Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study.
METHODS
Randomized clinical trial.


OBJECTIVE
To document the types and frequencies of adverse reactions associated with the most common chiropractic treatments for neck pain, and to identify possible clinical predictors of adverse reactions to chiropractic treatment.


BACKGROUND
Chiropractic care is frequently sought by patients for relief from neck pain; however, adverse reactions related to its primary modes of treatment have not been well examined.


METHODS
A total of 336 patients with neck pain presenting to 4 southern California health care clinics were randomized in a balanced 2 x 2 x 2 factorial design to manipulation with or without heat, and with or without electrical muscle stimulation (EMS); and mobilization with or without heat and with or without EMS. Discomfort or unpleasant reactions from chiropractic care were self-assessed at 2 weeks after the randomization/baseline visit.


RESULTS
Of the 280 participants (83%) who responded, 85 (30.4%) had 212 adverse symptoms as a result of chiropractic care. Increased neck pain or stiffness was the most common symptom, reported by 25% of the participants. Less common were headache and radiating pain. Patients randomized to manipulation were more likely than those randomized to mobilization to have an adverse symptom occurring within 24 hours of treatment (adjusted odds ratio [OR] = 1.44, 95% confidence interval [CI] = 0.83, 2.49). Heat and EMS were only weakly associated with adverse symptoms (heat: OR = 0.94, 95% CI = 0.54, 1.62; EMS: OR = 1.09, 95% CI = 0.63, 1.89). Moderate-to-severe neck disability at baseline was strongly associated with adverse neurologic symptoms (OR = 5.70, 95% CI = 1.49, 21.80).


CONCLUSIONS
Our results suggest that adverse reactions to chiropractic care for neck pain are common and that despite somewhat imprecise estimation, adverse reactions appear more likely to follow cervical spine manipulation than mobilization. Given the possible higher risk of adverse reactions and lack of demonstrated effectiveness of manipulation over mobilization, chiropractors should consider a conservative approach for applying manipulation to their patients, especially those with severe neck pain.
Hurwitz
Eric L
EL
Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA 90095-1772, USA. ehurwitz@ucla.edu
Morgenstern
Hal
H
Vassilaki
Maria
M
Chiang
Lu-May
LM
D000328:Adult; D002140:California; D002574:Cervical Vertebrae; D004185:Disability Evaluation; D004599:Electric Stimulation Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D026882:Manipulation, Chiropractic / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D019547:Neck Pain / Q000517:prevention & control / Q000628:therapy*; D018579:Patient Selection; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D017211:Treatment Failure