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335 A. Main St. Hackensack, NJ 07601
201-489-3400
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Welcome to the Drs. Angel and Lisa Carrion new patient center!

Arriving at a doctors office for the first time can be a nerve racking experience. Paperwork to fill out, new faces and names to learn, and getting to know your way around the office; this can hit the senses all the at same time causing overload.

In contrast, at Drs. Angel and Lisa Carrion our aim is to  remove any  stress or causing unnecessary tension and make you feel comfortable. In this area of the website you will be able to take care of items necessary for your visit prior to arriving, in the comfort of your home. 

We will start by providing you with Key Chiropractic Facts provided by the American Chiropractic Association (ACA): KEY FACTS ABOUT THE CHIROPRACTIC PROFESSION, American Chiropractic Association, 1701 Clarendon Blvd. – Ste 200, Arlington, VA 22209, www.acatoday.org

By the Numbers
• There are 77,000 Doctors of Chiropractic (DCs) in the United States who are required to pass a series of four national board exams1 and be state licensed.2 Roughly another 3,000 DCs work in academic and management roles.
• There are approximately 10,000 chiropractic students3 in 18 nationally accredited, chiropractic doctoral graduate education programs4 across the United States with 2,500 Doctors of Chiropractic (DCs) entering the workforce every year.5
• An estimated 40,000 chiropractic assistants (CAs)6 are in clinical7 and business management roles for chiropractic practices across the United States.
• It is estimated that Doctors of Chiropractic (DCs) treat over 27 million Americans (adults and children) annually.8
• Doctors of Chiropractic (DCs) are educated in nationally accredited, four-year doctoral graduate school programs9 through a curriculum that includes a minimum of 4,200 hours of classroom, laboratory and clinical internship,10 with the average DC program equivalent in classroom hours to allopathic (MD) and osteopathic (DO) medical schools.11
• Doctors of Chiropractic (DCs) are utilized by all 32 National Football League teams12 in optimizing the functionality, endurance and overall conditioning of professional football players in the treatment of neuromusculoskeletal strain injuries, including neck pain, low back pain, strains to hamstrings and quadriceps, and whiplash injuries.
• Injured workers with similar injuries are 28 times less likely to have spinal surgery if the first point of contact is a Doctor of Chiropractic (DC), rather than a surgeon (MD).13
• A recent study showed that treatment for low back pain initiated by a Doctor of Chiropractic (DC) costs up to 20 percent less than when started a MD.14
Patient Satisfaction/Clinical Effectiveness
• Doctors of Chiropractic (DCs) are designated as physician-level providers in the vast majority of states and federal Medicare program. The essential services provided by DCs are also available in federal health delivery systems, including those administered by Medicaid, the U.S. Departments of Veterans Affairs and Defense, Federal Employees Health Benefits Program, Federal Workers' Compensation, and all state workers' compensation programs.15
• Chiropractic outperformed all other back pain treatments, including prescription medication, deep-tissue massage, yoga, pilates, and over-the-counter medication therapies.16
• Doctors of Chiropractic (DCs) are the highest rated healthcare practitioner for low-back pain treatments above physical therapists (PTs), specialist physician/MD (i.e., neurosurgeons, neurologists, orthopaedic surgeons), and primary care physician/MD (i.e., family or internal medicine).17
• Doctors of Chiropractic (DCs) provide a patient-centered, whole person approach to health care marked by greater interaction and better communication, resulting in consistently higher patient satisfaction ratings than medical doctors.18
• With prescription pain drug abuse now classified as an epidemic19 in the United States and the number of spinal fusions soaring 500% over the last decade,20 the essential services provided by Doctors of Chiropractic (DCs) represent a primary care approach for the prevention, diagnosis and conservative management of back pain and spinal disorders that can often enable patients to reduce or avoid the need for these riskier treatments.

• Chiropractic care has an excellent safety record. 21 This should be viewed in the context of other treatments for back pain such as steroids,22 pain medications23 and surgery.24 As a result, Doctors of Chiropractic (DCs) pay malpractice premiums at significantly lower rates than allopathic doctors (MDs).25

• The Doctor of Chiropractic (DC) collaborative, whole person-centered approach reflects the changing realities of health care delivery, and fits well into Accountable Care Organization (ACO) and patient-centered, medical home (PCMH) models bringing greater clinical efficiency, patient satisfaction and cost savings.26
• A systematic review in 2010 found that most studies suggest spinal manipulation achieves equal or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up.27
• The American College of Physicians and the American Pain Society jointly recommended in 2007 that clinicians consider spinal manipulation for patients who do not improve with self-care options.28

