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Chiropractic Management of a Patient With Chronic Pain in a Federally Qualified Health Center

By |January 21, 2019|Categories: Chronic Neck Pain|

Chiropractic Management of a Patient With Chronic Pain in a Federally Qualified Health Center: A Case Report

The Chiro.Org Blog


SOURCE:   J Chiropractic Medicine 2018 (Jun);   17 (2):   117–120

David J. Mann, DC and Ross Mattox, DC

Department of Integrated Clinics,
Logan University,
St. Louis, Missouri.



OBJECTIVE:   The aim of this case report is to describe the response of a patient with chronic pain who received chiropractic care in a federally qualified health center.

CLINICAL FEATURES:   A 61-year-old female patient with neck and back pain after a traumatic motor vehicle accident 3 years prior was referred for chiropractic care. She had neck pain, low back pain, knee pain, and pain associated with over 20 surgeries, as well as depression, opioid dependence, and low quality of life.

INTERVENTIONS AND OUTCOMES:   The patient was treated with chiropractic manipulation for her low back and neck pain and was counseled on nutrition and exercise. After 6 months, she reported improvements in pain, improved quality of life, and discontinuation of opioid pain medication.

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Can Chiropractors Contribute to Work Disability Prevention Through Sickness Absence Management for Musculoskeletal Disorders?

By |January 20, 2019|Categories: Chiropractic Care, Return To Work, Workers' Compensation|

Can Chiropractors Contribute to Work Disability Prevention Through Sickness Absence Management for Musculoskeletal Disorders? – A Comparative Qualitative Case Study in the Scandinavian Context

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2018 (Apr 26); 26: 15

Mette Jensen Stochkendahl, Ole Kristoffer Larsen, Casper Glissmann Nim, Iben Axén, Julia Haraldsson, Ole Christian Kvammen, and Corrie Myburgh

Nordic Institute of Chiropractic and Clinical Biomechanics,
Campusvej 55, DK-5230
Odense M, Denmark.



BACKGROUND:   Despite extensive publication of clinical guidelines on how to manage musculoskeletal pain and back pain in particular, these efforts have not significantly translated into decreases in work disability due to musculoskeletal pain. Previous studies have indicated a potential for better outcomes by formalized, early referral to allied healthcare providers familiar with occupational health issues. Instances where allied healthcare providers of comparable professional characteristics, but with differing practice parameters, can highlight important social and organisational strategies useful for informing policy and practice. Currently, Norwegian chiropractors have legislated sickness certification rights, whereas their Danish and Swedish counterparts do not. Against the backdrop of legislative variation, we described, compared and contrasted the views and experiences of Scandinavian chiropractors engaging in work disability prevention and sickness absence management.

METHODS:   This study was embedded in a two-phased, sequential exploratory mixed-methods design. In a comparative qualitative case study design, we explored the experience of chiropractors regarding sickness absence management drawn from face-to-face, semi-structured interviews. We subsequently coded and thematically restructured their experiences and perceptions.

RESULTS:   Twelve interviews were conducted. Thematically, chiropractors’ capacity to support patients in sickness absence management revolved around four key issues: issues of legislation and politics; the rationale for being a sickness absence management partner; whether an integrated sickness absence management pathway existed/could be created; and finally, the barriers to service provision for sickness absence management.

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Our Blog is Just a Tool. Learn How To Use It Now

By |January 20, 2019|Categories: Announcement|

Our Blog is Just a Tool.
Learn How To Use It Now.

The Chiro.Org Blog


SOURCE:   A Chiro.Org Editorrial


Every Blog post is an announcement of new material that was just added to one of our many Sections.

I have been compiling (and archiving) peer-reviewed articles since early 1996, and to date we have thousands of Abstracts, and many hundreds of Full-Text articles on a wide variety of subjects.

When enough material, relating to a particular topic was collected, it was gathered into a new Topical Page in one of our many Sections.

Each Topical page is located in the Section most associated with that topic.
Thus, our Attention Deficit Page is located (is a part of) our Pediatrics Section   You get the idea.

