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  • Rebekah Bruner, DC

Putting Neck Pain Treatment Risks into Perspective


There are risks and benefits to all treatments; however, the chance of experiencing a serious adverse event following neck manipulation is extremely low.

The association between neck manipulation and vertebral artery dissection is about 1 in 5.85 million adjustments (less than 1 in 1 million 1). While it is impossible to make direct comparisons given likely differences in underlying patient demographics and co-morbidities, it is important to recognize that all healthcare treatments and procedures carry some association with adverse events. To put the association between neck manipulation and VAD in context, consider the following:

  • Overall risk of death from spine surgery: 1,800 per 1 million 2

  • Risk of serious side effects/death from cervical spine (neck) surgery: 500 per 1 million 3

  • Risk of death from combined use of NSAIDS/aspirin: 153 per 1 million 4

  • Risk of death from prescription opioid pain medications: 53.6 per 1 million 5

  • Risk of death from aspirin: 25 per 1 million 6

According to the Institute of Medicine, at least 1.5 million Americans are sickened, injured or killed each year by errors in prescribing, dispensing and taking medications. 7

Moreover, CDC has classified the abuse of prescription opioid pain medications in the U.S. as “epidemic.” In 2010, more than 15,000 people died as a result of taking these drugs. 8

Even over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen pose a greater risk than neck manipulation. One study estimated more than 100,000 patients are hospitalized every year for serious gastrointestinal complications resulting from their use. (There are over 16,000 NSAID-related deaths annually in the United States). 9

Doctors of chiropractic have some of the lowest malpractice insurance premiums in health care because of the low risk associated with the treatments they utilize.

RESOURCES:

1. Haldeman S, Carey P, Townsend M, Papadopoulos C: Arterial dissections following cervical manipulation: the chiropractic experience. CMAJ 2001;165:905.

2. Smith, JS et al. Rates and causes of mortality associated with spine surgery based on 108,419 procedures: a review of the Scoliosis Research Society Morbidity and Mortality Database. Spine 2012, Nov 1;37(23):1975-82.

3. Marquez-Lara A, Nandyala SV, Hassanzadeh H, Noureldin M, Sankaranarayanan S, Singh K: Sentinel Events in Cervical Spine Surgery. Spine 2014 Jan 29 [Epub ahead of print], http://www.ncbi.nlm.nih.gov/pubmed/24480955

4. Lanas A et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterology 2005, Aug;100(8):1685-93.

5. Email to ACA from Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, April 29, 2014.

6. Lanas A et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterology 2005, Aug;100(8):1685-93.

7. Preventing Medication Errors, Institute of Medicine, July 2006,

http://www.iom.edu/~/media/Files/Report%20Files/200

6/Preventing-Medication-Errors-Quality-Chasm-Series/medicationerrorsnew.pdf

8. Office of National Drug Policy, Fact Sheet: Opiod Abuse in the United States,

http://www.whitehouse.gov/sites/default/files/ondcp/Fact_Sheets/opioids_fact_sheet.pdf

9. Wolfe MM, Lichtenstein DR, Singh G: Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. NEJM 1999; 340:1888.


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