On this blog, I have discussed the adverse events (AEs) of spinal manipulative therapy (SMT) with some regularity, and we have seen that ~ 50% of patients who receive SMT from a chiropractor experience some kind of AE. In addition there are many serious complications. In my book, I discuss, apart from the better-known vascular accidents followed by a stroke or death, the following:
- atlantoaxial dislocation,
- cauda equina syndrome,
- cervical radiculopathy,
- diaphragmatic paralysis,
- disrupted fracture healing,
- dural sleeve injury,
- haemorrhagic cysts,
- muscle abscess,
- muscle abscess,
- neurologic compromise,
- oesophageal rupture
- soft tissue trauma,
- spinal cord injury,
- vertebral disc herniation,
- vertebral fracture,
- central retinal artery occlusion,
- Wallenberg syndrome,
- loss of vision,
- Horner’s syndrome.
Considering this long list, we currently have far too little reliable information. A recent publication offers further information on this important topic.
The aim of this study was to identify beliefs, perceptions and practices of chiropractors and patients regarding benign AEs post-SMT and potential strategies to mitigate them. Clinicians and patients from two chiropractic teaching clinics were invited to respond to an 11-question survey exploring their beliefs, perceptions and practices regarding benign AEs post-SMT and strategies to mitigate them.
A total of 39 clinicians (67% response rate) and 203 patients (82.9% response rate) completed the survey. The results show that:
- 97% of the chiropractors believed benign AEs occur.
- 82% reported their own patients have experienced an AE.
- 55% of the patients reported experiencing benign AEs post-SMT, with the most common symptoms being pain/soreness, headache and stiffness.
- 61.5% of the chiropractors reported trying a mitigation strategy with their patients.
- Yet only 21.2% of patients perceived their clinicians had tried any mitigation strategy.
- Chiropractors perceived that patient education is most likely to mitigate benign AEs, followed by soft tissue therapy and/or icing after SMT.
- Patients perceived stretching was most likely to mitigate benign AEs, followed by education and/or massage
The authors concluded that this is the first study comparing beliefs, perceptions and practices from clinicians and patients regarding benign AEs post-SMT and strategies to mitigate them. This study provides an important step towards identifying the best strategies to improve patient safety and improve quality of care.
The question that I have often asked before, and I am bound to ask again after seeing such results, is this:
If there were a drug that causes temporary pain/soreness, headache and stiffness in 55% of all patients (plus an unknown frequency of a long list of serious complications), while being of uncertain benefit, do you think it would still be on the market?