THE BONE AND JOINT DECADE TASK FORCE REPORT SHOWS SIGNIFICANT FINDINGS The Bone and Joint Decade Task Force on Neck Pain and Associated Disorders published its report on January 8 in the peer-reviewed journal Spine. The report has been compiled by an elite multidisciplinary team of research- ers and clinicians led by the task force president, Dr. Scott Haldeman of Santa Ana, California, and reflects the results of a six year study. In conducting its exhaustive review of the available published research on neck pain, the Neck Pain Task Force considered almost 32,000 research citations and undertook critical appraisal of more than 1,000 research studies that met relevance and admission criteria. The Task Force report synthesizes the best available current evidence on the onset, course and prognosis, assess- ment and management of neck pain, and includes the results of several original research studies. The work of the Task Force and its findings address all health profes- sions that treat neck pain. In addition to its literature review, the Neck Pain Task Force conducted several pieces of original research. Of particular interest to the chiropractic profession is the stroke study, conducted under the auspices of Toronto Western Hospital, Ontario, Canada. Some of the top-line findings of the study include the following: Neck pain including whiplash associated disorders should be classified into a common system and the Neck Pain Task Force recommends four grades: • Grade 1: neck pain with little or no interference with daily activities. • Grade 2: neck pain that limits daily activities. • Grade 3: neck pain accompanied by radiculopathy (“pinched nerve” – pain weakness and/or numbness in the arm). • Grade 4: neck pain with serious pathology, such as tumour, fracture, infection, systemic disease; it was beyond the mandate of the task force to study Grade 4 neck pain. Chiropractic manipulation, along with acupuncture, exercise and education, among other measures, is recommended for Grades 1 and 2 neck pain. All health-care providers are encouraged to conduct a thorough patient history, physical examination and patient self-assessment questionnaire to identify or rule out Grades 3 or 4 neck pain, e.g. radiculopathy, tumour, fracture, infection, systemic disease. And, of stroke the findings are as follows: Cervical manipulation is a reasonable option for people with Grade 1 or 2 neck pain. The risk of vertebrobasilar (VBA) stroke associated with a visit to a chiropractor’s office appears to be no differ- ent from the risk of stroke following a visit to an MD’s office. It is likely that patients in the early stages of VBA stroke are presenting to both chiropractors and family doctors because of neck pain and headache due to pre- existing vertebral artery dissection which is a risk factor for VBA stroke. VBA dissection and stroke is extremely rare and there is no practical way to screen neck pain and headache patients for this problem. For a complete summary of findings, please visit www.wfc.org. The WFC welcomes this important work that helps inform all health care providers who treat neck pain, and sheds further light on the efficacy and safety of chiropractic adjustment. The stroke study in particular provides the profession with additional research on this issue which will support ongoing inter-professional dia- logue and education. The WFC acknowledges the assistance of many, includ- ing the WFC Research Council, the WFC Council and the Canadian Chiropractic Association, in the preparation of this notice to members. Dear Editor, I enjoyed the article by Dr. Silk on “The Great Stroke Hoax.” I sincerely hope that everyone who is involved in our profession will read this and heed his ad- vice to challenge those that make empty allega- tions concerning the safety of chiropractic care. Thank you for the article Dr. Silk. David Brosz, DC 12 • CANADIAN CHIROPRACTOR |FEBRUARY 2008 www.canadianchiropractor.ca letter to the editor news
Chiropractic + Naturopathic Doctor March 20008: Page 12
