant female who presented to the emergency department with a cervical epidural hematoma resulting from chiropractic spinal manipulation therapy (American Journal of Emergency Medicine, October 2009)
http://www.ncbi.nlm.nih.gov/pubmed/...med_ResultsPanel.Pubmed_RVDocSum&ordinalpos=3

Visual field loss resulting from cervical chiropractic manipulation (American Journal of Ophthalmology,1997)
http://www.ncbi.nlm.nih.gov/pubmed/9535639?dopt=Abstract

Brain stem infarction due to chiropractic manipulation of the cervical spine
(South Med. Journal, 1983)
http://www.ncbi.nlm.nih.gov/pubmed/6359460?dopt=Abstract

Open Letter from Britt Harwe, President, Chiropractic Stroke Awareness Group (CSAG)

“… the National Quality Forum lists 28 ‘never events’ healthcare mistakes that should never happen and need to be reported. Death or serious disability from spinal manipulation is listed as no. 16. But chiropractors do not have to report this because they have a loophole. The National Quality Forum demands it of clinics and hospitals but no reporting is mandated for individual doctor’s offices where 99% of spinal manipulation is done. Chiropractors generally do not practise in hospitals or clinics. Therefore, there is no accurate reporting for injuries that occur as a result of spinal manipulation. Yet we have hundreds of victims who have suffered needless injuries due to a stroke as a direct result of a chiropractic manipulation, and they are horrible, permanent injuries and they happen to mostly young healthy people under the age of 45 years.”

Full text at Focus on Alternative and Complementary Therapies - March 2010
http://onlinelibrary.wiley.com/doi/10.1211/fact.15.1.0025/full

Not very reassuring is it?

Have you heard of Salon Stroke, or Bow Hunter's Stroke? It is well-known that people have strokes following such trivial events as backing their car out of the driveway, or after sneezing.

In which case it is utterly plausible that chiropractors can cause strokes by deliberately manipulating peoples’ necks.

A review of virtually ALL the stroke literature on my "Stroke and Chiropractic" page suggests that the odds of anyone having a stroke following chiropractic care is between 1:500,000 to 0:5,000,000, depending on which author you choose to quote.

My “Chiropractic Risks” page isn’t nearly so generous
http://www.ebm-first.com/chiropractic/risks.html

…why should I quote unfounded speculation to patients as fact?

Because you have an ethical duty to err on the side of caution and disclose potential risks to your patients.

Vertebral Artery Dissections After Chiropractic Neck Manipulation in Germany Over Three Years
J Neurol. 2006 Jun; 253 (6): 724-30. Epub 2006 Mar 6.

The abstract of this article blatantly conceals the facts stated within the body of the paper when it states that “we describe 36 patients with vertebral artery dissections and prior chiropractic neck manipulation”.

When I read that sentence, I am led to believe that “real-live chiropractors” (meaning licensed Doctors of Chiropractic, who received their training at a CCE/WCCE accredited schools) were the ones to provide the “chiropractic neck manipulation”. Unfortunately, that couldn't be further from the truth! Look at the table from this article:

The Debilitating Maneuver Was Conducted By:

Orthopedic Surgeons n=18 (50%)
Physiotherapists n= 5 (14%)
Chiropractors n= 4 (11%)
GP (Medical Doctors) n= 2 (6%)
Neurologist n= 1 (3%)
Homeopath n= 1 (3%)
"Unknown" n= 3 (9%)
Total Injuries n= 36 (100%)

So, in Germany at least, it appears that Orthopedic Surgeons are killing people with chiropractic, followed closely by PTs.

Where is your outrage, Blue Man?

Has it never occurred to you that surgeons and physiotherapists, being part of mainstream medicine, are likely to be more upfront about reporting adverse events?

Scientific medicine constantly criticizes itself and publishes the critiques for all to see. There is NOTHING comparable in the world of alternative medicine.

http://www.sciencebasedmedicine.org/index.php/death-by-medicine/

BTW, German medical doctors can undertake around four weeks of training and study in manipulation as part of their CPD in order to practice what they term “chirotherapy”. And South Korean MDs appear to have an even stricter set up:

“…South Korean law doesn't state that Chiropractic is illegal. Rather, the law states Chiropractors can't practice their techniques unless they're qualified Medical Doctors”

http://brumskeptics.blogspot.com/2011/07/south-koreas-medical-professionals.html

Personally, I think that South Korea has the right idea.

And what angers me is that people like you cite mis-information articles like this to their unsuspecting readers ALL THE TIME

I have repeatedly asked what your training was, what your stake is, and why you continue to peddle drivel and innuendo-as-fact on lists like this. This is NOT AN ATTACK.

I’ll leave that for readers to decide for themselves.

It's *plausible* that MARKET SHARE is the cause for publishing mis-leasing articles like Vertebral Artery Dissections After Chiropractic Neck Manipulation in Germany Over Three Years
J Neurol. 2006 Jun; 253 (6): 724-30. Epub 2006 Mar 6.
• Managed Care has decimated medical incomes.

• Organized Medicine has a long history of trying to destroy ANY profession they consider as poaching on their turf.

That may be true for the US, but it’s not really an issue here in the UK where most people rely on the NHS.

• They were found guilty TWICE of lying, and attempting to destroy my profession for solely financial reasons.

If you’re referring to the Wilk v AMA case, it’s interesting what the judge had to say about chiropractic:

"In 1987, federal court judge Susan Getzendanner concluded that during the 1960s "there was a lot of material available to the AMA Committee on Quackery that supported its belief that all chiropractic was unscientific and deleterious." The judge also noted that chiropractors still took too many x-rays. However, she ruled that the AMA had engaged in an illegal boycott. She concluded that the dominant reason for the AMA's antichiropractic campaign was the belief that chiropractic was not in the best interest of patients. But she ruled that this did not justify attempting to contain and eliminate an entire licensed profession without first demonstrating that a less restrictive campaign could not succeed in protecting the public. Although chiropractors trumpet the antitrust ruling as an endorsement of their effectiveness, the case was decided on narrow legal grounds (restraint of trade) and was not an evaluation of chiropractic methods."

http://www.chirobase.org/08Legal/AT/at00.html

Looks to me like chiropractors had a lucky escape.

It's *plausible* that Organized Medicine learned their lesson in Federal Court, and now financially supports lackeys and incompetent failed doctors to continue undermining alt-med in general and chiropractic in particular on websites just like yours, Blue Man.

But how do you know what my website’s like when you claimed the following at the end of post #45:

“I haven't read your own *evidence-based* website yet”

Did you decide to read it?