Today I wanted to discuss a little about the safety of chiropractic. Occasionally there are stories that make the news about someone getting hurt or possibly even dying after going to the chiropractor. Often these stories go along with the claim that chiropractic is unsafe and basically you should not go to the chiropractor. I will admit that on rare occasions someone is severely hurt or even dies after going to the chiropractor. But the question I want you to think about is if chiropractic is unsafe what are you comparing it to?
If you will allow me to indulge in a bit of hyperbole I could say that going outside is unsafe because you may be struck by lightning or hit by something falling out of the sky. Most people don’t even think about such things because the likelihood of being injured this way is really rather remote. But staying inside could be even more unsafe with the possibility of tripping and falling in the bathtub, etc. However, there are other things that are relatively more dangerous that we do each day without really thinking much about it. Driving actually is relatively dangerous, with statistics for the US from 2010 showing that 11.4 per 100,000 of the population died from a motor vehicle accident. That accounts for 35,332 deaths for that year.1
Safety of Chiropractic
So to be completely honest, people do die after going to the chiropractor, but that does not necessarily mean chiropractic caused their death. While I believe there are rare cases where chiropractic care may cause or contribute to the death of someone, chiropractic is very safe. To give you an idea of what kind of numbers we are talking about there is an article by a Dr. Edzard Ernst—who in my opinion definitely has a bias against chiropractic—in which he seeks to “summarise all cases in which chiropractic spinal manipulation was followed by death.” He searched the medical literature without restricting for time or language and found that there were 26 deaths recorded in the literature after a chiropractic adjustment. This includes deaths that happened a few hours after an adjustment up to 58 days later (of those that indicated time after chiropractic adjustment).2 So chiropractic has been around since 1895 and this article was published in 2010. That is a 115 year span that only includes 26 deaths in the literature that may or may not be caused by chiropractic. Dr. Ernst does say that there may be other deaths that are not included in the literature and cites other sources and I believe it. But even being generous and saying that only 1% ends up in the literature would equal less than 23 deaths per year since the start of chiropractic.
Now I don’t want to make light of anyone’s death, but to put that in perspective using a 30 year average the number of deaths from lightning strikes in the US each year is 51.3 Now remember that Dr. Ernst did not limit his search to just the US, so using his methodology we must assume that is a worldwide number. And Dr. Ernst conclusion is “Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit.”2 I will have to respectfully disagree with that conclusion.
There have been several other studies looking at the safety of chiropractic. One was a prospective survey of chiropractors. This study included “28,807 treatment consultations and 50,276 cervical spine manipulations. There were no reports of serious adverse events.”4 While mild adverse events do happen with the most common being soreness in the area of adjustment, serious adverse events are very rare. So again I ask you, if chiropractic is unsafe what are you comparing it to?
Safety of Pain Medication
So on the other hand the use of pain medication is something that most people do not consider to be risky. But what are the risks with pain pills? For this blog I will be focusing on a common type of pain drug class the non-steroidal anti-inflammatory drugs or NSAIDs for short. This class of drugs includes things like ibuprofen, aspirin, naproxen, and a number of others. They are some of the most commonly used pain drugs and many are available in non-prescription or over-the-counter (OTC) forms. But did you know that these drugs can cause bleeding problems such as ulcers or bleeding from the stomach or intestines? And also NSAIDs (except for aspirin – according to MedlinePlus) increases the chance of heart attack and stroke.5
Here is a list of the serious side effects of NSAIDs as found on the medication guide from the FDA.6
- heart attack
- stroke
- high blood pressure
- heart failure from body swelling (fluid retention)
- kidney problems including kidney failure
- bleeding and ulcers in the stomach and intestine
- low red blood cells (anemia)
- life-threatening skin reactions
- life-threatening allergic reactions
- liver problems including liver failure
- asthma attacks in people who have asthma
So, yes, those are some terrible side effects, but really how risky is it? Well in an article published in the New England Journal of Medicine in 1999 gives a pretty shocking estimate: “It has been estimated conservatively that 16,500 NSAID-related deaths occur among patients with rheumatoid arthritis or osteoarthritis every year in the United States.”7 That is a conservative estimate, only in arthritis patients. This would not include any deaths from OTC NSAID use or other patients with a prescription for NSAIDs. And that really is just an educated guess because there is not an accurate number for deaths from NSAIDs use.
Conclusion
Now I didn’t write this blog to try and instill fear in the populace over using NSAIDs for pain relief. However, I did want to bring some perspective to the risks associated with chiropractic and another commonly used treatment for pain. So as far as risks go for just pain relief, chiropractic is a safe and effective option. However, chiropractic can do so much more than merely relieve pain – it helps unlock your body’s natural ability to heal and function better. So before you pick up that bottle of pain pills think if the possible side effects are worth it and if there is a better option for your overall health.
References
- National Vital Statistics Report Vol. 61, No. 4, May 8, 2013
- E. Ernst, MD, PhD. Deaths after chiropractic: a review of published cases. Int J Clin Pract, July 2010, 64, 8, 1162–1165
- http://www.lightningsafety.noaa.gov/fatalities.htm
- H W Thiel, DC, PhD, J E Bolton, PhD, S Docherty, PhD, J C Portlock, PhD. Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey. SPINE Volume 32, Number 21, pp 2375–2378
- http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682159.html
- http://www.fda.gov/downloads/drugs/drugsafety/ucm089162.pdf
- M. M. Wolfe, MD, D. R. Lichtenstein, MD, and G. Singh, MD. Gastrointestinal Toxicity of Nonsteroidal Antiinflammatory Drugs. N Engl J Med 1999; 340:1888-1899
