Anti-Quackery & Science Blog
You might be interested in following up on the following press release, taken from EurekAlert:
Contact: Greg Welsh
greg.welsh@mq.edu.au
61-2-9850-7383
Research Australia
Clinical trial proves link between chiropractic and migraines
Seventy-two per cent of migraine sufferers in a clinical trial experienced either 'substantial' or 'noticeable' improvement after a period of chiropractic treatment, defying historical skepticism of chiropractics by some medical practitioners.
The randomised clinical trial was undertaken by Dr Peter Tuchin, a chiropractor for the past 20 years, as part of his recently-completed PhD thesis at Macquarie University.
"Around 22 per cent [of patients] had substantial reduction - which means that more than 60 percent of their symptoms reduced during the course of the treatment," Tuchin says. "What makes this a really strong result is that this was a really chronic group - the average length of time they'd had migraines was 18 years. To get a change of that sort of magnitude in a really chronic group was quite amazing.
"Another 50 per cent had quite noticeable improvement. They either found that the frequency of the migraines was less, the length of time they had them was less or that they didn't need to use their medications as much. This last result is very significant because some of the migraine medications are very strong drugs which have lots of side effects. Some of the migraine medications also have the problem of giving instant relief to the migraine, but creating another 'rebound migraine' the next day."
The trial used 123 migraine sufferers, whittled down from around 1000 who applied after seeing a television program about the research. This group was divided into a treatment group who received chiropractic care, and a control group who were told they were receiving a form of electrical physical therapy.
"Both groups kept a record of their migraines for the whole six months, noting down how often they got them, how severe they were, how long they lasted, and if there was anything they could think of that contributed to them," Tuchin explains. "For two months prior to any treatment they just diarised their migraines, followed by two months of treatment and then two months of post-treatment."
Despite this study, some medical practitioners still dispute the ability of chiropractic care to help migraine sufferers. However, Tuchin believes this is a fast-diminishing group.
"I think the vast majority of medical practitioners are now open to chiropractic, but there's a very small percentage who don't realise what developments we've had, what inroads we've made," Tuchin says.
"Chiropractic is not the be all and end all, but for a good percentage of migraine sufferers the neck is a significant contributing factor, and for them chiropractic treatment is really effective. I'm not saying that everybody's going to be cured, but there's very little to lose."
May 23-29 is National Chiropractic Care Week. This year the theme is safe drugfree treatment of headaches. It is estimated that 10 to 12 percent of the Australian population suffer from migraines which costs the country $1.5 billion each year.
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Media contact:
Dr. Peter Tuchin 61-2-9850-6384, peter.tuchin@mq.edu.au.
Published at University of California:
Chiropractic treatment of the neck can be a risk factor for stroke
A retrospective study of stroke cases at two major academic medical centers, led by University of California, San Francisco neurologists, indicates that chiropractic manipulation of the neck can cause vertebral artery dissection, a tearing of the vertebral artery leading to the brain that causes stroke or transient ischemic attack (TIA).
Evidence from the study also suggests that spinal manipulative therapy may exacerbate pre-existing vertebral artery dissections.
The findings are published in the May 13 issue of Neurology. Several previously published studies have reported cases in which spinal manipulative therapy of the neck has preceded stroke by minutes or weeks in patients who subsequently developed vertebral artery dissections, but these studies were not designed to establish causation. The current study teased out the variables that could explain the onset of stroke -- including addressing the question of whether patients with spontaneous cervical arterial dissection seek spinal manipulative therapy because of neck pain or whether spinal manipulative therapy either causes dissection or exacerbates a pre-existing dissection – and determined that treatment is an independent risk factor.
The researchers reported that patients under age 60 who had strokes or transient ischemic attacks from tears in the vertebral artery were six times more likely to have had spinal manipulative therapy in the 30 days prior to their stroke than patients who had strokes from other causes. The patients tended to be otherwise healthier than most stroke patients, lacking such risk factors as diabetes, high blood pressure and atherosclerosis.
The number of chiropractic manipulations performed in the United States each year is in the millions, and the incidence of stroke from all causes is only 10 per 100,000, so we’re not talking about large numbers of victims. But rare incidences do happen, and physicians and patients should be aware of spinal manipulation therapy as a rare but potentially causal factor in stroke, said the first author of the study, Wade S. Smith, MD, PhD, UCSF associate professor of neurology and director of the UCSF Neurovascular Service at UCSF Medical Center.
