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Monthly Archives: April 2017

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Areas of Capsaicin-Induced Secondary Hyperalgesia and Allodynia Are Reduced by a Single Chiropractic Adjustment

By |April 29, 2017|Chiropractic Care, Pain Relief|

Areas of Capsaicin-Induced Secondary Hyperalgesia and Allodynia Are Reduced by a Single Chiropractic Adjustment: A Preliminary Study

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SOURCE:   J Manipulative Physiol Ther. 2004 (Jul); 27 (6): 381–387

Parvaneh Mohammadian, PhD, Antonio Gonsalves, DC,
Chris Tsai, DC Thomas Hummel, MD, Thomas Carpenter, DC

School of Medicine,
University of California,
Los Angeles, Calif 90024, USA.


INTRODUCTION:   The aim of the study was to investigate the hypoalgesic effects of a single spinal manipulation treatment on acute inflammatory reactions and pain induced by cutaneous application of capsaicin.

METHODS:   Twenty healthy subjects participated in the experiment, which consisted of 2 sessions. In both sessions, following control measurements, topical capsaicin was applied to the right or left forearm to induce cutaneous inflammatory reactions. The cream was removed after 20 minutes. Then subjects received either spinal manipulation treatment (SMT) or “nonspinal manipulation treatment” (N-SMT), respectively. In control as well as pretreatment and posttreatment intervals, the following tests were performed: measurement of the areas of mechanical hyperalgesia and stroking allodynia, assessment of spontaneous pain, and measurement of blood flow.

RESULTS:   The results confirmed that topical capsaicin induced inflammatory reactions based on occurrence of hyperalgesia and allodynia, augmented pain perception, and increased blood flow following capsaicin application compared with the control session. When compared with N-SMT, spontaneous pain was rated significantly lower post-SMT (P < .014). In addition, areas of both secondary hyperalgesia and allodynia decreased after SMT (hyperalgesia: P <.007; allodynia: P <.003). However, there was no significant treatment effect for local blood flow.

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Subluxation Neurology Section

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The Influence of Expectation on Spinal Manipulation Induced Hypoalgesia: An Experimental Study in Normal Subjects

By |April 27, 2017|Hypoalgesia, Patient Expectations|

The Influence of Expectation on Spinal Manipulation Induced Hypoalgesia: An Experimental Study in Normal Subjects

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SOURCE:   BMC Musculoskelet Disord. 2008 (Feb 11); 9: 19

Joel E Bialosky, Mark D Bishop,
Michael E Robinson, Josh A Barabas,
and Steven Z George

University of Florida Department of Physical Therapy,
Gainesville, Florida, USA.


BACKGROUND:   The mechanisms thorough which spinal manipulative therapy (SMT) exerts clinical effects are not established. A prior study has suggested a dorsal horn modulated effect; however, the role of subject expectation was not considered. The purpose of the current study was to determine the effect of subject expectation on hypoalgesia associated with SMT.

METHODS:   Sixty healthy subjects agreed to participate and underwent quantitative sensory testing (QST) to their leg and low back. Next, participants were randomly assigned to receive a positive, negative, or neutral expectation instructional set regarding the effects of a specific SMT technique on pain perception. Following the instructional set, all subjects received SMT and underwent repeat QST.

RESULTS:   No interaction (p = 0.38) between group assignment and pain response was present in the lower extremity following SMT; however, a main effect (p < 0.01) for hypoalgesia was present. A significant interaction was present between change in pain perception and group assignment in the low back (p = 0.01) with participants receiving a negative expectation instructional set demonstrating significant hyperalgesia (p < 0.01).

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Chiropractic and Spinal Pain Management

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Individual Expectation: An Overlooked, But Pertinent, Factor in the Treatment of Individuals Experiencing Musculoskeletal Pain

By |April 26, 2017|Hypoalgesia, Musculoskeletal Pain, Patient Expectations|

Individual Expectation: An Overlooked, But Pertinent, Factor in the Treatment of Individuals Experiencing Musculoskeletal Pain

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SOURCE:   Phys Ther. 2010 (Sep); 90 (9): 1345–1355

Joel E. Bialosky Mark D. Bishop Joshua A. Cleland

Department of Physical Therapy,
University of Florida,
Gainesville, FL 32610-0154, USA


Physical therapists consider many factors in the treatment of patients with musculoskeletal pain. The current literature suggests expectation is an influential component of clinical outcomes related to musculoskeletal pain for which physical therapists frequently do not account. The purpose of this clinical perspective is to highlight the potential role of expectation in the clinical outcomes associated with the rehabilitation of individuals experiencing musculoskeletal pain. The discussion focuses on the definition and measurement of expectation, the relationship between expectation and outcomes related to musculoskeletal pain conditions, the mechanisms through which expectation may alter musculoskeletal pain conditions, and suggested ways in which clinicians may integrate the current literature regarding expectation into clinical practice.


