Adverse effects of spinal manipulation

Guidelines on acute back pain recommend spinal manipulation, but some comme ntators express concern that the adverse effects are under-reported. Eleven chiropractors distributed questionnaires to 108 consecutive new patients a ged >18 years, enquiring about adverse effects one hour, one day and two da ys after spinal manipulation. The forms were to be completed anonymously. 80 questionnaires (74%) were returned, 68 suitable for analysis. 28 patient s reported adverse effects at one hour after treatment, the most common of which were extra pain (14) and radiating pain (9). 8 had reactions beginnin g the morning after. No serious adverse effects were reported. The adverse reactions, recorded in 53% of respondents, are those to be expe cted from a treatment that entails initial discomfort. They need to be set against the long-term benefits of spinal manipulation.