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Chiropractic may cause strokes

edthedoc

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Dec 26, 2002
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Interesting new study shows possible link between chiropractic treatment and tearing of neck arteries causing stroke. Of course dismissed by chiropractics but interesting comment by researchers along the lines of "there's no evidence that chiropractic neck treatment works so it's not worth the risk of causing strokes even though this risk is low".



"The latest research, published in the journal Neurology, looked at dozens of cases of "cervical arterial dissection" - a tearing of an artery near the spine - followed by a stroke arriving at the University of California at San Francisco Medical Center and Stanford Medical Center over a five year period.

They found that these patients were six times more likely to have had spinal manipulation in the 30 days prior to their stroke than people who had had a different kind of strokes.

Dr Wade Smith, who led the study, said: "These observations suggest that spinal manipulative therapy can directly produce dissection. "



How about some more intelligent discussion about this.

P.S.
Please, mature responses only.
 
edthedoc said:
Interesting new study shows possible link between chiropractic treatment and tearing of neck arteries causing stroke. Of course dismissed by chiropractics but interesting comment by researchers along the lines of "there's no evidence that chiropractic neck treatment works so it's not worth the risk of causing strokes even though this risk is low".



"The latest research, published in the journal Neurology, looked at dozens of cases of "cervical arterial dissection" - a tearing of an artery near the spine - followed by a stroke arriving at the University of California at San Francisco Medical Center and Stanford Medical Center over a five year period.

They found that these patients were six times more likely to have had spinal manipulation in the 30 days prior to their stroke than people who had had a different kind of strokes.

Dr Wade Smith, who led the study, said: "These observations suggest that spinal manipulative therapy can directly produce dissection. "



How about some more intelligent discussion about this.

P.S.
Please, mature responses only.
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Hmmm--the summary's a bit vague for me to pass any kind of judgement; do you have links to the actual study please?
 
Interesting. I'd heard about stroke risk before but the chiropractic industry always seemed to pass those off as isolated incidents or anecdotes. I think this is the first report I'd heard of an established statistical correlation.

Interesting also is the chiropracters' reaction; they don't seem to understand what the study actually says, if the article reports it correctly. The study presumably establishes a statistical correlation, it does not examine how chiropractic adjustments might lead to a stroke. How much force the chiropracter believes he's exerting is irrelevant, the correlation exists.
 
Sorry about the lack of link: http://news.bbc.co.uk/1/hi/health/3020923.stm

BillyJoe: I politely asked for sensible mature posts only. Please do not post to this thread unless you have something intelligent, and relevant to add to the thread. I'm going to raise this with the moderators because it is becoming increasingly difficult to hold a decent discussion on this forum because of people like you.
 
From the article:
However, Professor Alan Breen, a member of the General Chiropractic Council, was critical of the study.

He said: "It is irresponsible to suggest that chiropractic has caused these effects based on a study of this small size.

"What you have to remember is that someone who is in the process of having a dissection often experiences neck pain - precisely the symptom that might influence them to seek help from a chiropractor.

"Many of the people in this study who have gone on to suffer a stroke may have been experiencing an arterial dissection before they decided to consult a chiropractor."
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My question: if it is likely that someone attending a chiropractic clinic with neck pain is in the process of 'experiencing' an arterial dissection, what do chiropractors do to exclude this as a possible cause of the symptoms described by the patient before attempting to treat them with manipulation only? Are patients advised their symptoms may be an indication of an imminent stroke?

Also, what are the likely causes of arterial dissection if chiropractic treatment is excluded?
 
The article states that they "aren't talking about a large number of victims", but if you happen to be one of them, that is hardly comfort.

I have had an aversion to chirpractors for a few years now. I
started to have spinal problems - both cervical and lumbar - about six years ago. Pain causes desperation. I succumbed to trying things I would not usually consider. Chiropractic treatment and even accupuncter were two acts of that desperation.

They both resulted in my being hospitalized. After one chiropractic treatment, my left leg and foot became temporarily paralyzed. I was actually told by the chiropractor that it was just common for a patient to get worse before they get better.

I don't know what, if any, controls the UK puts on this health field. I am dissapointed at how lax they seem to be in the US. I am glad to see at least this study casting some negative slant on what I view as a bunch of quacks.
 
