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Adverse Drug Reactions

Association Between Chiropractic Spinal Manipulation for Sciatica and Opioid-related Adverse Events: A Retrospective Cohort Study

By |January 31, 2025|Adverse Drug Reactions, Adverse Events, Chiropractic Management, Low Back Pain, Opioid Epidemic, Sciatica|

Association Between Chiropractic Spinal Manipulation for Sciatica and Opioid-related Adverse Events: A Retrospective Cohort Study

The Chiro.Org Blog


SOURCE:   PLoS One 2025 (Jan 28); 20 (1): e0317663

  OPEN ACCESS   

Robert J. Trager • Zachary A. Cupler • Roshini Srinivasan • Elleson G. Harper • Jaime A. Perez

Connor Whole Health,
University Hospitals Cleveland Medical Center,
Cleveland, Ohio, United States of America.



Background:   Patients receiving chiropractic spinal manipulation (CSM) for spinal pain are less likely to be prescribed opioids, and some evidence suggests that these patients have a lower risk of any type of adverse drug event. We hypothesize that adults receiving CSM for sciatica will have a reduced risk of opioid-related adverse drug events (ORADEs) over a one-year follow-up compared to matched controls not receiving CSM.

Methods:   We searched a United States (US) claims-based data resource (Diamond Network, TriNetX, Inc.) of more than 216 million patients, yielding data ranging from 2009 to 2024. We included patients aged ?18 years with sciatica, excluding those post-spine surgery, prior anesthesia, serious pathology, high risk of ORADEs, and an ORADE ? 1-year prior. Patients were divided into two cohorts: (1) CSM and (2) usual medical care. We used propensity score matching to control for confounding variables associated with ORADEs. Comparative outcomes were analyzed by calculating risk ratios (RRs) and 95% confidence intervals (CIs) for the incidence of ORADEs and oral opioid prescription between cohorts.

Results:   372,471 patients per cohort remained after matching. The incidence of ORADEs over 1-year follow-up was less in the CSM cohort compared to the usual medical care cohort (CSM: 0.09%; usual medical care: 0.30%), yielding an RR of 0.29 (95% CI: 0.25-0.32; P < .00001). CSM patients had a lower risk of receiving an oral opioid prescription (RR of 0.68 [95% CI: 0.68-0.69; P < .00001]).

Conclusions:   This study found that adults with sciatica who initially received CSM had a lower risk of an ORADE compared to matched controls not initially receiving CSM, likely explained by a lower probability of opioid prescription. These findings corroborate existing practice guidelines which recommend adding CSM to the management of sciatica when appropriately indicated.


From the FULL TEXT Article:

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LOW BACK PAIN Section and the

ADVERSE EVENTS Section and the


OPIOID EPIDEMIC Section

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Adverse Reactions of Medications in Children:The Need for Vigilance, A Case Study

By |July 19, 2014|Adverse Drug Reactions, Pediatrics|

Adverse Reactions of Medications in Children:
The Need for Vigilance, A Case Study

The Chiro.Org Blog


SOURCE:   J Clinical Chiropractic Pediatrics 2014 (Mar);   14 (2) ~ FULL TEXT


Edward Holmes [1], DC and Joyce Miller, BSc, DC, DABCO, FCC [2]

1 – Edward Homes, DC,
private practice,
Bournemouth, United Kingdom

2 – Joyce Miller, BSc, DC, DABCO, FCC,
Associate Professor,
Anglo-European College of Chiropractic,
Bournemouth, United Kingdom.
jmiller@aecc.ac.uk


Summary:   This study demonstrates that adverse drug reactions do potentially pose a public health risk within the pediatric population and all healthcare providers need to be mindful of this risk. Adverse events to medication within this population are prevalent particularly in children under the age of two. Chiropractors must therefore be aware of adverse drug reactions and recognize symptoms within their patient population.

Key terms:   off label use; non-prescription drugs, child, pediatrics, drug toxicity guidelines, adverse medication reactions in children


 

From the Full-Text Article:

Introduction

A 19-week-old premature infant presented to a chiropractic teaching clinic with a ‘poor feeding pattern, recent slowing in weight gain and increase in crying’ over a three week period. The mother stated that this had started following a respiratory infection which occurred two months ago, with an associated rash that spread from her abdomen to the back of her neck, face and head. At least six weeks previously her GP had prescribed a cold remedy for the day (Calcold®) and Calpol® Night for the evening for the respiratory infection, and cortisone cream when a rash developed two weeks later. The medications seemed to help the child sleep, in fact she seemed to sleep much more during the day and night, which was put down to illness. However this did not change in the ensuing weeks after the respiratory infection abated. The mother continued with the Calpol® Night at the recommendation of the GP along with a change to Calpol® (instead of Calcold®) in the day, since it seemed to have helped with sleep. We examined a lethargic infant with an erythematous rash covering the trunk, head and neck who had decreased almost two centiles on her growth chart in the previous several weeks, and although not losing weight, she was nevertheless not gaining weight. Without another obvious etiology, was there an association between the medication and the child’s signs and symptoms?

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Iatrogenic Injury Page and our:

Chiropractic Pediatrics Page

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