According to the American Chiropractic Association, approximately 20 million Americans visit chiropractors each year, most seeking relief from back pain, neck pain and headaches. Scientific research strongly supports the benefits of chiropractic care for these conditions. But all health care treatments carry the possibility of complications. So it is important to know the associated risks and benefits.

Many quality research studies have examined adverse events in patients receiving chiropractic manipulation. Two case-control studies provide the best data to date on the relationship between neck manipulation and stroke. The studies, conducted in Canada and the U.S., looked at millions of individuals exposed to either chiropractic or primary physician care. They found no causal association between chiropractic or primary physician care and the risk of stroke.

Both of these independent research teams found that patients are no more likely to suffer a stroke following a visit to a chiropractor than they would after stepping into their family medical doctor’s office. They concluded that chiropractic manipulation is an unlikely cause of stroke. More than a dozen other high-quality published scientific studies agree with this conclusion.

Although there is no causal link between chiropractic or primary care physician care and the risk of stroke, there remains a weak association. This association is most likely due to patients seeking care for the symptoms of artery failure, which are headache and neck pain. Essentially, these patients seek care when a stroke is already in progress.

Several important studies have used MRI to examine the stress that chiropractic manipulation places on the arteries of the neck. They have found that examining the neck with simple range-of-motion tests places more stress on the arteries of the neck than does chiropractic manipulation. Another study using doppler ultrasound confirmed this finding.

Research suggests that serious events like stroke or death following chiropractic care occur in fewer than five cases per million treatments, and they occur at the same rate with medical doctor visits. Even more rare is disc herniation or cauda equina syndrome, estimated to occur in fewer than one case per million treatments. Muscle soreness is not uncommon, but it is usually temporary and mild to moderate in severity, similar in rate and severity to soreness from home exercise.

In contrast, serious adverse events caused by spinal surgery are remarkably common. Several published studies conducted by independent medical research teams found that the re-operation rate (failure rate) for spinal surgery is greater than 22 percent. Serious post-operative pain and disability was experienced by more than 29 percent of patients following total lumbar disc replacement. Death rates following spinal surgery are about five per 1,000 operations, and blindness occurs in more than one per 1,000 operations.

The New England Journal of Medicine reports conservative estimates that 16,500 NSAID-related deaths occur annually among patients with arthritis in the United States. If deaths from gastrointestinal toxic effects from NSAIDs were reported separately in Vital Statistics Reports, NSAIDs would constitute the 15th most common cause of death in the U.S.

One of the most common challenges in providing healthcare is balancing the benefits and risks of treatment. This balance plays a role in nearly every medical decision. By providing informed consent, doctors give patients the information necessary to understand the scope and nature of the potential risks and benefits before making a decision.

Dr. Ron Feise is president of the Institute of Evidence-Based Chiropractic.

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