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  Diagnosis and Treatment of Low Back Pain
Ann of Int Med 2007 (Oct 2);   147 (7):   478–491
You will enjoy these recommendations from the Oct 2, 2007 issue of the Annals of Internal Medicine. Their ONLY recommendation for active treatment of acute low back pain is spinal adjusting (manipulation).


  Steroid Injections Offer Little Relief for Lower Back Pain
A randomized, controlled trial has shown an epidural or translaminar steroid injection is ineffective for the relief of lower back pain. "I'm not saying that steroids don't work. I'm just saying there's definite reason to question whether they work or not," Dr. Daniel Steinitz, an orthopedic surgeon at Belleville General Hospital in Ontario, said in an interview after his presentation at the American Academy of Orthopedic Surgeons meeting here. Dr. Steinitz, who worked on the study during his residency at McGill University in Montreal, said steroid injections for lumbar pain are popular but research on their use over the past 40 years has produced conflicting results. Nor is the procedure benign, with dural puncture leading to headache being one of the more common complications.


  Inappropriate Use of the Title Chiropractor
The results of this year-long prospective review suggests that the words chiropractor and chiropractic manipulation are often used inappropriately by European biomedical researchers when reporting apparent associations between cervical spine manipulation and symptoms suggestive of traumatic injury. Furthermore, in those cases reported here, the spurious use of terminology seems to have passed through the peer-review process without correction. Additionally, these findings provide further preliminary evidence, beyond that already provided by Terrett, that the inappropriate use of the title chiropractor and term chiropractic manipulation may be a significant source of over-reporting of the link between the care provided by chiropractors and injury. You may also want to read this Editorial Comment by the author.


  Wellness Care and Chiropractic
Chiropractors have recommended spinal adjustments for correction and prevention of musculoskeletal and visceral conditions for a significant period of time. Let's review the literature supporting wellness or maintenance care.


Are German Orthopedic Surgeons Killing People With Chiropractic?
Journal of Neurology 2006 (Mar 6)
Editorial Commentary: I present for your review an abstract from the Journal of Neurology. This abstract blatantly conceals the facts stated in the body of the paper when it states that “we describe 36 patients with vertebral artery dissections and prior chiropractic neck manipulation”. When I read that sentence, I am led to believe that “real-live chiropractors” (meaning licensed Doctors of Chiropractic, who received their training at a CCE/WCCE accredited schools) were the ones to provide the “chiropractic neck manipulation”. Unfortunately, that couldn't be further from the truth! You may review other articles like this in the Stroke Page


What is the Identity of the Chiropractic Profession?
The World Federation of Chiropractic (WFC) just completed a 2-year comprehensive identity consultation that lead to describing our profession as the spinal health care experts in the health care system. Read all about it now!


Effects of a Managed Chiropractic Benefit on the Use of Specific Diagnostic and Therapeutic Procedures in the Treatment of Low Back and Neck Pain
J Manip Physiol Ther 2005 (Oct);   28 (8):   564–569
For the treatment of low back and neck pain, the inclusion of a chiropractic benefit resulted in a significant reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs. This effect was greater on a per-episode basis than on a per-patient basis.


Cost-effectiveness of Medical and Chiropractic Care for Acute and Chronic Low Back Pain
J Manip Physiol Ther 2005 (Oct);   28 (8):   555–563
Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction. Chiropractic care appeared relatively cost-effective for the treatment of chronic LBP. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulation efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis. This evidence can guide physicians, payers, and policy makers in evaluating chiropractic as a treatment option for low back pain. There are more articles like this in the Cost-Effectiveness Page and the Low Back Pain Page.


Chronic Pain in Persons With Neuromuscular Disease
Clin J Pain 2005 (Jan);   21 (1):   18–26
In this paper, researchers in a medical school rehabilitation department were interested in finding out what treatments were most effective at reducing pain for neuromuscular diseases (like amyotrophic lateral sclerosis and myotonic muscular dystrophies). Interestingly, chiropractic scored the highest pain relief rating (7.33 out of 10), scoring higher than the relief provided by either nerve blocks (6.75) or opioid analgesics (6.37). WOW!!!