Almost ALL of our Sections contain some, or many Topical collections. The LINKS Section is the most extreme example, because it contains 89 different topical pages.

All of the following are “active” Sections that are constantly adding new (and important) materials:

Acupuncture
Alternative Healing Abstracts
Case Studies
Chiropractic Assistants
Chiropractic Research
Documentation
The LINKS
Medicare Info
Nutrition
Pediatrics
Radiology
Stroke and Chiropractic Page
What is the Chiropractic Subluxation?

These other valuable Sections are “archival” in nature, and contain
valuable tools for you to use freely:

Chiropractic History
Free Images
New DC’s
Office Forms
R.C. Schafer’s Rehab Monographs
Search Section


How Blog Posts Work

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Managing Sickness Absence of Patients with Musculoskeletal Pain

By |January 19, 2019|Categories: Return To Work, Workers' Compensation|

Managing Sickness Absence of Patients with Musculoskeletal Pain – A Cross-sectional Survey of Scandinavian Chiropractors

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2019 (Jan 11); 27: 1

Mette Jensen Stochkendahl, Casper Glissmann Nim, Eleanor Boyle, Ole Kristoffer Larsen, Iben Axén, Ole Christian Kvammen and Corrie Myburgh

Nordic Institute of Chiropractic and Clinical Biomechanics,
Campusvej 55, DK-5230
Odense M, Denmark.



BACKGROUND:   Musculoskeletal pain is a major cause of work disability. Many patients with musculoskeletal pain seek care from health care providers other than their general practitioners, including a range of musculoskeletal practitioners. Therefore, these musculoskeletal practitioners may play a key role by engaging in sickness absence management and work disability prevention. This study aimed to determine the prevalence of musculoskeletal practitioners’ practice behaviours, and their perceptions and beliefs about sickness absence management by using Scandinavian chiropractors as an example, as well as to examine the association between these characteristics and two different practice behaviours.

METHODS:   As part of a mixed-methods study, we surveyed members of the national chiropractic associations in Denmark, Norway, and Sweden in 2016. Descriptive statistics were used to describe prevalence. Multilevel logistic regression with backwards stepping was used to estimate odds ratios with 95% confidence intervals between each of the two practice behaviours and the characteristics.

RESULTS:   Out of the 802 respondents (response rate 56%), 372 were Danish, 349 Norwegian, and 81 Swedish. In Denmark and Norway, 38.7 and 37.8% always/often considered if sick leave was appropriate for their patient compared to 21.0% in Sweden (p = 0.007); and 86.5% of the Norwegian chiropractors always/often recommended to return-to-work versus 64.5 and 66.7% in Denmark and Sweden respectively (p < 0.001). In the final models, factors associated with the two practice behaviours were age, level of clinical experience, working as a teacher, the tendency to be updated on current legislations and policies using social services, contact with general practitioners, relevance of engagement in SAM, consideration of workplace factors, SAM as part of the clinical tool box, patient out-of-pocket fee, and recommending fast return-to-work.

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Coverage of Nonpharmacologic Treatments for Low Back Pain Among US Public and Private Insurers

By |January 17, 2019|Categories: Chiropractic Care|

Coverage of Nonpharmacologic Treatments for Low Back Pain Among US Public and Private Insurers

The Chiro.Org Blog


SOURCE:   JAMA Netw Open. 2018 (Oct 5); 1 (6): e183044

James Heyward, MPH; Christopher M. Jones, PharmD, MPH; Wilson M. Compton, MD, MPE; et al

Center for Drug Safety and Effectiveness,
Johns Hopkins Bloomberg School of Public Health,
Baltimore, Maryland.



IMPORTANCE:   Despite epidemic rates of addiction and death from prescription opioids in the United States, suggesting the importance of providing alternatives to opioids in the treatment of pain, little is known regarding how payers’ coverage policies may facilitate or impede access to such treatments.

