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FCER News Release

For Immediate Release: January 25, 2008

Contact: Tom Blackett, APR

380 Wright Road, Norwalk, IA 50211 USA

Phone: 800-622-6309 or 515-981-9888

Fax: 515-981-9427 E-mail: teblackett@fcer.org

The Bone and Joint Decade Task Force on Neck Pain Report - January 2008

The decade of 2000-2010 is the “Bone and Joint Decade.” Around the world, research, clinical and academic personnel have focused on the improvement of diagnosing and caring for bone and joint conditions. A great deal of good work has been produced by various individuals, teams and task forces sponsored by this international effort.

The latest release (Jan 2008) has been the report by the Task Force on Neck Pain. Of this 13 member task force, several should be familiar to the chiropractic profession. Those marked with an asterisk have been previously supported by FCER:

Scott Haldeman, DC, MD, PhD, FRCP(C), President, Neck Pain Task Force*

Linda Carroll, PhD, Scientific Secretary, Neck Pain Task Force

J. David Cassidy, DC, PhD, DrMedSc, Scientific Secretary, Neck Pain Task Force*

Eugene J. Carragee, MD, FACS

Pierre Côté, DC, PhD*

Stephen W. Greenhalgh, MA, MLIS, Library Scientist, Neck Pain Task Force

Jaime Guzman, MD, MSc, FRCP(C)

Lena Holm, DrMedSc

Sheilah Hogg-Johnson, PhD

Eric L. Hurwitz, DC, PhD*

Margareta Nordin, PT, DrMedSc, CIE

Paul Peloso, MD, MSc, FRCP(C)

Gabrielle van der Velde, DC, PhD (Candidate)

In a report released by the Canadian Chiropractic Association (CCA) on the activities of the Neck Pain Task Force the following statement shows the depth and breadth of work that was undertaken:

... the Neck Pain Task Force considered almost 32,000 research citations and performed critical appraisals of the more than 1,000 research studies that were relevant to its mandate. The Task Force report synthesizes the best available evidence on the onset, course and prognosis, assessment and management of neck pain, and includes the results of several original research studies.

This same CCA release summarized the Task Force report in these words:

Summary

1. Neck pain is common and frequently persistent or recurrent.

2. There is typically no single cause and no single effective treatment for Grades 1
   or 2 neck pain:

• Effective treatment options are all low risk and may provide short-term relief when provided in moderation.

• Informed patient preferences are key to treatment decisions.

• A variety of treatments may need to be tried.

3. Routine imaging of Grades 1 or 2 neck pain will not increase understanding of
   causation.

4. There is not enough evidence to support the use of invasive interventions in
   Grades 1 or 2 neck pain.

5. Providers, policy makers and insurers need to move toward universal, validated,
   evidence-based treatment guidelines.

In conjunction with the release of the Neck Pain Task Force report, Cassidy and co-workers also published in Spine, “Risk of Vertebrobasilar Stroke and Chiropractic Care.” This populations-based, case-control, and case-crossover study employed rigorous epidemiological methodology to establish, as best as possible, controls between the two populations studied, i.e. patients of chiropractors and patients of primary care providers (PCP).

Out of over one million patient years (the length of time the total number of patients had been under care), 818 hospitalized vertebrobasilar artery stroke patients were identified. In the patients below the age of 45, those experiencing a stroke were three times more likely to have visited either their chiropractor or their PCP than the control patients. Those over 45 showed no increased association between experiencing a stroke and having seen their chiropractor than those experiencing a stroke and having seen their PCP.

The authors concluded:

• Vertebrobasilar artery stroke is a rare event in the population.

• There is an association between vertebrobasilar artery stroke and chiropractic visits in those under 45 years of age.

• There is also an association between vertebrobasilar artery stroke and use of primary care physician visits in all age groups.

• We found no evidence of excess risk of VBA stroke associated chiropractic care.

• The increased risks of vertebrobasilar artery stroke associated with chiropractic and physician visits is likely explained by patients with vertebrobasilar dissection-related neck pain and headache consulting both chiropractors and primary care physicians before their VBA stroke.

While the findings of this study cast a much more positive light on the chiropractic profession’s use of cervical spinal manipulation than previous studies that have tended to vilify the chiropractor, it must be noted that all treatments, including cervical manipulation, have some inherent risk. The chiropractic profession continues its support of on-going research to determine the full extent of such risk related to cervical manipulation and ways to reduce that risk.

It should also be noted that chiropractic physicians are some of the most well-trained and highly-skilled practitioners of manual medicine, specifically in the use of cervical spine manipulation. The thorough training received by doctors of chiropractic equips individual practitioners in the art and science of diagnosing spine related problems. There are multiple methods doctors of chiropractic can utilize in manipulating or mobilizing troublesome cervical spines, ranging from very low-force to even non-force techniques to the more standard high-velocity, low-amplitude manipulation. Within the profession there are even non-thrust methods that can be applied in special situations.

In this evidence-based health care delivery system that we are now all a part, the work of the Neck Pain Task Force and the work of Cassidy and colleagues provide valued contributions to the overall framework of evidence that guides all rational practitioners in how to provide the best care to their patients. 

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