ADVERSE EVENTS AND CHIROPRACTIC CARE
 
   

Adverse Events
and Chiropractic Care

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:
  Frankp@chiro.org


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Chronic Neck Pain Low Back Pain Stroke & Chiropractic


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ChiroZine Case Reports Pediatric Section


Conditions That Respond Alternative Medicine Approaches to Disease



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Association of Spinal Manipulative Therapy With Clinical Benefit and Harm
for Acute Low Back Pain: Systematic Review and Meta-analysis

JAMA. 2017 (Apr 11);   317 (14):   1451–1460 ~ FULL TEXT

For the second time in as many months, a prominent medical journal has endorsed spinal manipulation for the management of low back pain. [1] On April 11th 2017, JAMA published a systematic review of 26 randomized clinical trials in order to evaluate the safety and effectiveness of spinal manipulation for low back pain.   The authors concluded:   “Among patients with acute low back pain, spinal manipulative therapy was associated with improvements in pain and function with only transient minor musculoskeletal harms.”

Adverse Events Due to Chiropractic and Other Manual Therapies
for Infants and Children: A Review of the Literature

J Manipulative Physiol Ther. 2015 (Nov);   38 (9):   699–712 ~ FULL TEXT

Published cases of serious adverse events in infants and children receiving chiropractic, osteopathic, physiotherapy, or manual medical therapy are exceedingly rare. There have been no cases of deaths associated with chiropractic care reported in the academic literature to date. Three deaths were reported caused by other types of manual therapists (1 physical therapist, 1 unknown practitioner, and 1 craniosacral therapist). Performing a thorough history and examination to exclude anatomical or neurologic anomalies before the provision of care, appropriate technique selection and its application may further reduce adverse events across all manual therapy professions.

Adverse Events Among Seniors Receiving Spinal Manipulation and Exercise
in a Randomized Clinical Trial

Man Ther. 2015 (Apr);   20 (2):   335–341 ~ FULL TEXT

Non-serious AE were reported by 130/194 participants. AE were reported by three times as many participants in supervised plus home exercise, and nearly twice as many as in SMT with home exercise, as in home exercise alone. The majority of AE were musculoskeletal in nature; several participants associated AE with specific exercises. One incapacitating AE occurred when a participant fell during supervised exercise session and fractured their arm. One serious adverse event of unknown relationship occurred to an individual who died from an aneurysm while at home. Eight serious, non-related AE also occurred. Musculoskeletal AE were common among elderly participants receiving SMT and exercise interventions for NP. As such, they should be expected and discussed when developing care plans.

Adverse Reactions of Medications in Children:
The Need for Vigilance, A Case Study

Journal of Clinical Chiropractic Pediatrics 2014 (Mar);   14 (2) ~ FULL TEXT

This study demonstrates that adverse drug reactions do potentially pose a public health risk within the pediatric population and all healthcare providers need to be mindful of this risk. Adverse events to medication within this population are prevalent particularly in children under the age of two. Chiropractors must therefore be aware of adverse drug reactions and recognize symptoms within their patient population.

Quantifying the Impact of NSAID-associated Adverse Events
Am J Manag Care. 2013 (Nov);   19 (14 Suppl):   s267–272

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used among patients experiencing many different types of pain, including inflammatory, acute pain (eg, injury, low back pain, headache, postoperative pain), and chronic pain (eg, rheumatoid arthritis, osteoarthritis).   However, both traditional NSAIDs and second-generation NSAIDs (cyclooxygenase-2 inhibitors) can lead to very expensive and serious adverse events. Gastrointestinal, cardiovascular, and renal complications associated with NSAIDs have been shown to be dose-dependent. In 2005, to help minimize these risks, the US Food and Drug Administration issued a public health advisory stating that "NSAIDs should be administered at the lowest effective dose for the shortest duration consistent with individual patient treatment goals."