Given this link, he said, physicians presented with patients displaying the neurological symptoms of stroke or TIA – particularly younger patients - should be alert to the possibility that dissection is the cause, so that they can institute presumptive treatment to prevent further strokes. Likewise, he said, chiropractic practitioners performing spinal manipulative therapy should warn patients of the risk of cervical artery dissection. In fact, he says patients should be screened by a physician for symptoms of pre-existing vertebral arterial dissection, such as TIA, before beginning therapy, and be told that a significant increase in neck pain or neurological signs or symptoms within 30 days following spinal manipulative therapy warrants immediate medical evaluation.
In their paper, the researchers propose that since spinal manipulative therapy is a medical procedure, practitioners should carry out a formal consent process, in which risk would be disclosed. Smith noted that physicians are expected to disclose any risk to patients regarding procedures or drug therapies.
The researchers were not able to determine whether particular neck manipulations cause the rare cases of vertebral arterial dissection, though there is evidence in the scientific literature, says Smith, that rapid movements over short distances are safer than quick movements over long distances.
(Scientists suspect that the vertebral artery is particularly vulnerable to mechanical dissection due to its horizontal course along the first cervical vertebra, where it can be compressed or placed under traction as the head is extended and rotated.)
Regardless, the tear in the artery causes the formation of a blood clot in the artery, either leading to the brain or in the brain itself, that blocks blood flow to the brain and leads to the often severe neurological impairment associated with stroke and TIA. Approximately 16 to 19 percent of strokes in young patients are attributed to spontaneous cervical arterial dissection, often accompanied by neck or head pain.
While most spontaneous cases do not have a clear cause, certain uncommon conditions, as well as trauma, can predispose people.
However, it has been unclear whether minor trauma or simple, self-initiated head and neck motions can produce dissection. In their study, the scientists reviewed all patients under age 60 at UCSF Medical Center and Stanford Medical Center stroke centers who developed cervical arterial dissection and stroke or TIA between 1995 and 2000. After excluding patients who either did not meet the criteria for the study or who declined to participate, the scientists examined the medical cases and conducted interviews with 51 dissection patients (mean age 41, +/- 10 years; 59 percent female) and 100 control patients (mean age 44 +/- 9 years; 58 percent female). Participants in the latter group, who had strokes not caused by dissection, were matched by gender and age, and were randomly selected.
Of this group, ten patients (seven dissection patients, three controls) were able to provide detailed information about the timing of spinal manipulative therapy and the timing of pain symptoms relative to stroke or TIA. Notably, the seven dissection patients received spinal manipulative therapy within 1.4 days of the neurovascular event, while the controls received it on average 8.4 days prior to stroke. Six of the dissection patients had their dissection in the vertebral artery, as opposed to other arteries leading to the brain.
Of these seven patients, four had substantial increase or new and different pain immediately following spinal manipulative therapy – in contrast to the three controls who said they experienced relief of their pain -- and all four had vertebral artery dissections. Two of the dissection patients had a stroke within seconds of receiving spinal manipulative therapy. Both of these patients had vertebral dissections.
These observations suggest that spinal manipulative therapy can directly produce dissection, says Smith. It is highly improbably that a young patient will have a stroke and have had spinal manipulative therapy within seconds purely by chance, given the relatively low frequency of both events.
The researchers cited several limitations of their study, such as the fact that the data was collected retrospectively from a population of patients who responded to solicitation, leaving room for variables in patient recollection, variation in the diagnostic work-ups and patient self selection. However, they noted, while a prospective study could reduce the potential for such biases, it might be difficult to obtain a large enough sample given the rarity of the disease.
In an accompanying editorial in Neurology, neurologists Linda S. Williams, MD, and Jose Biller, MD, noted the limitations of the study but wrote that the six-fold risk determined by the scientists must be taken seriously.
Moreover, they wrote, In the absence of randomized controlled trial evidence demonstrating the effectiveness of cervical manipulation, the best current evidence suggests that the small risk of dissection and stroke outweighs the benefit of this treatment modality for patients with acute neck pain.