Julia said:
The article states that they "aren't talking about a large number of victims", but if you happen to be one of them, that is hardly comfort.
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And spoonhandler quoted this quote:
It is irresponsible to suggest that chiropractic has caused these effects based on a study of this small size.
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The methods by which you decide whether you have a statistically significant effect are well understood. I would expect the actual study includes this. You don't necessarily need thousands of cases to decide that a procedure is hazardous, especially when it has no benefits, you just need a statistically significant result.

Unfortunately, Neurology wants $20 for a PDF of the actual paper on their website (http://www.neurology.org), and its not worth that much to me (and I probably wouldn't understand much anyway). However, the Highlights section has this to say:
Neck manipulation is causal in vertebral dissection

Smith et al., using a nested case-control design, compared patients with and without cervical arterial dissection and found that recent spinal manipulative therapy was an independent risk factor for stroke or TIA from vertebral dissection.

The accompanying editorial by Williams and Biller considers this possible risk of chiropractic. They note that Smith et al. addressed the "chicken–egg" issue of chiropractic manipulation for neck pain: Could the symptoms of dissection have prompted the visit to the chiropractor? The study carefully pursued this possibility with interviews of all subjects. Whereas recall bias as well as age differences in the control vs dissection patients are concerns, the sixfold increase of dissection/stroke suggests that the risk of chiropractic neck manipulation for patients with acute neck pain outweighs its benefits.
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The reference to experimental design and consideration of independance suggests that the authors knew what they were doing statistically, and it sounds like the researchers were careful to consider the possibility that at-risk patients sought chiropractic care at a higher rate.
 
edthedoc said:
BillyJoe: I politely asked for sensible mature posts only.
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Eddy, my dear friend, you can start as many threads as you like but you cannot control the input from other posters. That was the point of my reply.
(Also, I have a pussy just like yours so I feel a sort of affinity :) :D )

edthedoc said:
Please do not post to this thread unless you have something intelligent, and relevant to add to the thread.
Click to expand...
Please, kindly, do not tell me what to do.
You do not actually own this thread, Eddy.

edthedoc said:
I'm going to raise this with the moderators.....
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I would suggest my dear friend, Hal Bidlack. He is on record as owning up to being a "stuff shirt".
The two of you should get on famously :D
But seriously, they will not help you in this matter because, apart from Hal, they all have a sense of humour

edthedoc said:
.....because it is becoming increasingly difficult to hold a decent discussion on this forum because of people like you.
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You have slandered me.
But, don't worry, I won't go running off to the moderators.
(However, I do know a certain Maxwell ;) )
 
Julia said:
I don't know what, if any, controls the UK puts on this health field.
Click to expand...

In the UK, chiropractors have to be registered with the General Chiropractic Council, are regulated by the Chiropractors Act 1994 and must have an accredited qualification (typically degree level) in the subject.

According to the abstract Zombified kindly provided a link for Smith et al used a sample size of 457--151 participants who had suffered a stroke, 306 participants used as controls--with the 151 participants subsequently assigned to two conditions--51 patients who had suffered "cervical arterial dissection" and 100 who had suffered some other form of stroke. My immediate response would be that matching different sample sizes like this can be problematic, although there's statistical tests which can account for this (damn, where's my Robson's?). My other response would be that there may be problems generalising from from such a small sample size; in the BBC article Smith notes that the incidence of stroke is 10 per 100,000 anyway (<>24,000 for the US?), but regardless of the problems of small sample size, there's a correlation which needs to be taken into account, and further research wtih larger trials undertaken. I remember a report from a few years back suggesting that hairdressing chairs could be linked with stroke because of the way they inclined the neck, but I digress.

My gut feeling is that there's always some degree of risk with any treatment, and ultimately you've got to weigh up the negative and positive outcomes. Of course it's always the problem of attempting to become fully informed on any treatment--I've always wondered if there's an inverse relationship between amount of empirical data and degree of quackery involved in any practice. So if I lived in the US and was at risk of stroke I'd be careful about seeking chiropractic treatment for neck compaints, or for having any treatment which involved wrenching of the neck. But then, if it's the case that US chiropractors are unregulated, I'd be wary about going anywhere near them anyway.
 
Spinal Roulette?

