Connecticut to Mandate Chiropractic Stroke Risk Warnings?

Published: 2010-07-21 17:25:50
Author: CHARLES ROCK | 27-7 Press Release | April 23, 2010

This past January, the Connecticut State Board of Health and Board of Chiropractic Examiners held a series of public hearings on whether there is a need to mandate that chiropractors warn their patients of the risk of stroke prior to performing certain spinal manipulations.

Chiropractors have been adamant that they should not be required to provide patients with information on the risks of stroke prior to performing cervical spine adjustments. During the hearings, chiropractors from many states were brought in to argue that the Board should not mandate informed consent because it unfairly singles out chiropractors. They also argued that they should not be required to warn patients of the risk because there is no credible scientific proof that such a risk is real.

There is, however, a substantial body of scientific literature developed in over sixty years of case studies, and through other medical evidence including autopsy and radiology, confirming the cause and effect relationship between neck adjustments and stroke.

Medical doctors are required to inform their patients of the risks of undergoing their proposed treatment, the risk of foregoing treatment altogether, the benefits and alternatives to their treatment, so that when their patient gives permission for the treatment, their consent is truly informed. So it is unclear how chiropractors can argue in good conscience that they are being singled out.

Last year, Connecticut state lawmakers attempted to pass a bill that would have required chiropractors receive written informed consent from their patients prior to performing cervical spine adjustments. The consent included a warning of the risk of chiropractic stroke. The bill, however, received strong opposition from state chiropractic groups and never passed.

Should the Connecticut State Board of Chiropractic Examiners vote in favor of informed consent, it will be the first state in the country to have such a requirement and may pave the way for other state boards to follow suit.

Risk of Chiropractic Stroke Real

Chiropractic cervical manipulations cause stroke in a certain number of patients by tearing the lining of either the vertebral or carotid arteries. These blood vessels travel up the neck and supply blood to the brain. When these arteries are torn, blood clots may develop which can break off and flow up into the brain until they lodge into a smaller artery, causing a cessation of fresh blood to that portion of the brain. This tissue dies quickly and can never be replaced. This is called a stroke.

One way the arterial lining can be torn is by rapid rotation motion of the neck, which can occur when a chiropractor improperly performs a neck manipulation. In some cases, chiropractic patients actually have seized and died on the table after receiving one of these neck adjustments in a chiropractor's office. In other cases, patients may not suffer a stroke until hours, days or even weeks after their chiropractic visit.

The true incidence of chiropractic stroke is not known. Estimates range anywhere from one out of every 4.5 million manipulations to one out of every 40,000 manipulations. Several factors make it difficult to determine a more accurate risk level. For example, because chiropractors do not follow-up with their patients progress the way that medical doctors do, they may never know when a stroke occurs. Also, depending on the length of time between the chiropractic visit and the stroke, the patient may not make the connection between the neck manipulation and the stroke. This is in part why advising the chiropractic patient about the risk would enhance patient safety. The patient would be able to advise the physician about the cervical manipulation when they have stroke-like symptoms, then the physician could evaluate the arteries and if there is a tear, preventive measures could be undertaken in time to prevent a full-blown stroke.

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