review of the literature which revealed that conclusive evidence is lacking for a strong association between neck manipulation and stroke.8


al, performed a systematic review and meta-analysis of 253 articles which showed that there is no convincing evidence to support a causal link between chiropractic manipulation and coronary artery dissection.9


2010, Miller, et al, performed a systematic review of 17 randomized controlled trials and found moderate quality evidence supporting the treatment combination of manual therapy and exercise for pain reduction over manual therapy alone for chronic neck pain and suggests greater short-term pain reduction when compared to traditional care for acute whiplash.12


2008, Hurwitz, et al, conducted a review of the literature between 1980 and 2006 which revealed that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain.11


In


SPINAL MANIPULATION EFFICACY FOR NECK PAIN: Regarding spinal manipulation efficacy for neck pain, four studies should be referenced. In 2002, Gross, et al, published a systematic review of randomized trials which revealed that multi-modal manual therapy care including exercise were superior to a control, to certain physical medicine methods and to rest for pain10


In Finally, in 2016, Church, et


In conclusion, there seems to be good evidence to suggest a combination of chiropractic and exercises as the first line of therapy for neck pain as an alternative to NSAIDs. Perhaps acupuncture could be used as adjunct therapy to chiropractic for the treatment of neck associated disorders since there is research supporting its efficacy.18,19


to the high risk of cardiovascular and gastrointestinal events, NSAIDs should be avoided for the treatment of neck associated disorders.


References


1. Machado GC, Maher CG, Ferreira PH, Day RO, Pinheiro MB, Ferreira ML. Non-steroidal


2. Abramson SB, Weaver AL. Current state of therapy for pain and inflammation. Arthritis Res Ther. 2005;7 Suppl 4:S1-6.


3. Trelle Cardiovascular


Finally, in 2016, Zhu, et al, conducted a systematic review and meta-analysis of three randomized controlled trials with 502 participants which showed moderate level evidence to support the immediate effectiveness of cervical spine manipulation in treating people with cervical radiculopathy.13


NSAIDs VS SPINAL MANIPULATION: In 2012, Furlan, et al, conducted a systematic review and meta- analysis and found that in two trials manipulation was significantly better than medication (e.g., NSAIDs, Celebrex, Vioxx, Paracetamol) in reducing pain intensity for neck pain at immediate/short-term follow up.14


2016, Wong, et al, conducted a systematic review of systematic reviews which showed that in one study for the management of neck pain and associated disorders, intramuscular NSAIDs lead to similar outcomes as combined manipulation and soft tissue therapy.15


OTHER MODALITIES:


found that the combination between chiropractic and Acupuncture reduced back pain as much as NSAIDs.17


SPINAL MANIPULATION VS ACUPUNCTURE: The systematic review and meta-analysis by Yuan, et al, revealed that acupuncture was inferior to manipulation in reducing neck pain.15


THE ORIGINAL INTERNIST MARCH 2018


NSAIDs VS ACUPUNCTURE: The systematic review and meta-analysis by Furlan, et al, also revealed that in one trial for subjects with chronic non-specific pain, acupuncture was significantly better in reducing pain than NSAIDs immediately after treatment. In 2015, Yuan, et al, performed a systematic review and meta-analysis of 75 randomized controlled trials and found significant superiority favoring acupuncture over medications for pain relief at immediate term.16


A recent study in 2017 In


5. Bhala N, Emberson J, Merhi A, et al. Vascular and upper gastrointestinal effects of non-steroidal anti- inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013;382(9894):769-79.


4. Mcgettigan P, Henry D. Cardiovascular risk with non- steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. PLoS Med. 2011;8(9):e1001098.


inflammatory drugs: network meta-analysis. BMJ. 2011;342:c7086.


7. Dabbs V, Lauretti WJ. A risk assessment of cervical manipulation vs. NSAIDs for the treatment of neck pain. J Manipulative Physiol Ther. 1995;18(8):530-6.


8. Haynes MJ, Vincent K, Fischhoff C, Bremner AP, Lanlo O, Hankey GJ. Assessing the risk of stroke from neck manipulation: a systematic review. Int J Clin Pract. 2012;66(10):940-7.


Causation. Cureus.


S, Reichenbach safety


of S, Wandel non-steroidal S, et anti-


inflammatory drugs for spinal pain: a systematic review and meta-analysis. Ann Rheum Dis. 2017;76(7):1269-1278.


al. anti- Due


6. Harbin M, Turgeon RD, Kolber MR. Cardiovascular safety of NSAIDs. Can Fam Physician. 2014;60(3):e166.


9. Church EW, Sieg EP, Zalatimo O, Hussain NS, Glantz M, Harbaugh RE. Systematic Review and Meta- analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for 2016;8(2):e498.


10. Gross AR, Kay T, Hondras M, et al. Manual therapy for mechanical neck disorders: a systematic review. Man Ther. 2002;7(3):131-49.


11. Hurwitz EL, Carragee EJ, van der Velde G, et al. Treatment of Neck Pain: Noninvasive Interventions: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. European Spine Journal. 2008;17(Suppl 1):123-152. doi:10.1007/s00586-008-0631-z.


13. Zhu L, Wei X, Wang S. Does cervical spine manipulation reduce pain in people with degenerative cervical


15


12. Miller J, Gross A, D’sylva J, et al. Manual therapy and exercise for neck pain: a systematic review. Man Ther. 2010;15(4):334-54.


radiculopathy? A systematic review of (Continued on page 35)


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