Chiropractic and Chest Pain (Angina Pectoris)

The term “angina pectoris” refers to chest pain. Angina is classified into three groups: 1. Stable angina (or, “effort angina”); 2. Unstable angina (“crescendo angina”); and 3. Microvascular angina (“syndrome X angina”). The 3rd type is caused by narrowing of the tiny blood vessles supplying the heart muscle and the symptoms vary, making it less easy to identify, but the good news is that it’s usually easy to treat and not fatal. Stable or effort angina refers to the more common type of chest pain related to myocardial ischemia (starving the heart muscle of blood and therefore, oxygen). This type is brought on by some form of activity like running or walking with slight or no symptoms noted at rest. This type responds quickly to the use of nitroglycerine under the tongue, and symptoms usually only last a few minutes after discontinuing the activity and reoccurs when activity resumes. It can continue for a long time but may never progress into unstable angina, which is then treated surgically, often emergently.

The American Heart Association has reported that >6 million Americans have angina pectoris. Typically, because this symptom is quite alarming to the patient, running to a chiropractor for chest pain is appropriately NOT the first course of action, as this symptom is considered a sign of heart disease and indicates an increase risk exists of suffering a heart attack or cardiac arrest. Therefore, AFTER the patient is properly diagnosed and initially medically managed, a patient may elect to seek chiropractic care as benefits have been reported.

A Danish study published in the Journal of Manipulative and Physiological Therapeutics (November 2005) reported that patients with the stable angina may benefit from a four-week course of chiropractic care, though the authors appropriately caution the reader that further studies are needed to verity their findings and to not discontinue cardiology care. In this study, the researchers recruited 275 patients with known or suspected stable angina. Of this group, 50 were found to have “cervicothoracic angina,” (CTA) or chest pain arising from the neck or midback spinal region, and were considered the experimental group and the others were considered the control group and not treated. The 50 treated patients received eight chiropractic treatments over four weeks with at least one adjustment (thrust) to the neck and/or mid-back by the same chiropractor as well as trigger point therapy (deep pressure over tight muscles). Each patient was evaluated at the start and at the end of the eight sessions with questionnaires completed concerning the present intensity of chest, shoulder, arm, and/or spine pain. A second questionnaire measured the patient’s physical and mental status assessing their quality of life. At the end of the eight sessions, the subjects were also asked if they felt better, no change, or worse compared with when they started care and if they thought the treatment was beneficial. The results showed that approximately 70% of the CTA group reported improvement in chest pain and general health. Specifically, in comparing the CTA vs. the control group: 26% vs. 5% = “better”; 42% vs. 16% = “a little better;” and 24% vs. 67% = “no change.” Moreover, no one in the CTA treated group reported “a little worse” or “worse” vs. the control group which included 13% and 2%, respectively. When asked directly, 96% of the CTA treated group reported that chiropractic treatment had been beneficial. Also, ONLY the CTA treated group showed quality of life improvement. This study supports that coordinated care between a chiropractor and the cardiologist can significantly improve the quality of life for the stable angina pectoris patient.

The angina patient’s management plan should also include the following: 1. Smoking cessation; 2. Weight control/healthy diet; 3. Control BP and cholesterol; 4. Avoid temperature extremes; 5. Avoid strenuous activity; 6. Add relaxation methods and stress management; and 7. CALL your doctor if chest pain changes such as if the angina pain occurs at rest and/or is more intense.