05 May Research from Neck Pain Task Force
The Risk of Vetebrobasilar Stroke and Manipulation …In a Cochrane review for mechanical neck disorders, manipulation made it into the highest level of evidence. No medical interventions achieved this level of evidence. CMT: safe and effective. Use of prescription drugs: much less safe and proven to be ineffective for managing spinal pain.6 A study by Cassidy et. Al, published in SPINE, which was part of the Bone and Joint Decade 200-2010 Task Force on Neck Pain and Its Associated Disorders project, is now the definitive study on the subject of stroke risk and cervical manipulation. This study looked at all the residents of Ontario, Canada over a 9-year period (1993-2002). This represents the equivalent of 109 million person-years of observation. Their design looked at not only visitations to chiropractic physicians in the period preceding the stroke, but also visits to their primary care physician (PCP). The idea in this design is that a PCP, in their work up of patients, is unlikely to subject them to a maneuver that might produce a stroke. They concluded that the odds ratio (statistic of probability) was about the same for both groups. They concluded that patients with a VBA stroke are likely to consult with their PCP or chiropractic physician because of their symptoms, meaning the stroke incident was already underway. Meanwhile, practitioners of manipulation should remain highly vigilant concerning the possibility of Vertebrobasilar Artery Dissection(VAD). These patients may present with neck pain and/or headaches-usually one sided and described as a quality and severity of pain the patient has never experienced in the past. References 1. Coulter ID, Hurwitz EL, Adams AH, Meekr WC, Hansen DT, Mootz RD, Aker PD, Genovese BJ, Shelkelle PG. The appropriateness of manipulation and mobilization of the cervical spine. 1 ed. Santa monica: The RAND Corporation; 1996. 2. Croft A. Stroke risk from CMT? Is the pressure finally off? Florida Chiropractic Association Journal. July/August/September 2008. 3. Cassidy JD, Boyle E, Cote P, He Y, Hogg-Johnson S, Silver F, Bondy S. Risk of vertebrobasilar stroke and chiropractic care: Results of a populationbased-control and cross-over study. Spine. 2008; 33(45):S176-183 4. Wolf SMea. Worst Pills, Best Pills. A Consumer’s Guide to Avoiding Drug-Induced Death & Illness. New York: Simon & Schuster, Inc. 2005 5. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998;279(15):1200-5. 6. Gross AR, Goldsmith C, Hoving JL, Haines T, Peloso P, Aker P, Santaguida P, Myers C. Cervical Overview Group. Conservative management of mechanical neck disorders: a systematic review. J Rheumatol. 2007;34(3):1083-102.