Tuesday, 21 April 2015 00:06

The Journal of the American Medical Association Suggest a Link between Pregnant Woman – Back Pain – Tylenol Use & ADHD: Chiropractic Offers a Solution

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The Journal of the American Medical Association Suggest a Link between Pregnant Woman – Back Pain – Tylenol Use & ADHD: Chiropractic Offers a Solution

 

A report on the scientific literature 


 

By Travis McKay DC,

William J Owens Jr DC DAAMLP CPC

Mark Studin DC, FASBE(C), DAAPM, DAAMLP

 

Liew, Ritz, Rebordosa, Lee and Olsen (2014) reported that pregnant women, at some point during their pregnancies, may experience musculoskeletal pain, particularly in the lower back, pelvis and hips.  Since the symptoms are related to biomechanical changes associated with pregnancy, it is important to be able to offer relief while limiting potentially harmful side effects.   One of the most common ways to treat musculoskeletal pain in general and during pregnancy, in particular, is through over-the-counter (OTC) medications.  Most doctors and family members will recommend acetaminophen, more commonly known and marketed as Tylenol, as a pain reliever and as a safe choice for both mothers and their babies. However, Liew et al. (2014) reported, “Acetaminophen (paracetamol) is the most commonly used medication for pain and fever during pregnancy in many countries. Research data suggest that acetaminophen is a hormone disruptor, and abnormal hormonal exposures in pregnancy may influence fetal brain development” (p. 313).   

According to Liew et al. (2014):

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders worldwide, characterized by inattention, hyperactivity, increased impulsivity, and motivational/emotional dysregulation. Hyperkinetic disorder (HKD; International Statistical Classification of Diseases, 10th Revision) is a particularly severe form of ADHD (Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition]). The etiology of HKD/ADHD is not well understood but both environmental and genetic factors are believed to contribute. (p. 313) 

The study reported that children whose mothers used acetaminophen during pregnancy were at higher risk for a diagnosis of hyperkinetic disorder, use of attention deficit hyperactivity disorder (ADHD) medications, and/or having ADHD like behaviors by age 7.  The study found that these outcomes were seen more in the mothers who used acetaminophen during more than one trimester of their pregnancies and that the more acetaminophen that was taken, the greater the likelihood that one of the previously mentioned conditions would be seen in their children.  The authors reported, “We observed an increased risk for ADHD-like behaviors in children at age 7 years with maternal acetaminophen use during pregnancy…as well as use in more than 1 pregnancy trimester, especially in later pregnancy, and a stepwise increase in risks with increasing frequency of use throughout pregnancy” (Liew et al., 2014, p. 318).

What does this mean for pregnant women?  If additional studies confirm the association between acetaminophen and hyperkinetic disorder and ADHD, what options are available for pregnant women who are suffering from spinal pain during pregnancy?  The answer lies in understanding other forms of pain management and non-medication based therapies which are already available to pregnant women.    According to Coronado et al. (2012), “The mechanism of SMT [spinal manipulation therapy] remains elusive, but SMT appears to modulate pain through both central [brain and spinal cord] and peripheral pathways [down the arms and legs]. Studies have investigated the effect of SMT using variable experimental pain modalities including chemical, electrical, mechanical, and thermal stimuli. SMT demonstrated a favorable effect over other interventions on pressure pain thresholds (PPT)” (p. 763).  This means that the chiropractic adjustment has a very specific influence on the body’s perception and management of pain. 

Since the most common reason for pregnancy-related spine and pelvic pain during pregnancy has to do with altered mechanics, a non-drug approach to reducing pain and increasing function should be considered as a first-line alternative to eliminate the possible connection between acetaminophen and ADHD. Chiropractic care offers a neuromuscular and spinal biomechanical approach that focuses on the underlying causes of a patient’s spinal-related pain.   

Chiropractic is one of the safest treatments currently available in healthcare and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration, particularly as a first line treatment. Whedon, Mackenzie, Phillips, and Lurie (2015) based a study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury in normal healthy tissues has been identified” (Whedon et al., 2015, p. 265).

Chiropractic should be considered as a first-line, safe choice for pregnant woman with back pain to avoid any potential side effects from all medications, when clinically indicated.

References:

1. Liew, Z., Ritz, B., Rebordosa, C., Lee, P. C., & Olsen, J. (2014). Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatrics, 168(4), 313-320.

2. Coronado, R. A., Gay, C. W., Bialosky, J. E., Carnaby, G. D., Bishop, M. D., & George, S. Z. (2012). Changes in pain sensitivity following spinal manipulation: A systematic review and meta-analysis. Journal of Electromyography and Kinesiology22(5), 752-767.

3. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.

           

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