From the Full-Text Article:

Background

Physical therapy interventions for musculoskeletal pain conditions often address impairments with the implication that pain and function will improve in response to stretching a tight muscle or strengthening a weak muscle. Realistically, the mechanisms through which physical therapy interventions alter musculoskeletal pain are likely multifaceted and dependent upon a variety of factors related to the therapist, the patient, and the environment. [1] The current literature indicates factors other than the correction of physical impairments influence clinical outcomes in the conservative management of patients experiencing musculoskeletal pain. For example, psychological factors such as fear are useful in directing treatment. [2, 3] Similarly, factors related to patient expectations are associated with both clinical outcomes, [4, 5] satisfaction with treatment, [6, 7] and influence of behavior. [8, 9]

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Chiropractic and Spinal Pain Management

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A Regional Interdependence Model of Musculoskeletal Dysfunction

By |April 25, 2017|Musculoskeletal Dysfunction|

A Regional Interdependence Model of Musculoskeletal Dysfunction:
Research, Mechanisms, and Clinical Implications

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SOURCE:   J Man Manip Ther. 2013 (May); 21 (2): 90-102

Derrick G Sueki, Joshua A Cleland,
and Robert S Wainner

Department of Physical Therapy,
Mount St Mary’s College,
Los Angeles, CA, USA.


The term regional interdependence or RI has recently been introduced into the vernacular of physical therapy and rehabilitation literature as a clinical model of musculoskeletal assessment and intervention. The underlying premise of this model is that seemingly unrelated impairments in remote anatomical regions of the body may contribute to and be associated with a patient’s primary report of symptoms. The clinical implication of this premise is that interventions directed at one region of the body will often have effects at remote and seeming unrelated areas.

The formalized concept of RI is relatively new and was originally derived in an inductive manner from a variety of earlier publications and clinical observations. However, recent literature has provided additional support to the concept. The primary purpose of this article will be to further refine the operational definition for the concept of RI, examine supporting literature, discuss possible clinically relevant mechanisms, and conclude with a discussion of the implications of these findings on clinical practice and research.

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Prevalence of Low Back Pain in Adolescents
with Idiopathic Scoliosis

By |April 24, 2017|Chiropractic Research, Scoliosis|

Prevalence of Low Back Pain in Adolescents with Idiopathic Scoliosis: A Systematic Review

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SOURCE:   Chiropractic & Manual Therapies 2017 (Apr 20); 25: 10

Jean Théroux, Norman Stomski, Christopher J. Hodgetts,
Ariane Ballard, Christelle Khadra, Sylvie Le May and
Hubert Labelle

Research Center,
Sainte-Justine University Hospital Center
School of Health Profession,
Murdoch University


Background   Adolescent idiopathic scoliosis is the most common spinal deformity occurring in adolescents and its established prevalence varies from 2 to 3%. Adolescent idiopathic scoliosis has been identified as a potential risk factor for the development of low back pain in adolescents. The purpose of this study was to systematically review studies of the prevalence of low back pain in adolescents with idiopathic scoliosis in order to establish the quality of the evidence and determine whether the prevalence estimates could be statistically pooled.

Methods   Systematic electronic searches were undertaken in PubMed, CINAHL, and CENTRAL without any restrictions. Studies were eligible for inclusion if they reported the prevalence of low back pain in adolescents with idiopathic scoliosis. Studies were excluded if they detailed the prevalence of pain in post-surgical subjects or were published in languages other than English or French. Data were reported qualitatively, since there was insufficient evidence for statistical pooling.

Results   The electronic search strategies yielded 1811 unique studies. Only two studies fulfilled the eligibility criteria. The prevalence of low back pain in adolescents with idiopathic scoliosis ranged from 34.7 to 42.0%. However, these prevalence estimates should be viewed cautiously as the included studies were at high risk of bias.

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Scoliosis and Chiropractic Page

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Elevated Production of Inflammatory Mediators Including Nociceptive Chemokines in Patients With Neck Pain: A Cross-Sectional Evaluation

By |April 23, 2017|Chronic Neck Pain|

Elevated Production of Inflammatory Mediators Including Nociceptive Chemokines in Patients With Neck Pain: A Cross-Sectional Evaluation

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J Manipulative Physiol Ther. 2011 (Oct);   34 (8):   498–505

Julita A. Teodorczyk-Injeyan, PhD, John J. Triano, DC, PhD, Marion McGregor, DC, PhD,
Linda Woodhouse, PT, PhD, H. Stephen Injeyan, PhD, DC

Associate Professor,
Graduate Education and Research Programs,
Canadian Memorial Chiropractic College,
Toronto, Ontario, Canada


OBJECTIVE:   This study investigated whether the production of inflammatory mediators and chemotactic cytokines (chemokines) is altered in patients with chronic and recurrent neck pain (NP).

METHODS:   Cross-sectional data evaluating blood and serum samples were obtained from 27 NP patients and 13 asymptomatic (control) subjects recruited from a chiropractic outpatient clinic. Cell cultures were activated by lipopolysaccharide (LPS) and phytoheamagglutinin for 24 to 48 hours. The levels of tumor necrosis factor α (TNF-α), monocyte chemotactic protein 1, also known as CCL2 (CCL2/MCP-1), and macrophage inflammatory protein 1α or CCL3 (CCL3/MIP-1α) were determined by specific immunoassays. Serum levels of nitric oxide metabolites were evaluated simultaneously, in vanadium III-reduced samples, by Griess reaction.

RESULTS:   Low levels of constitutive (spontaneous) TNF-α production were present in 7 of the 27 cultures from patients with NP. Both LPS-induced TNF-α production and inducer (LPS/phytoheamagglutin)-stimulated production of CCL2 were significantly elevated (P = .00) in patients compared with controls. In patients, the constitutive synthesis of CCL3 occurred significantly more frequently (P = .00) and ranged from 30 to more than 2000 pg/mL. Finally, serum levels of nitric oxide were significantly elevated (P = .00) in NP patients.

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Chronic Neck Pain and Chiropractic Page and the:

Chiropractic and Spinal Pain Management

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