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.
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 Kinesiology, 22(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.
Attention-Deficit Hyperactivity Disorder (ADHD) Outcomes Improve with Chiropractic Care
A report on the scientific literature
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Sangwoo Mah DC, DAAMLP
William J. Owens DC, DAAMLP
As a family practitioner of chiropractic, I, the first author, have treated many children who were diagnosed with a spectrum of hyperactivity disorders in the 1980’s. Each of these diagnoses revolved around children being uncontrollably hyperactive and their ages ranged from 3 years through 10 years old. In most of the cases, under chiropractic care, I witnessed that most of these children, according to their parents, demonstrated calmer behavior over a short amount of time with chiropractic care and this scenario became a regular pattern in my office. These clinical observations by a single practitioner is by no means a scientific answer, nor one that should garner conclusions to suggest an entire populous migrate towards this specific potential solution. However, over time, these results have been reported in many chiropractic offices by both parents and chiropractors alike and research is now catching up to these observations in a formal setting.
Attention-deficit hyperactivity disorder, or ADHD, has become a major concern to parents everywhere as of late. It seems that more and more children are being diagnosed with ADHD as time passes and has the hallmark characteristics of hyperactivity, inattention and impulsivity according to Alcantara and Davis (2010). They go on to report that parents are concerned regarding the causes of ADHD in children and what kinds of treatment are available should they become diagnosed with ADHD. Although the definitive cause of ADHD is unknown, genetics and the environment seem to have strong effects. Medical treatment of ADHD involves use of psychiatric medications and behavior therapy. However, there are growing concerns for long-term use of psychotropic drugs for children. Again, according to Alcantara, 10 years ago it was estimated that 20% of all white males were taking some type of psychotropic drug for behavioral disorders and based upon the potential for serious side effects, conservative alternative medical approaches were sought. With regards to the practitioner-based alternative therapies for children, chiropractic has become the most popular and highly utilized for ADHD.
In their literature search, Alcantara and Davis (2010) reported that 4 case studies recounted successful treatment of ADHD. There appears to be, in those cases, a strong connection between the neuro-muscular-structural connections. This suggests to the authors of this article that there is a resultant neuro-chemical imbalance as a result.
Such a case was four children treated with chiropractic adjustment in a single-doctor’s office. The parents of these children reported a 50% improvement in behavior of their children after 5 months. These results were collected via questionnaires.
Another significant case in the same study was a 5-year-old boy with seriously poor neck posture. This caused him to go for chiropractic treatment, but after 8 weeks, the boy’s behavior improved so significantly that his pediatrician declared he no longer exhibited symptoms of ADHD. During this time, his neck posture also improved dramatically, suggesting a link between the neck posture and ADHD.
Perhaps even more significant, a 9-year-old child who suffered for years from multiple chronic conditions including asthma, headaches, Tourette’s syndrome, ADHD, depression, insomnia, and neck pain also improved dramatically with chiropractic care. The child was taking multiple strong medications. This child was also found to have significantly stiff joints in the neck. After six weeks chiropractic care, the child no longer displayed any symptoms and all medications were discontinued except for a half dose of Wellbutrin. After 5 months, at the conclusion of the treatment, the child remained symptom free.
Muir (2012) reported:
Parents of a 5-year-old boy with diagnosed ADHD brought him for chiropractic care to address his subjective signs (acting out, ability to follow instructions, and poor home and school performance), which also included waking at night due to asthmatic symptoms and low self-esteem. Palpation revealed hypertonicity and trigger points in the paraspinal muscles at the thoracolumbar region with local pain. A preliminary diagnosis included cervical and thoracolumbar facet joint irritation with concurrent muscle hypertonicity.
Intervention and Outcomes: Treatment including spinal manipulative therapy, soft tissue therapy, and stretching was provided. Treatment began on a thrice-weekly basis and declined to twice weekly over the course of approximately 12 weeks. After 1 year of treatment, subjective improvements were noted in episodes of acting out, ability to follow instructions, and general home and school performance (p. 221).
Although much more research is indicated, these examples, along with our personal observations suggest that chiropractic should be considered to be included in comprehensive treatment of ADHD. 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. Whedon et al. (2014) based their 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 into normal healthy tissues has been identified. (Whedon et al., 2014, p. 5)
If your child suffers from symptoms of ADHD, consider having a chiropractor evaluate your child.