The “Best Practice” Initiative
Learn the distinction between Guidelines and Best Practices, and find out more about the progress of the Council on Chiropractic Guidelines and Practice Parameters.


Treatment of Bipolar, Seizure, and Sleep Disorders and Migraine Headaches Utilizing a Chiropractic Technique
J Manip Physiol Ther 2004 (Mar);   27 (3):   E5 ~ FULL TEXT
At initial examination, evidence of a subluxation stemming from the upper cervical spine was found through thermography and radiography. Chiropractic care using an upper cervical technique was administered to correct and stabilize the patient's upper neck injury. Assessments at baseline, 2 months, and 4 months were conducted by the patient's neurologist. After 1 month of care, the patient reported an absence of seizures and manic episodes and improved sleep patterns. After 4 months of care, seizures and manic episodes remained absent and migraine headaches were reduced from 3 per week to 2 per month. After 7 months of care, the patient reported the complete absence of symptoms. Eighteen months later, the patient remains asymptomatic. You may enjoy other valuable reports like this at the Case Reports Section.


Florida Judge Rules That SEMG Has Demonstrated Medical Value
FEB. 16, 2005 -   Florida insurers can no longer deny reimbursement of charges for surface electromyography (SEMG) in personal injury (PI) cases. A Florida administrative judge struck down a rule that had denied reimbursement of SEMGs because they were “not medically necessary”.


Comparative Analysis of Individuals With and Without Chiropractic Coverage: Patient Characteristics, Utilization, and Costs
Arch Intern Med 2004 (Oct 11);   164 (18):   1985-1892
A 4-year retrospective claims data analysis comparing more than 700,000 health plan members within a managed care environment found that members had lower annual total health care expenditures, utilized x-rays and MRIs less, had less back surgeries, and for patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode-related costs ($289 vs $399, P<.001). The authors concluded: “Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care.” You will also enjoy this recent press release. There are more articles on this topic in the Cost-Effectiveness Page.


First Report on a US Project Analyzing Chiropractic and Medical Interprofessional Relationships
J Interprof Care 2004 (Aug);   18 (3):   320-321
Evidence points to increased utilization of complementary and alternative medicine services (CAM), although little knowledge exists about the coordination or integration of CAM with conventional health care. The project described here explores two dimensions of the relationship between chiropractors and conventional allopathic primary care physicians in the U.S., using two modes of data collection. All chiropractors (DCs) and medical primary care providers (MDPCPs) in Iowa were surveyed in 2003 to measure patterns of referrals/consults and bidirectional communication between the two practitioner types. In addition, nine focus groups made up of both academic and community leaders in their respective fields were convened throughout 2002 and 2003, to gather information about the conceptual formulation and barriers and facilitators of the design, delivery and implementation of practice-based research networks (PBRNs) that would include both CAM and medical providers.

NSAIDs and Musculoskeletal Treatment: What Is the Clinical Evidence?
PHYSICIAN AND SPORTSMEDICINE 2003 (Jan);   31 (1)
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for musculoskeletal injuries because the conditions are believed to be inflammatory in nature. However, because inflammation is a necessary component in the healing process, decreasing inflammation may prove counterproductive. Also, many tendon injuries called 'tendinitis' are, in fact, degenerative and not inflammatory conditions.
An analysis of the pathophysiology and healing of musculoskeletal injuries questions the use of NSAIDs in many treatment protocols. Because NSAIDs have profound side effects, they should not automatically be the first choice for treating musculoskeletal injuries. There are many more articles like this in the Iatrogenic Injury Page.


Upper Crossed Syndrome and Its Relationship to Cervicogenic Headache
J Manip Physiol Ther 2004 (Jul);   27 (6):   414-420
The principles of upper crossed syndrome and the use of exercise, chiropractic care, and myofascial release in the treatment of cervicogenic headache are discussed. A review of the literature indicates that analyzing muscle imbalance as well as vertebral subluxation may increase the effectiveness of chiropractic treatment for cervicogenic headache. NOTE: There are more articles on this topic in the Rehabilitation Diplomate Information Page.