The primary reason people seek chiropractic care is for pain. Chiropractic is considered an alternative therapy for pain management, and especially for spinal pain (5, 6). An important study looking at some of the risks associated with the chronic use of nonsteroidal anti‐inflammatory drugs (NSAIDs) for pain was published by M. Michael Wolfe, MD, and colleagues, from Stanford’s Medical School and Boston University School of Medicine, and published in the New England Journal of Medicine in 1999. The article was titled (7):
Gastrointestinal Toxicity of Nonsteroidal Anti‐inflammatory Drugs
The authors make the following points:
“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.”
“If deaths from gastrointestinal toxic effects of NSAIDs were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States.”
“Yet these toxic effects remain largely a ‘silent epidemic,’ with many physicians and most patients unaware of the magnitude of the problem.”
“Furthermore, the mortality statistics do not include deaths ascribed to the use of over‐the‐counter NSAIDs.”
The authors note that Cox‐2 inhibitors (a prescription form of NSAID) have been available in the US since February 1999, in the hope that they will have a reduced capacity to cause injury to the gastroduodenal mucosa. However, Cox‐2 inhibitors are also known to cause defects in renal function, alter the regulation of bone resorption, impair female reproductive physiology, and increase the rate of thrombotic events in patients with increased risk of cardiovascular disease.
In 2003, researchers from the University of Queensland, Australia, published a study in the Journal Spine, titled (8):
Chronic Spinal Pain:
A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation
In this study, the spinal manipulation was performed by licensed chiropractors (two visits per week). The medications used were Celebrex or Vioxx, both prescription NSAIDs. The acupuncture (also two visits per week) was performed by an experienced acupuncturist. The study evaluated 115 chronic neck and back pain patients. The treatment interventions extended over a 9‐week period. These authors made the following observations and statements:
“Adverse reactions to nonsteroidal antiinflammatory (NSAID) medication have been well documented.”
“Gastrointestinal toxicity induced by NSAIDs is one of the most common serious adverse drug events in the industrialized world.”
“The newer COX‐2‐selective NSAIDs are less than perfect, so it is imperative that contraindications be respected.”
"There is “insufficient evidence for the use of NSAIDs to manage chronic low back pain.”
“The highest proportion of early (asymptomatic status) recovery was found for manipulation (27.3%), followed by acupuncture (9.4%) and medication (5%).”
“Manipulation yielded the best results over all the main outcome measures.”
“The consistency of the results provides evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short‐term improvement than acupuncture or medication.”
“The results of this efficacy study suggest that spinal manipulation, if not contraindicated, may be superior to needle acupuncture or medication for the successful treatment of patients with chronic spinal pain syndrome.”
“Medication apparently did not achieve a marked improvement in chronic spinal pain and caused adverse reactions in 6.1% of the patients.”
“In summary, the significance of the study is that for chronic spinal pain syndromes, it appears that spinal manipulation provided the best overall short‐term results, despite the fact that the spinal manipulation group had experienced the longest pre-treatment duration of pain.”
Highlights of this study show that chiropractic spinal manipulation is five times more effective than prescription NSAIDs in the treatment of chronic low back and neck pain, and the results from spinal manipulation were accomplished without any reported adverse events. In contrast, for the patients taking the drugs, more experienced an adverse event (6.1%) than those who became asymptotic (5%) over the nine‐week clinical trial.
Importantly, when this study was published in 2003, Vioxx had been on the market since 1999, four years. The following year, 2004, Vioxx was pulled off the market due to an unacceptable incidence of fatal heart attacks and strokes (9, 10). It has since been established that in the five years that Vioxx was on the market it caused more US deaths (about 60,000) than the Viet Nam war did in 10 years (about 58,000).
Cliff Atwell, B.S., D.C.