References
1 National Board of Chiropractic Examiners (NBCE) www.NBCE.org. Accessed December 2013.
2 Federation of Chiropractic Licensing Boards (FCLB) www.FCLB.org Accessed December 2013.
3 Association of Chiropractic Colleges, www.acc.org. Accessed December 2013.
4 Council on Chiropractic Education (CCE) www.cce-usa.org is the agency certified by the U.S. Department of Education to accredit doctoral graduate school programs who offer Doctor of Chiropractic (D.C.) degree; Accessed December 2013.
5 Association of Chiropractic Colleges, www.acc.org. Accessed December 2013.
6 American Chiropractic Association (ACA) www.ACAtoday.org and Federation of Chiropractic Licensing Boards (FCLB) www.FCLB.org 2013.
7 Certified Chiropractic Clinical Assistant (CCCA) program. Federation of Chiropractic Licensing Boards (FCLB), 2013.
8 Barnes, Bloom, Nahin. CDC National Health Statistics Report #12. Complementary and Alternative Medicine Use among Adults and Children: United States, 2007. December 10, 2008. Extrapolated to 2013 U.S. population from 2007 National Health Interview Survey (NHIS) finding that 8 percent of the adults and 3 percent of the children in the United States received chiropractic services annually.
9 Council on Chiropractic Education (CCE) www.cce-usa.org 2013.
10 Meeker, DC, MPH; Scott Haldeman, DC, PhD, MD; Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine. 2002; 136(3): 216-227. http://annals.org/article.aspx?articleid=474085
11 Coulter, Adams, Coggan, Wilkes, Gonyea. A Comparative Study of Chiropractic and Medical Education. Alternative Therapy Health Medicine. 1998; 4:64-75.
12 Professional Football Chiropractic Society (PFCS) 2010 www.profootballchiros.com
13 Keeney BJ; Fulton-Kehoe D; Turner JA; Wickizer TM; Chan KC; Franklin GM; Early Predictors of Lumbar Spinal Surgery After Occupational Back Injury; Results from a Prospective Study of Workers in Washington State. Spine, May 2013; 38(11):953-64. http://www.ncbi.nlm.nih.gov/pubmed/23238486
14 Richard L. Liliedahl, Michael D. Finch, David V. Axene, Christine M. Goertz. Cost of Care for Common Back Pain Conditions Initiated with Chiropractic Doctor vs. Medical Doctor/Doctor of Osteopathy as First Physician: Experience of One Tennessee-Based General Health Insurer. Journal of Manipulative and Physiological Therapeutics; November 2010; 33(9):640-643.
15 American Chiropractic Association (ACA), 2013. http://www.acatoday.org/pdf/physicianstatus.pdf
16 Consumer Reports Health Ratings Center. Back-Pain Treatments. ConsumerReports.org; July 2011.
17 Consumer Reports Health Ratings Center. Relief for your aching back: What worked for our readers. ConsumerReports.org; March 2013.
18 Gaumer G, PhD. Factors associated with patient satisfaction with chiropractic care: survey and review of the literature. JMPT 2006 July-Aug; 29(6):455
19 Unintentional Drug Poisoning in the United States. Centers for Disease Control and Prevention, 2010. Prescription Drug Abuse. White House Office on National Drug Policy. Accessed November 2013.
20 Whoriskey, Keating. Boom in spinal fusions questioned. Washington Post. Page 1. October 28, 2013; Rise in spinal fusion surgeries driven partly by financial incentives. Washington Post. November 13, 2013.
21 Stevinson, MS & Ernst, MD, PhD (2002). Risks Associated With Spinal Manipulation. The American Journal of Medicine, 112(7), 566-571.
22 Dabbs, Lauretti. A Risk Assessment of Cervical Manipulation vs. NSAIDs for the Treatment of Neck Pain. Journal of Manipulative Physiology and Therapeutics. 1995 October; 18(8):530-6.
23 Bronfort, Evans, Anderson, Svendsen, Bracha, Grimm. Spinal Manipulation, Medication, or Home Exercise with Advice for Acute and Subacute Neck Pain – A Randomized Trial. Annals of Internal Medicine. January 2012; 156:1-10.
24 Dekutoski, MD, Norvell, PhD,, Dettori, PhD, Fehlings, MD, PhD, & Chapman, MD (2010). Surgeon Perceptions and Reported Complications in Spine Surgery. Spine, 35(9S).
25 NCMIC, 2013. https://www.ncmic.com/ Shaw. Avoiding Risky Business. American Chiropractic Association. Accessed December 2013. http://www.acatoday.org/content_css.cfm?CID=1967
26 Accountable Care Organizations Optimize Outcomes, Cost Savings and Patient Satisfaction with Chiropractic Care. Foundation for Chiropractic Progress. May 2013.
27 Dagenais S, Gay RE, Tricco AC, Freeman MD, Mayer JM (2010). NASS Contemporary Concepts in Spine Care: Spinal manipulation therapy for acute low back pain. The Spine Journal 10 (10): 918–940.
28 Chou R, Qaseem A, Snow V et al. Recommendation 7. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine 147 (7): 478–91.