OBJECTIVE:   To examine coverage policies for 5 nonpharmacologic approaches commonly used to treat acute or chronic low back pain among commercial and Medicare Advantage insurance plans, plus an additional 6 treatments among Medicaid plans.

DESIGN, SETTING, AND PARTICIPANTS:   Cross-sectional study of 15 commercial, 15 Medicaid, and 15 Medicare Advantage health plans for the 2017 calendar year in 16 states representing more than half of the US population. Interviews were conducted with 43 senior medical and pharmacy health plan executives from representative plans.

MAIN OUTCOMES AND MEASURES:   Medical necessity and coverage status for the treatments examined, as well as the use of utilization management tools and cost-sharing magnitude and structure.

RESULTS:   Commercial and Medicare insurers consistently regarded physical and occupational therapy as medically necessary, but policies varied for other therapies examined.

Payers most commonly covered

physical therapy (98% [44 of 45 plans]),

occupational therapy (96% [43 of 45 plans]), and

chiropractic care (89% [40 of 45 plans]),

while transcutaneous electrical nerve stimulation (67% [10 of 15 plans]) and steroid injections (60% [9 of 15 plans]) were the most commonly covered among the therapies examined for Medicaid plans only.

Despite evidence in the literature to support use of acupuncture and psychological interventions, these therapies were either not covered by plans examined (67% of all plans [30 of 45] did not cover acupuncture) or lacked information about coverage (80% of Medicaid plans [12 of 15] lacked information about coverage of psychological interventions). Utilization management tools, such as prior authorization, were common, but criteria varied greatly with respect to which conditions and what quantity and duration of services were covered. Interviewees represented 6 Medicaid managed care organizations, 2 Medicare Advantage or Part D plans, 9 commercial plans, and 3 trade organizations (eg, Blue Cross Blue Shield Association). Interviews with plan executives indicated a low level of integration between the coverage decision-making processes for pharmacologic and nonpharmacologic therapies for chronic pain.

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Pain-Related Fear-Dissociable Neural Sources of Different Fear Constructs

By |January 15, 2019|Categories: Fear Avoidance, Outcome Assessment, Pain Management|

Pain-Related Fear-Dissociable Neural Sources of Different Fear Constructs

The Chiro.Org Blog


SOURCE:   eNeuro. 2019 (Jan 3);   5 (6) pii: ENEURO.0107-18.2018

Michael Lukas Meier, Andrea Vrana, Barry Kim Humphreys, Erich Seifritz, Philipp Stämpfli, and Petra Schweinhardt

Integrative Spinal Research,
Department of Chiropractic Medicine,
Balgrist University Hospital,
8008 Zurich, Switzerland.



Fear of pain demonstrates significant prognostic value regarding the development of persistent musculoskeletal pain and disability. Its assessment often relies on self-report measures of pain-related fear by a variety of questionnaires. However, based either on “fear of movement/(re)injury/kinesiophobia,” “fear avoidance beliefs,” or “pain anxiety,” pain-related fear constructs plausibly differ while it is unclear how specific the questionnaires are in assessing these different constructs. Furthermore, the relationship of pain-related fear to other anxiety measures such as state or trait anxiety remains ambiguous. Advances in neuroimaging such as machine learning on brain activity patterns recorded by functional magnetic resonance imaging might help to dissect commonalities or differences across pain-related fear constructs. We applied a pattern regression approach in 20 human patients with nonspecific chronic low back pain to reveal predictive relationships between fear-related neural pattern information and different pain-related fear questionnaires.

More specifically, the applied multiple kernel learning approach allowed the generation of models to predict the questionnaire scores based on a hierarchical ranking of fear-related neural patterns induced by viewing videos of activities potentially harmful for the back. We sought to find evidence for or against overlapping pain-related fear constructs by comparing the questionnaire prediction models according to their predictive abilities and associated neural contributors. By demonstrating evidence of nonoverlapping neural predictors within fear-processing regions, the results underpin the diversity of pain-related fear constructs. This neuroscientific approach might ultimately help to further understand and dissect psychological pain-related fear constructs.

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