1. Alcantara J., & Davis J. (2010). The chiropractic care of children with attention-deficit/hyperactivity disorder: A retrospective case series. EXPLORE, 6(3), 173-182.
2. Muir, J. M. (2012). Chiropractic management of a patient with symptoms of attention-deficit/hyperactivity disorder. Journal of Chiropractic Medicine, 11(3), 221-224.
3. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2014). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69. Spine, [Epub ahead of print] 1-33.
Children/Pediatric Utilization of Chiropractic Care
A report on the scientific literature
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
83% of children under 3 years old were referred by their medical practitioners
Children have been under chiropractic care for almost 100 years according to my 30 years of rendering chiropractic care to children and the 2 generations of my instructors and mentors that taught me how to care for children. While there is a growing body of evidence of the efficacy of chiropractic care and childhood maladies, the amount of children under care and being referred to chiropractors by pediatricians and other medical doctors is growing.
In December, 2008, the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, released findings on Americans and the use of complementary and alternative medicine (CAM). "The findings are from the 2007 National Health Interview Survey (NHIS), an annual in-person survey of Americans regarding their health- and illness-related experiences. The CAM section gathered information on 23,393 adults aged 18 years or older and 9,417 children aged 17 years and under" (National Center for Complementary and Alternative Medicine, 2008, http://nccam.nih.gov/news/camstats/ 2007/camsurvey_fs1.htm). They found that 11.8% of children in the United States have undergone CAM therapies, indicating that children aren’t obtaining the desired outcomes and their parents are looking for solutions.
CAM is a term applied to any healing discipline that does not fall into the category of traditional medicine or any health care that traditional medicine must govern over, such as nursing or physical therapy, rendering those as secondary health care providers and not allowing them to care for patients unless under the supervision of a medical doctor. Chiropractic is considered part of CAM simply because doctors of chiropractic are not medical doctors or secondary providers requiring supervision by a medical doctor.
Miller reported in 2010 on 2,645 children that were treated in the outpatient clinic of the Anglo-European College of Chiropractic from 2006-2010 for various maladies. Of these children, 87% were under the age of 5 and 13% were between 5 and 13. 34% were seen for musculoskeletal problems such as neck pain and postural issues, 30% were treated for infant colic/excessive crying, 16% for feeding disorders and the balance for various other issues. Every child had been seen by at least one medical practitioner and some by many medical providers. Of the 2,645 children referred to the chiroprctic clinic, 83% were referred by thier medical physicians.
According to Jandial, Myers, Wise, and Foster in 2009, 21% of all medical practitioners, including pediatricians, had no confidence in treating musculoskeletal issues and only 53% had "some" confidence in treating musculoskeletal issues in children. Considering the "self-rated" format of this study, there are no interpretation issues of the results. Miller (2010) also reported in the study that 83% of the children under 3 years of age were referred by medical practitioners, underscoring the need for this type of care and the efficacy of the care for children. In a limited study, Alcantara and Davis (2010) reported improvement with chiropractic treatment in children with attention deficit hyperactivity disorder (ADHD) as well as various other limited and case studies. While significantly more research is required for children and chiropractic care, the growing body of recognition by the medical and chiropractic communities and the public gives evidence to the results of chiropractic care in the pediatric population.
1. National Center for Complementary and Alternative Medicine. (2008, December). The use of complementary and alternative medicine in the United States. Retrieved from http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm
2. Miller, J. (2010). Demographic survey of pediatric patients presenting to a chiropractic teaching clinic, Chiropractic & Osteopathy,18(33), Retrieved from http://www.chiroandosteo.com/content/pdf/1746-1340-18-33.pdf
3. Jandial, S., Myers, A., Wise, E., & Foster, H. E. (2009). Doctors likely to encounter children with musculoskeletal complaints have low confidence in their clinical skills. Journal of Pediatrics, 154(2), 267-271.
4. Alcantara, J., & Davis, J. (2010). The chiropractic care of children with attention-deficit/hyperactivity disorder: A retrospective case series. Explore, 6(3), 173-182.