Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study

Eric L. Hurwitz, Hal Morgenstern, Maria Vassilaki, Lu May Chiang

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

Study Design. Randomized clinical trial. Objectives. To document the types and frequencies of adverse reactions associated with the most common chiropractic treatments for neck pain, and to identify possible clinical predictors of adverse reactions to chiropractic treatment. Summary of Background Data. Chiropractic care is frequently sought by patients for relief from neck pain; however, adverse reactions related to its primary modes of treatment have not been well examined. Methods. A total of 336 patients with neck pain presenting to 4 southern California health care clinics were randomized in a balanced 2 × 2 × 2 factorial design to manipulation with or without heat, and with or without electrical muscle stimulation (EMS); and mobilization with or without heat and with or without EMS. Discomfort or unpleasant reactions from chiropractic care were self-assessed at 2 weeks after the randomization/baseline visit. Results. Of the 280 participants (83%) who responded, 85 (30.4%) had 212 adverse symptoms as a result of chiropractic care. Increased neck pain or stiffness was the most common symptom, reported by 25% of the participants. Less common were headache and radiating pain. Patients randomized to manipulation were more likely than those randomized to mobilization to have an adverse symptom occurring within 24 hours of treatment (adjusted odds ratio [OR] = 1.44, 95% confidence interval [CI] = 0.83, 2.49). Heat and EMS were only weakly associated with adverse symptoms (heat: OR = 0.94, 95% CI = 0.54, 1.62; EMS: OR = 1.09, 95% CI = 0.63, 1.89). Moderate-to-severe neck disability at baseline was strongly associated with adverse neurologic symptoms (OR = 5.70, 95% CI = 1.49, 21.80). Conclusions. Our results suggest that adverse reactions to chiropractic care for neck pain are common and that despite somewhat imprecise estimation, adverse reactions appear more likely to follow cervical spine manipulation than mobilization. Given the possible higher risk of adverse reactions and lack of demonstrated effectiveness of manipulation over mobilization, chiropractors should consider a conservative approach for applying manipulation to their patients, especially those with severe neck pain.

Original languageEnglish (US)
Pages (from-to)1477-1484
Number of pages8
JournalSpine
Volume30
Issue number13
DOIs
StatePublished - Jul 1 2005
Externally publishedYes

Fingerprint

Chiropractic
Neck Pain
Electric Stimulation
Hot Temperature
Odds Ratio
Confidence Intervals
Muscles
Spinal Manipulation
Therapeutics
Self Care
Random Allocation
Neurologic Manifestations
Headache
Spine
Neck
Randomized Controlled Trials
Delivery of Health Care
Pain

Keywords

  • Adverse reactions
  • Cervical spine
  • Chiropractic
  • Iatrogenesis
  • Neck pain
  • Spinal manipulation

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study. / Hurwitz, Eric L.; Morgenstern, Hal; Vassilaki, Maria; Chiang, Lu May.

In: Spine, Vol. 30, No. 13, 01.07.2005, p. 1477-1484.

Research output: Contribution to journalArticle

Hurwitz, Eric L. ; Morgenstern, Hal ; Vassilaki, Maria ; Chiang, Lu May. / Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study. In: Spine. 2005 ; Vol. 30, No. 13. pp. 1477-1484.
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AU - Vassilaki, Maria

AU - Chiang, Lu May

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N2 - Study Design. Randomized clinical trial. Objectives. To document the types and frequencies of adverse reactions associated with the most common chiropractic treatments for neck pain, and to identify possible clinical predictors of adverse reactions to chiropractic treatment. Summary of Background Data. Chiropractic care is frequently sought by patients for relief from neck pain; however, adverse reactions related to its primary modes of treatment have not been well examined. Methods. A total of 336 patients with neck pain presenting to 4 southern California health care clinics were randomized in a balanced 2 × 2 × 2 factorial design to manipulation with or without heat, and with or without electrical muscle stimulation (EMS); and mobilization with or without heat and with or without EMS. Discomfort or unpleasant reactions from chiropractic care were self-assessed at 2 weeks after the randomization/baseline visit. Results. Of the 280 participants (83%) who responded, 85 (30.4%) had 212 adverse symptoms as a result of chiropractic care. Increased neck pain or stiffness was the most common symptom, reported by 25% of the participants. Less common were headache and radiating pain. Patients randomized to manipulation were more likely than those randomized to mobilization to have an adverse symptom occurring within 24 hours of treatment (adjusted odds ratio [OR] = 1.44, 95% confidence interval [CI] = 0.83, 2.49). Heat and EMS were only weakly associated with adverse symptoms (heat: OR = 0.94, 95% CI = 0.54, 1.62; EMS: OR = 1.09, 95% CI = 0.63, 1.89). Moderate-to-severe neck disability at baseline was strongly associated with adverse neurologic symptoms (OR = 5.70, 95% CI = 1.49, 21.80). Conclusions. Our results suggest that adverse reactions to chiropractic care for neck pain are common and that despite somewhat imprecise estimation, adverse reactions appear more likely to follow cervical spine manipulation than mobilization. Given the possible higher risk of adverse reactions and lack of demonstrated effectiveness of manipulation over mobilization, chiropractors should consider a conservative approach for applying manipulation to their patients, especially those with severe neck pain.

AB - Study Design. Randomized clinical trial. Objectives. To document the types and frequencies of adverse reactions associated with the most common chiropractic treatments for neck pain, and to identify possible clinical predictors of adverse reactions to chiropractic treatment. Summary of Background Data. Chiropractic care is frequently sought by patients for relief from neck pain; however, adverse reactions related to its primary modes of treatment have not been well examined. Methods. A total of 336 patients with neck pain presenting to 4 southern California health care clinics were randomized in a balanced 2 × 2 × 2 factorial design to manipulation with or without heat, and with or without electrical muscle stimulation (EMS); and mobilization with or without heat and with or without EMS. Discomfort or unpleasant reactions from chiropractic care were self-assessed at 2 weeks after the randomization/baseline visit. Results. Of the 280 participants (83%) who responded, 85 (30.4%) had 212 adverse symptoms as a result of chiropractic care. Increased neck pain or stiffness was the most common symptom, reported by 25% of the participants. Less common were headache and radiating pain. Patients randomized to manipulation were more likely than those randomized to mobilization to have an adverse symptom occurring within 24 hours of treatment (adjusted odds ratio [OR] = 1.44, 95% confidence interval [CI] = 0.83, 2.49). Heat and EMS were only weakly associated with adverse symptoms (heat: OR = 0.94, 95% CI = 0.54, 1.62; EMS: OR = 1.09, 95% CI = 0.63, 1.89). Moderate-to-severe neck disability at baseline was strongly associated with adverse neurologic symptoms (OR = 5.70, 95% CI = 1.49, 21.80). Conclusions. Our results suggest that adverse reactions to chiropractic care for neck pain are common and that despite somewhat imprecise estimation, adverse reactions appear more likely to follow cervical spine manipulation than mobilization. Given the possible higher risk of adverse reactions and lack of demonstrated effectiveness of manipulation over mobilization, chiropractors should consider a conservative approach for applying manipulation to their patients, especially those with severe neck pain.

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