Spinal manipulation is associated with frequent, mild and temporary adverse effects,[14][138] including new or worsening pain or stiffness in the affected region.[139] They have been estimated to occur in 33% to 61% of patients, and frequently occur within an hour of treatment and disappear within 24 to 48 hours;[13] adverse reactions appear to be more common following manipulation than mobilization.[140] The most frequently stated adverse effects are mild headache, soreness, and briefly elevated pain fatigue.[141] Chiropractic is correlated with a very high incidence of minor adverse effects.[4] Chiropractic are more commonly associated with serious related adverse effects than other professionals following manipulation.[17] Rarely,[46] spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults[14] and children.[142] There is a case of a three-month-old dying following manipulation of the neck area.[137] Estimates vary widely for the incidence of these complications,[13] and the actual incidence is unknown, due to high levels of underreporting and to the difficulty of linking manipulation to adverse effects such as stroke, which is a particular concern.[14] Adverse effects are poorly reported in recent studies investigating chiropractic manipulations.[143] A 2016 systematic review concludes that the level of reporting is unsuitable and unacceptable.[144] Reports of serious adverse events have occurred, resulting from spinal manipulation therapy of the lumbopelvic region.[145] Estimates for serious adverse events vary from 5 strokes per 100,000 manipulations to 1.46 serious adverse events per 10 million manipulations and 2.68 deaths per 10 million manipulations, though it was determined that there was inadequate data to be conclusive.[13] Several case reports show temporal associations between interventions and potentially serious complications.[146] The published medical literature contains reports of 26 deaths since 1934 following chiropractic manipulations and many more seem to remain unpublished.[17]
If the pain is due to muscle spasm or a pinched nerve, your provider may prescribe a muscle relaxant or a more powerful pain reliever. Over-the-counter medicines often work as well as prescription drugs. At times, your provider may give you steroids to reduce swelling. If there is nerve damage, your provider may refer you to a neurologist, neurosurgeon, or orthopedic surgeon for consultation.
A 2010 study by questionnaire presented to UK chiropractors indicated only 45% of chiropractors disclosed with patients the serious risk associated with manipulation of the cervical spine and that 46% believed there was possibility of patient would refuse treatment if risk correctly explained. However 80% acknowledged the ethical/moral responsibility to disclose risk to patient.[206]
Among people seeking back pain relief alternatives, most choose chiropractic treatment. About 22 million Americans visit chiropractors annually. Of these, 7.7 million, or 35%, are seeking relief from back pain from various causes, including accidents, sports injuries, and muscle strains. Other complaints include pain in the neck, arms, and legs, and headaches.
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