Vertebrobasilar Artery (VBA) Stroke and Neck Manipulation
Key Messages

 

Primary Messages
• The chiropractic profession has relied on the largest and most credible research study to date on this issue (Cassidy et al). The study shows that a patient is as likely to have seen a medical doctor (MD) as a doctor
of chiropractic (DC) in the week prior to a vertebral artery dissection.
• 
The evidence suggests those experiencing symptoms of a stroke in progress—such as severe headache and/or neck pain—may visit an MD or a DC for treatment.

• Doctors of chiropractic are trained to provide informed consent, which involves describing to patients the risks and benefits of all treatment options. 
• Millions of cervical manipulations are performed safely in the United States every year, providing patients relief from common forms of neck pain and headache, and helping them to get back to their normal activities.
• Doctors of chiropractic focus on using the least invasive, safe, conservative treatment options.

 

Approximately 27 million people in the U.S. seek the care of a chiropractor each year.
 

Secondary Messages

• There are risks and benefits to all treatments; however, the chance of experiencing a serious adverse event following neck manipulation is extremely low.
• The risk associated with neck manipulation and vertebral artery dissection/stroke is about 1 in 5.85
million adjustments – that’s far less than 1 in 1 million1.

Compare that to…
o Overall risk of death from spine surgery: 1,800 per 1 million (2)
o Risk of serious side effects/death from cervical spine (neck) surgery: 500 per 1 million (3)
o Risk of death from combined use of NSAIDS/aspirin: 153 per 1 million (4)
o Risk of death from prescription opioid pain medications: 53.6 per 1 million (5)
o Risk of death from aspirin: 25 per 1 million (6)

• Chiropractic services offer a conservative approach to pain that can often help people reduce or eliminate the need for riskier treatments.

o A study in the Annals of Internal Medicine found that spinal manipulative therapy and exercise are more effective at relieving neck pain than pain medication.(7)
o Cervical manipulation has demonstrated physiological benefits. Studies have shown that it produces a consistent and significant increase in active range of motion.(8)
o The most common side effects associated with chiropractic care are temporary, mild and non-serious.  
These are typically symptoms of increased pain, radiating pain, and/or stiffness that usually resolve within 24 hours of treatment. Serious complications are rarely associated with chiropractic care.

• Using a conservative approach to pain makes sense before moving on to riskier treatments.
 

o According to the Institute of Medicine, at least 1.5 million Americans are sickened, injured or killed each year by errors in prescribing, dispensing and taking medications.(9)
o One study estimated 100,000 patients are hospitalized every year in the United States for serious gastrointestinal complications due to the use of common non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. There are about 16,500 NSAID-related deaths annually in the United States, making this the 15th most common cause of death. (10)
o The CDC has classified the abuse of prescription opiod pain medications in the U.S. as an “epidemic,”  resulting in about 15,000 deaths per year.(11)
• Doctors of chiropractic have some of the lowest malpractice insurance premiums in health care because of the low risk associated with the treatments they utilize.

 

References
1. Haldeman S, Carey P, Townsend M, Papadopoulos C: Arterial dissections following cervical manipulation: the chiropractic experience. CMAJ 2001;165:905.
2. Smith, JS et al. Rates and causes of mortality associated with spine surgery based on 108,419 procedures: a review of the Scoliosis Research Society Morbidity and Mortality Database. Spine 2012, Nov 1;37(23):1975-82.
3. Marquez-Lara A, Nandyala SV, Hassanzadeh H, Noureldin M, Sankaranarayanan S, Singh K: Sentinel Events in Cervical Spine Surgery. Spine 2014 Jan 29 [Epub ahead of print], http://www.ncbi.nlm.nih.gov/pubmed/24480955
4. Lanas A et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterology 2005, Aug;100(8):1685-93.
5. Email to ACA from Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, April 29, 2014.
6. Lanas A et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterology 2005, Aug;100(8):1685-93.
7. Bronfort G, Evans R, AndersonA, Svendsen K, Bracha Y, Grimm R. Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial. Annals of Internal Medicine. 2012; 156(1): 1-10.
8. Guzman J, Haldeman S. et al. Clinical Practice Implications of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: From Concepts and Findings to Recommendations. SPINE 2008; 33(4S): S199–S213.
9. Preventing Medication Errors, Institute of Medicine, July 2006, http://www.iom.edu/~/media/Files/Report%20Files/2006/Preventing-
Medication-Errors-Quality-Chasm-Series/medicationerrorsnew.pdf
10. Wolfe MM, Lichtenstein DR, Singh G: Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. NEJM 1999; 340:1888.
11. Office of National Drug Policy, Fact Sheet: Opiod Abuse in the United States,
http://www.whitehouse.gov/sites/default/files/ondcp/Fact_Sheets/opioids_fact_sheet.pdf

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