In the United States, gastrointestinal complications induced by non-steroidal anti-inflammatory drugs (NSAIDs) result in more than 100 000 hospital admissions and an estimated 16 500 deaths annually.1 Any discussion of the adverse effects of cervical manipulations for neck pain2 should take into account the dangers of other therapies.
Although I do not advocate cervical manipulation, I think that the risk of cervical artery dissection following this procedure should be weighed against the risk of complications associated with the use of NSAIDs, because these drugs are commonly prescribed for neck pain. The risks and benefits of less dangerous treatments such as acetaminophen and soft collars should also be compared with those of chiropractic and NSAIDs.
Axel Ellrodt Emergency Physician American Hospital of Paris Paris, France