Outcomes of Usual Chiropractic.
The OUCH Randomized Controlled Trial of Adverse Events

Spine (Phila Pa 1976). 2013 (Sep 15);   38 (20):   1723–1729 ~ FULL TEXT

Completed adverse questionnaires were returned by 94.5% of the participants after appointment 1 and 91.3% after appointment 2. Thirty-three percent of the sham group and 42% of the usual care group reported at least 1 adverse event.   Common adverse events were:

increased painsham 29%usual care 36%
muscle stiffnesssham 29%usual care 37%
headachesham 17%usual care   9%

The relative risk (RR) was not significant for adverse event occurrence (RR = 1.24; 95% CI: 0.85-1.81), occurrence of severe adverse events (RR = 1.9; 95% CI: 0.98-3.99), adverse event onset (RR = 0.16; 95% CI: 0.02-1.34), or adverse event duration (RR = 1.13; 95% CI: 0.59-2.18).   No serious adverse events were reported.
CONCLUSION:   A substantial proportion of adverse events after chiropractic treatment may result from natural history variation and nonspecific effects.

Adverse Events From Spinal Manipulation in the Pregnant
and Postpartum Periods: A Critical Review of the Literature

Chiropractic & Manual Therapies 2012 (Mar 28);   20:   8 ~ FULL TEXT

Five articles identifying adverse events in seven subjects following spinal manipulation were included in this review, along with two systematic reviews. The articles were published between 1978 and 2009. Two articles describing adverse effects from spinal manipulation on two postpartum patients were included, while the remaining three articles on five patients with adverse effects following spinal manipulation were on pregnant patients. Injury severity ranged from minor injury such as increasing pain after treatment that resolved within a few days to more severe injuries including fracture, stroke, and epidural hematoma. SIGN scores of the prospective observational cohort study and systematic reviews indicated acceptable quality.

Possible Adverse Events in Children Treated By Manual Therapy: A Review
Chiropractic & Osteopathy 2010 (Jun 2);   18:   12 ~ FULL TEXT

Miller and Benfield [16] estimate 1% of pediatric patients (one in 749 treatments) suffered from a minor and self limited AE. A detailed description of the AE allowed the authors to review and classify them. Based on their analysis, three of the events attributed as AE may have been incorrectly attributed as a result of treatment (i.e. pre-existing constipation, common behavior of child, etc.). If these are excluded, the AE rate becomes one reaction per 1310 treatments.

Safety of Chiropractic Manual Therapy for Children:
How Are We Doing?

J Clinical Chiropractic Pediatrics 2009 (Dec);   10 (2):   655–660

Based on the published literature, chiropractic spinal manipulation, when performed by skilled chiropractors, provides very low risk of adverse effect to the pediatric patient. Vigilance to detect occult pathology as well as other steps to maintain safe practice are of utmost importance.

Adverse Effects of Spinal Manipulative Therapy in Children Younger Than
3 Years: A Retrospective Study in a Chiropractic Teaching Clinic

J Manipulative Physiol Ther 2008 (Jul);   31 (6):   419–423 ~ FULL TEXT

This study shows that for the population studied, chiropractic manipulation produced very few adverse effects and was a safe form of therapy in the treatment of patients in this age group.

The Benefits Outweigh the Risks for Patients Undergoing Chiropractic Care
for Neck Pain:   A Prospective, Multicenter, Cohort Study

J Manipulative Physiol Ther 2007 (Jul);   30 (6):   408–418 ~ FULL TEXT

In contrast to clinical trials of prescription medication, researchers in the area of conservative care for musculoskeletal complaints have focused their attention on treatment effectiveness and, to a much lesser degree, on adverse events. This study, consisting of patients treated in a wide variety of chiropractic practices and settings, describes both positive and negative, and short- and long-term clinical outcomes for a relatively large study population with neck pain. Although many of the subjects (in this study) had chronic, recurrent neck pain and had undergone prior care for this complaint, many patients experienced benefit from the treatment (based upon diminished pain and disability, the percentage of patients recovered and percentage satisfied with care). Furthermore, many responded relatively quickly to treatment (48% were recovered at the fourth visit).



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