Chiropractic and Acute Chest Pain Study Title: Chiropractic treatment versus self-management in patients with acute chest pain: A randomized controlled trial of patients without acute coronary syndrome Author(s): Stochkendahl M, Christensen HW, Vach W et al. Publication Information: Journal of Manipulative & Physiological Therapeutics 2012; 35: 7-17 This review was prepared by Michael Haneline, DC, MPH, of Research Review Service. Shawn Thistle, BKin (Hons), DC, CSCS In addition to practising full time in Toronto, Dr. Shawn Thistle is founder and president of Research Review Service Inc., an online, subscription-based service designed to help busy practitioners integrate current, relevant scientific evidence into their practice (www.researchreviews -ervice.com). Shawn also recently launched The Epicurean Scholar, which offers continuing education seminars combined with gour-met food and wine events (www. epicureanscholar.com). Dr. Thistle graduated from CMCC (where he lectures in the Orthopedics Depart-ment) and holds an Honours De -gree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medical Acupunc-ture from McMaster University, and is a Certified Active Release Tech-niques (ART®) Provider and Func -tional Range Release®/Functional Anatomical Palpation® instructor and provider. BACKGROuND INFORMATION The primary symptom of acute coronary syndrome (ACS) is acute chest pain and this symptom accounts for about five per cent of all admissions to hospital emergency depart -ments in Europe and the United States. Most patients with acute chest pain, however, do not actually have ACS (only 20 to 25 per cent do); rather, their symptoms stem from non-cardiac sources, such as the musculoskeletal or digestive systems. Sometimes no pain source is identified, resulting in the patient leaving the hospital with a diagnosis of undif -ferentiated chest pain. This often results in repeated emergency room consultations, repre -senting a high cost exposure for health-care systems. The authors of this study have done previous work in this area, which pointed to mus -culoskeletal disorders as a possible source of pain in patients with undifferentiated chest pain. However, the study’s methodology did not permit them to draw strong conclusions about the value of chiropractic treatment to these patients. In addition, that study did not consider patients with acute chest pain. The purpose of this study was to gauge the relative effectiveness of two conservative treatment approaches in patients with an acute episode of musculoskeletal chest pain. The treatment treatment approaches included: chiropractic treatment, including spinal manipulation; and self-management, ie, a minimal intervention. CONCLuSIONS AND PRACTICAL APPLICATIONS Patients with acute musculoskeletal chest pain improved when they were managed with ei -ther chiropractic treatment or self-management. Most of the differences between the groups favoured the chiropractic group. However, not all of the differences were statistically significant. Very little work has been done on chiropractic care for acute chest pain. The authors men -tioned that this was the first randomized controlled trial to assess the effect of chiropractic treatment on acute musculoskeletal chest pain. Thus, their conclusion is sensible – that the study’s results suggest chiropractic treatment might be useful, but further research is needed. Practitioners may use this study to support evidence-based care for selected patients with chest pain who have been thoroughly screened for the presence of other possible causes. Pa -tients should be advised that the evidence supporting chiropractic care for acute chest pain is preliminary and that they will be given a trial of chiropractic treatment for a predetermined period of time. Continued treatment would be conditional upon symptomatic improvement per standard outcome measures. • To see this review in full, please visit the “Current Issue” page at www.canadianchiropractor.ca. The April 2013 edition of Research Review Corner in Canadian Chiropractor (Vol. 18, No. 2, page 38) erroneously carried the title “Altering loads and LBP relief.” It should have been titled “SMT and Cervical Radiculopathy.” CC apologizes for any inconvenience resulting from this discrepancy. www.canadianchiropractor.ca 42 • CANADIAN CHIROPRACTOR | MAY 2013
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