October 2016
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Mechanisms of Low Back Pain:
A Guide for Diagnosis and Therapy

Chiro.Org Blog: CLBP represents the leading cause of disability worldwide and is a major welfare and economic problem. [1] Given this complexity, the diagnostic evaluation of patients with LBP can be very challenging and requires complex clinical decision-making. Answering the question, “what is the pain generator?” among the several structures potentially involved in CLBP is a key factor in the management of these patients, since a diagnosis not based on specific pain generator can lead to therapeutic mistakes. This article aims to provide a brief clinical guide that could help in the identification of pain generators through a careful anatomical description, thereby directing clinicians towards the correct diagnosis and therapeutic approach. […]

An Updated Overview of Clinical Guidelines for the Management of Non-specific Low Back Pain in Primary Care

Chiro.Org Blog: This updated review includes national clinical guidelines from 13 countries and 2 international clinical guidelines from Europe published from 2000 until 2008. The content of the guidelines appeared to be quite similar regarding the diagnostic classification (diagnostic triage) and the use of diagnostic and therapeutic interventions. Consistent features for acute low back pain were the early and gradual activation of patients, the discouragement of prescribed bed rest and the recognition of psychosocial factors as risk factors for chronicity. […]

Estimating the Risk of Chronic Pain: Development and Validation of a Prognostic Model (PICKUP) for Patients with Acute Low Back Pain

Chiro.Org Blog: Low back pain (LBP) is a major global health problem that, compared to all other diseases and health conditions, is responsible for the most years lived with disability, an estimated 80 million years lived with disability in 2010. [1] The costs of care, investigations, and lost productivity associated with LBP are a significant economic burden for industrialized nations. [2] For example, estimates for treatments alone are US$50 billion per annum in the United States [3] and US$4 billion in the United Kingdom. [4] The impact of LBP can be profound; in Australia, LBP is the leading cause of early retirement [5] and of income poverty in older adults. [6] […]

Cost-Effectiveness Of General Practice Care For Low Back Pain: A Systematic Review

Chiro.Org Blog: Findings of this systematic review suggest that although GP care alone was often associated with lower treatment costs from the healthcare sector’s perspective, it may not provide a cost saving for society if the costs associated with loss of earnings or productivity are taken into account. When considering costs relative to effects, GP care alone may not be cost-effective in managing sub-acute or chronic LBP. Adding advice, education and exercise to usual GP care, clinical intervention and/or occupational rehabilitation, and acupuncture appeared to dominate over usual GP care. Adding exercise and behavioural counselling to usual GP care, adding exercise and/or spinal manipulation to guideline-based GP care, and using the Alexander technique also appeared cost-effective. The cost-effectiveness of GP care can be improved by referring patients to receive additional services, such as advice and exercise, or by the GPs providing the additional services themselves. […]

Imperfect Placebos Are Common In Low Back Pain Trials:

Chiro.Org Blog: This review reveals that imperfect placebos are common in low back pain trials, a finding that has implications for the design of future trials and also for the interpretation of published trials evaluating treatment of low back pain. Two common problems were identified in the design of trials: the use of placebos that are potentially not inert (as indicated by contemporary treatment) and the uncertain success of blinding. […]

Placebo Effects In Trials Evaluating 12 Selected Minimally Invasive Interventions

Chiro.Org Blog: It is normally assumed that medical practices are based on firm clinical evidence and that new practices or techniques are introduced when superiority, or at least non-inferiority, has been demonstrated compared to established treatments. However, medical history reveals numerous examples contradicting this assumption. Forty-two per cent of 146 medical practices were found to be reversed in a recent review analysing 10-years of publication in a high-impact medical journal. [1] Large effects of an intervention in initial reports are often spurious findings, while the vast majority may represent substantial overestimations. [2] […]

Identification Of Subgroups Of Inflammatory And Degenerative MRI Findings In The Spine And Sacroiliac Joints:

Chiro.Org Blog: The two subgroups with MRI findings at the sacroiliac joints [SIJs] (Subgroups 4 and 5) had a higher activity limitation score and a higher level of hsCRP, compared with the three other subgroups. Previous LBP episodes and being overweight were also more common among patients with MRI findings at the SIJs compared with patients with no or few MRI findings (Subgroup 1). Furthermore, the two SIJ subgroups had a higher prevalence of women compared with the two subgroups with spinal degeneration (Subgroups 2 and 3). The two SIJ subgroups differed according to age and prevalence of HLA-B27-positive status: Subgroup 5 was younger and had a higher prevalence of HLA-B27-positive status compared with patients in Subgroup 4. […]

Chiropractic Spinal Manipulative Therapy For Migraine:
A Three-Armed, Single-Blinded, Placebo, Randomized
Controlled Trial

Chiro.Org Blog: The blinding was strongly sustained throughout the RCT, AEs were few and mild, and the effect in the CSMT and placebo group was probably a placebo response. Because some migraineurs do not tolerate medication because of AEs or co-morbid disorders, CSMT might be considered in situations where other therapeutic options are ineffective or poorly tolerated. […]

Preliminary Study Into The Components Of The
Fear-Avoidance Model Of LBP

Chiro.Org Blog: In the last decade the sub grouping of low back pain (LBP) patients according to their likely response to treatment has been identified as a research priority. As with other patient groups, researchers have found few if any factors from the case history or physical examination that are helpful in predicting the outcome of chiropractic care. However, in the wider LBP population psychosocial factors have been identified that are significantly prognostic. This study investigated changes in the components of the LBP fear-avoidance beliefs model in patients pre- and post- their initial visit with a chiropractor to determine if there was a relationship with outcomes at 1 month. […]

The Physiological Role of Tumor Necrosis Factor in Human Immunity and Its Potential Implications in Spinal Manipulative Therapy

Chiro.Org Blog: Physiological roles of tumor necrosis factor (TNF) have recently regained attention in the biomedical research community; new findings, particularly with the discovery of the interaction between TNF and Tregs, offer new insights to understanding human immunophysiology. This progress may provide a new paradigm in understanding SMT. […]