Prize-winning paper from the World Federation of Chiropractic 7th Biennial CongressAdverse reactions to chiropractic treatment and their effects on satisfaction and clinical outcomes among patients enrolled in the UCLA Neck Pain Study
Introduction
Although major complications resulting from chiropractic care are very rare,1, 2, 3 transient discomfort and other minor side effects of chiropractic care are common. Recent prospective studies have shown 30% to 55% of patients receiving spinal manipulation experience minor side effects, such as local discomfort4, 5, 6 or additional pain7 shortly after treatment. Much less common are radiating pain or discomfort,4, 5, 7 stiffness,7 headache, and tiredness or fatigue.4, 5, 6, 7 Nausea and dizziness each comprise 5% or less of reported symptoms.4, 5, 6, 7 The majority of reactions have been reported to begin within 24 hours of the treatment visit and to resolve in less than 24 hours. However, little is known about (1) the frequency of adverse reactions specifically following chiropractic treatment of the cervical spine, (2) the effect of type of manual therapy on the incidence of adverse reactions, and (3) the effects of adverse reactions on patient satisfaction and clinical outcomes.
The objectives of this study are to compare the relative effects of cervical spine manipulation and mobilization on adverse reactions and to estimate the effects of adverse reactions on satisfaction and clinical outcomes among patients with neck pain.
Section snippets
Study design and source population
Neck pain patients were randomized in a balanced 2 × 2 × 2 factorial design to manipulation with and without heat and with and without electrical muscle stimulation (EMS) and mobilization with and without heat and with and without EMS. Subjects were followed for 6 months with assessments for pain and disability at 2 and 6 weeks and 3 and 6 months. The source population was approximately 90,000 to 110,000 members of a southern California health care network, which had chiropractors on staff at 4
Screening, enrollment, and follow-up
We screened a total of 1848 patients. Eight hundred eighty-eight (48%) patients were excluded for the following nonmedical reasons (frequency): pain not primarily in the neck (283), over 70 years old (169), third-party liability or workers' compensation (112), fee-for-service or non-HMO insurance (104), treatment in the past 1 month (100), less than 18 years old (24), inability to read English (24), plans to relocate (14), and not easily accessible by telephone (4). Patients were excluded for
Discussion
The results from this study of neck pain patients randomized to receive chiropractic manipulation or mobilization suggest that cervical spine manipulation is associated with relatively more adverse reactions than cervical spine mobilization and that experiencing an adverse reaction during the first 2 weeks of care results in relatively less satisfaction and perceived improvement 2 weeks later and less reductions in pain and disability after 6, 13, and 26 weeks of follow-up. Although these
Conclusion
Among neck pain patients treated by chiropractors, adverse reactions are more likely to be reported following cervical spine manipulation than cervical spine mobilization. Compared with subjects who did not report any adverse treatment effects, the findings suggest that subjects with adverse symptoms (1) were relatively less satisfied with care, (2) perceived less improvement in neck symptoms, and (3) had more pain and disability during subsequent follow-up. Larger prospective studies should be
Acknowledgements
This study was funded by grants from the Health Resources and Services Administration (R18 AH10008) and the National Chiropractic Mutual Insurance Company (NCMIC). Dr Hurwitz was also supported by a grant from the National Center for Complementary and Alternative Medicine (K23 AT00055). We wish to thank Dr Gary Pirnat and his staff of chiropractors for their active involvement and cooperation during the study. Special thanks also to the clinic management teams from La Habra, Brea, Buena Park,
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Non-serious adverse events do not influence recovery in patients with neck pain treated with manual therapy; an observational study
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2019, Musculoskeletal Science and PracticeCitation Excerpt :As a result, thoracic manipulation has been recommended as a primary manual therapy intervention for the treatment of neck pain by clinical practice guidelines (Blanpied et al., 2017). Thoracic manipulation is considered to be safer and have fewer side-effects than cervical manipulation (Cagnie et al., 2004; Hurwitz et al., 2004), while resulting in similar neurophysiological effects such as muscle inhibition and hypoalgesia (Pickar, 2002; Vicenzino et al., 1998). While serious adverse events following thoracic spine manipulation are extremely rare, the risk of adverse effects does exist with the use of thrust manipulation and may be underreported (Puentedura and O'Grady, 2015).
Predictive factors for reporting adverse events following spinal manipulation in randomized clinical trials – secondary analysis of a systematic review
2017, Musculoskeletal Science and PracticeAdverse events in a chiropractic spinal manipulative therapy single-blinded, placebo, randomized controlled trial for migraineurs
2017, Musculoskeletal Science and PracticeCitation Excerpt :Our RCT reported fewer AEs in general than were reported in previous studies, although similar transient and mild characteristics were reported (Cagnie et al., 2004; Walker et al., 2013; Hurwitz et al., 2004; Thiel et al., 2007; Rubinstein et al., 2007; Eriksen et al., 2011; Maiers et al., 2015). Common AEs from previous studies included local tenderness (mean 26.4%; 95% CI 26.2–26.6) (Cagnie et al., 2004; Walker et al., 2013; Hurwitz et al., 2004; Thiel et al., 2007; Rubinstein et al., 2007; Eriksen et al., 2011; Maiers et al., 2015), and tiredness on the treatment day (mean 10.5%; 95% CI 10.4–10.6) (Cagnie et al., 2004; Hurwitz et al., 2004; Rubinstein et al., 2007; Eriksen et al., 2011). Headache was reported as a common AE (mean 10.3%; 95% CI 10.2–10.4), which is likely because previous studies primarily investigated neck pain and not headache (Cagnie et al., 2004; Walker et al., 2013; Hurwitz et al., 2004; Thiel et al., 2007; Rubinstein et al., 2007; Eriksen et al., 2011; Maiers et al., 2015).
Spinal Manipulation
2017, Clinical Orthopaedic Rehabilitation: A Team Approach, Fourth EditionRelationship Between Subjective Experience of Individuals, Practitioner Seniority, Cavitation Occurrence, and 3-Dimensional Kinematics During Cervical Spine Manipulation
2017, Journal of Manipulative and Physiological TherapeuticsCitation Excerpt :Patients’ contextual factors may contribute to or alter the clinical outcomes. These include patient-practitioner relationship, patient’s previous experience, beliefs, side effects, and global satisfaction of the health care setting features.13,14 Also, it has been suggested that the confidence of the practitioner in the performance of the spinal manipulation technique influences the effectiveness of the patient’s management.15