Co-authors of the study were S. Claiborne Johnston, MD, PhD, UCSF associate professor of neurology and director of the UCSF Stroke Service, UCSF Medical Center; E.J. Skalabrin, MD, of the Department of Neurology, University of Utah; M. Weaver, MS, of the Stanford University Center for Biomedical Ethics Department; P. Azari, St. George’s University School of Medicine; G.W. Albers, MD, Department of Neurology, Stanford University and D.R. Gress, MD, of Lynchburg General Hospital
More health information on reflector.com: Chiropractic Tied to Rare Strokes
Fact is that stroke is a serious sideeffect of manipulating someones neck.
Fact is that many chiropractors manipulate the neck, even when the pain is in the back.
Fact is that they don't warn their patients about the possible complication of stroke.
Dr. Tuchin's study, in the first comment, is seriously flawed. It appears to have recruited "believers" from a TV audience. The study makes no attempt at "blinding". I agree that neck manipulation could reduce the frequency and severity of migraine episodes, however this study is far too open to the placebo effect. I'm surprised that it qualified for PhD research.
One problem with chiropractors is that some places uses tehm as part of medical treatment. In Denmark authorized chiropractors sometimes are used on the doctors' directions. This makes people believe that they are actually practicing something based on sound science.
I am sixtiesh and had chiro treatments in the past from several chiropractors for sore neck/back and one with standard neck manipulation did help but he retired 8 yeasrs ago. In an old life i was a lawyer handling personal injury claims and was always skeptical of the tremendous numbers of treatments that chiros billed out for collection. i also became scared of chiro's generally when info about the strokes caused became public. I because of health challenges have done a lot of alternative treatment 80% of which i now question its help although fibromyalgia is challenging. HOWEVER, i do put a plug in for a certain chiropractic protocal called NUCCA - North America Upper Cervical Chiropractic Association. I discoverd this type of chiropractor, about 4 years ago at a time my neck was excrutiating in pain and i had also been diagnosed with TMJ (jaw problems). These Chiros only adjust the top two vertebrae of the neck (sort of like puting the head back on straight) and their claim is if this is done the rest of the spine will also line up properly. The adjustment is not a twist manipulation but extremely gentle pressure on the side of the supported neck with edge of their hand. Although they insist on several hundreds of dollars extra very precise xrays to start with the upkeep for me is only two visits per year so in fact the costs are much less than other chiros. After the intial two treatments both my neck pain and TMJ pain of many years standing were gone. One thing they do is check the length of your legs to see if even - so after the years now i can tell myself by the fact that i will go off balance when i walk and almost fall over and then i know my neck is out (confirms the pain is definitely this upper problem) and go for adjustment. i without hestiation recomend NUCCA but cannot with other chiro treatment and wander how much the placebo effect is in play with those.
I have had chiro treatments many times to releive back pain after back injuries! I have also had the services of a physotherapist with many letters behind his name who basically did the same as a neck manipulation but in such a slow and gentle fashion that i could barely feel what he did but because of chiro treatments i knew he put things back right? What type of physiotherapists do this? it reminds me of a chiropracter but with a really gentle touch
You need to take a serious look at the studies done with chiropractic care and there benefits. Like all practices errors are possible. Don't be so one sided and closed minded. The world is not just you!!!
There are risks in all medical procedures and medications, some much more common than the risk of stroke from a cervical manipulation by a DC. If that is your only reason for not continuing chiropractic care it is very sad. We have had some patients at our office that are afraid to have their neck adjusted but once it is done they can't believe the positive difference.
I have been receiving chiropractic care since I was 5 years old. I have also worked as a CA for 10 years. I have had nothing but positive results from chiropractic adjustments. I choose a life of natural medicine, organic foods, vitamins, healthy diet and exercise along with chiropractic care. But I strongly believe that if MD's and DC's could work together we would all be better off.
In my years of Chiropractic I have never heard of a patient fainting from a treatment or having a stroke. But I have seen a man walk after an adjustment when he could not walk before. I have seen proof of it helping headaches, colic, earaches, TMJ, sinus problems, and the list goes on.
Chiropractic is not the answer to everyones problems but it most certainly has earned its place in the medical profession.
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