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Study
Looks at Chiropractic
Treatment, Stroke Risk
Excerpt
By
Alison McCook,
Reuters Health
People who undergo chiropractic neck and spine adjustments may
be at higher risk of having a stroke as a result of tiny tears
in their arteries, researchers said Monday.
However, experts said the risk
of such a problem is rare at best and that chiropractic manipulations
are safe overall.
Previous research has suggested
that certain "high velocity" neck manipulations used by chiropractors
can lead to a stroke-inducing condition called artery dissection,
in which the inside wall of an artery becomes torn.
These findings, however, have been
sharply criticized by representatives from the American Chiropractic
Association, claiming that the research does not demonstrate that
the manipulation is the cause of stroke.
In the newest study to suggest
a link between chiropractic treatment and stroke, researchers
found that people under age 60 who experienced stroke as a result
of dissection were almost seven times more likely to have undergone
a spine and neck adjustment 30 days before their stroke than other
patients.
During the study, Dr. Wade S. Smith
of the University of California, San Francisco, and colleagues
interviewed 51 people who had experienced stroke as a result of
arterial dissection and compared their chiropractic history to
that of 100 patients who had a stroke as a result of other causes.
Their findings appear in the journal
Neurology.
In an interview with Reuters Health,
Smith said the results suggest that chiropractic manipulations
can either cause the dissection to occur, or worsen a pre-existing
dissection, causing stroke, he said.
He noted that more than half of
the people whose stroke resulted from dissection reported a severe
worsening of pain after their manipulations, a phenomenon not
reported by any people who suffered stroke from other causes.
Smith noted, however, that he believed
that the chance of stroke after neck manipulations was very small,
and that chiropractic medicine was, overall, safe.
That said, Smith added that patients
probably deserve to know that certain manipulations carry that
risk. "I think that patients deserve the right to be informed
about it ... to hear that this can cause injury, although it's
probably rare."
However, Dr. Linda S. Williams
of the Health Services Research and Development Service in Indianapolis,
Indiana, who wrote an accompanying editorial, said she disagrees.
"I personally haven't felt consent
for the procedure is something that definitely needs to be done,"
she told Reuters Health.
She explained that Smith and his
colleagues did not determine which chiropractic manipulations
were performed during patient visits and so cannot say that patients
who developed dissections even received the potentially dangerous
neck manipulation.
Moreover, the authors tried to
determine if people developed dissection before or after their
chiropractic manipulation by asking them if they felt neck pain
before or after visiting a practitioner, a technique that is notoriously
unreliable, Williams said. As such, errors in patients' abilities
to recall when their pain occurred may have influenced the findings,
she noted.
Dr. William Lauretti, a chiropractor
in private practice in Bethesda, Maryland, and a spokesperson
for the American Chiropractic Association, told Reuters Health
that the study does not clearly establish that stroke-causing
dissections are linked to chiropractic medicine.
He explained that previous research
has shown that the neck manipulations featured in the study may
not stress arteries enough to cause dissection.
Moreover, even if the procedure
does increase the risk of dissection and stroke, Lauretti noted
that the risk is so small that patients may have just as high
a risk of dying in a car accident on the way to the appointment,
but chiropractors are not required to warn them of that.
As evidence, Lauretti added that
he has been in practice for 12 years and has performed around
15,000 head and neck treatments. "I've never seen any sort of
a significant complication from it."
SOURCE: Neurology 2003;60:1424-1428,1408-1409.
Reference
Source 89
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