In 1992, researchers at the Stanford Stroke Center asked 486 California members of the American Academy of Neurology how many patients they had seen during the previous two years who had suffered a stroke within 24 hours of neck manipulation by a chiropractor. The survey was sponsored by the American Heart Association. One hundred seventy-seven neurologists reported treating 55 such patients, all of whom were between the ages of 21 and 60. One patient had died, and 48 were left with permanent neurologic deficits such as slurred speech, inability to arrange words properly, and vertigo. The usual cause of the strokes was thought to be tearing of the vertebral artery walls [3]. A recent review of 116 articles published between 1925 and 1997 found 177 cases of neck injury associated with neck manipulation, at least 60% of which was done by chiropractors [4].


One patient proven to have been killed by neck manipulation was Kristi A. Bedenbaugh, a medical office administrator and former beauty queen from Little Mountain, South Carolina. In 1993, Kristi consulted a chiropractor seeking relief from the pain of sinus headaches. During her second visit, she suffered a stroke immediately after the chiropractor manipulated her neck. She died three days later, one day before her 25th birthday. The autopsy revealed that the manipulation had split the inside walls of both of her vertebral arteries, causing the walls to balloon and block the blood supply to the lower part of her brain. Additional studies concluded that blood clots had formed on the days the manipulation took place. In 1997, the State Board of Chiropractic Examiners of South Carolina issued a consent order in which the chiropractor agreed to pay a $1,000 fine and to acquire 12 hours of continuing education credits in the areas of neurological disorders and emergency response.

http://www.quackwatch.org/01QuackeryRelatedTopics/chiro.html
 
Dear Kally,

Observational studies.

How does the stroke rate compare to the non-chiropractic stroke rate?


A recent review of 116 articles published between 1925 and 1997 found 177 cases of neck injury associated with neck manipulation, at least 60% of which was done by chiropractors
Click to expand...


So that is 177 cases (only of neck injury, not stroke) over 72 years, so about 2.5 cases of neck injury per year. I think we have an epedemic on our hands. :rolleyes:

I'm not saying that incompetent chiropractors are beyond this, but making it sound like a major thing is absurd. There is a much higher rate of non-chiropractic stroke. Talk about that some.

Sincerely,

S. H.
 
I'm not interested in playing Spinal Roulette no matter what any study says.

Kally
 
Dear Kally,

I'd agree with that, but note that you are probably more at risk from strokes from non-chiropractic means.

Sincerely,

S. H.
 
Who said chiros caused the most strokes? For gawd's sake I'm an RN and I've seen it all. Very rarely we get one caused by a chiro... Of course they are more rare than other types of cerebral vascular accidents. It actually angers the physical therapists the most. Of course this is only anecdotal evidence and we know what that's worth. lol
 
Kally said:
Spinal Roulette?
One patient proven to have been killed by neck manipulation was Kristi A. Bedenbaugh, a medical office administrator and former beauty queen from Little Mountain, South Carolina. In 1993, Kristi consulted a chiropractor seeking relief from the pain of sinus headaches.
Click to expand...

Good grief! Chiropractors in the US think they can treat sinus problems? What claims are these guys making?
 
Let's not forget that some are treating infants for ear infections. As we all know, untreated ear infections can lead to irreversable hearing problems.
 
The reason people are upset about this is because chiro do not test their practice. For example, no medical school professor, nor any chiro has ever shown a "subluxation" exists. Think about that. Further, if a standard practice were to cause 1 in 100,000 strokes even with efficacy, it would be stopped, or modified. Further, the Massachusetts chiro licensing board does not investigate or prosecute people claiming to be licensed, nor does the attourney general, so just say you are licensed and you are. So even though it is "regulated," it really isn't. What regulation does is it stops the public from suing quacks and protecting snake oil salesmen. You literally have to prove the chiro ripped you off and hurt you using practices outside of the licensure (good luck!) The same is true for naturopathy and the 1994 DSHEA and 1994 FDC acts, which make it legal to commit health fraud on a large scale. Think about it, if you licensed armed robbers, you would have to prove they robbed you outside of the licensure to prosecute them, or get your money back. This is why alt/comp people want licensure, to cover up their incompetence.

Quasi
 
I said it once and I'll say it again. Spinal manipulation has been shown to be effective for neck and low back pain. It has not been proven to be effective for visceral ailments. Many DC mistakenly believe they are somewhat effective for these diseases. If you need a rational DC I suggest you check with the National Association of Chiropractic Medicine.
 
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