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(HealthNewsDigest.com) – To accurately assess the origin of health care problems and complications requires careful study and analysis. Everyone involved in the continuum of care would like health care to be safer and more effective. This is particularly true when we see a child battling cancer or a young adult who experiences a heart attack or stroke. Unfortunately, in these situations the answers are usually multi-faceted and complex. While we desire simple, quick answers they often aren’t present.
A prime example of this challenge is cervical artery dissection (CAD) – a condition where a defect or tear presents in the wall of a blood vessel (artery) in the neck. Dissections are important as they can precipitate the development of blood clots leading to a stroke.
From time to time, observers question whether there is an association between chiropractic care and stroke caused by CAD, with some jumping to a conclusion based on temporal rather than factual evidence.
Case reports – a very low level of evidence – have suggested a causal relationship between cervical spinal manipulation and cervical artery injuries, resulting in dissections in the vertebral arteries or the internal carotid arteries.
The difficulty with case reports is that they are inadequate to establish causation. More advanced studies involving a number of cases and controls start to give the research power to draw causation conclusions.
THE FACTS
In fact, a team of neurosurgeons at the Penn State Hershey Medical Center published research in 2016 which evaluated stroke in relation to CAD and cervical spine manipulation.
They conducted a systematic review of all case-controlled and case cross-over studies ever published on this subject as well as a meta-analysis of the literature. The researchers evaluated the evidence for a causal link between chiropractic care and CAD, and they were very up-front about the results of their inquiry as their conclusion appeared in the article title: “No Evidence for Causation.”
CAD is Rare
It’s been estimated that internal carotid artery dissections occur in only 2-3 people per 100,000 population annually, while vertebral artery dissections are even less frequent occurring at a rate of 1-2 per 100,000 persons per year.
In the early stages, arterial dissections frequently result in neck pain and headache. Epidemiologic studies have demonstrated that patients seek care from primary care medical providers as well as doctors of chiropractic for these symptoms, and a percentage of these patients go on to experience a stroke at essentially the same rate.
The data reveals that there is no excess risk for patients under chiropractic care in comparison to patients under care from a primary medical provider. Therefore, it is not how either provider is caring for the patient that is the problem — the problem is very likely in-progress when the patient walks through either provider’s office door.
When researchers fail to appreciate that a disease process is already underway, they often suggest that the care provided to the patient caused the problem. This is an error that is known as protopathic bias.
MOVING FORWARD
It is important for anyone experiencing a new or otherwise unexplained occurrence of neck pain and headache to be sure to tell their health care providers about any other symptoms that they might experience with this pain, particularly changes in vision, speech, movement, balance, swallowing, eye movements, dizziness, nausea and numbness.
Chiropractic care is a remarkably safe approach that helps patients avoid the complications and side effects of prescription medication and invasive surgical procedures. Although medication and surgery may be needed in certain circumstances, most individuals agree that avoidance of the two – whenever possible – is most sensible on the part of both the patient and their health care providers.
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