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Monthly Archives: April 2017

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Elevated Production of Nociceptive CC-chemokines and sE-selectin in Patients with Low Back Pain and the Effects of Spinal Manipulation: A Non-randomized Clinical Trial

By |April 22, 2017|Low Back Pain, Spinal Joint Pain|

Elevated Production of Nociceptive CC-chemokines and sE-selectin in Patients with Low Back Pain and the Effects of Spinal Manipulation: A Non-randomized Clinical Trial

The Chiro.Org Blog


SOURCE:   Clin J Pain. 2017 (Apr 19) [Epub]

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

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


BACKGROUND:   The involvement of inflammatory components in the pathophysiology of low back pain is poorly understood. It has been suggested that spinal manipulative therapy (SMT) may exert anti-inflammatory effects.

PURPOSE:   To determine the involvement of inflammation-associated chemokines (CC series) in the pathogenesis of non-specific low back pain and to evaluate the effect of SMT on that process.

METHODS:   Patients presenting with non-radicular, non-specific low back pain (minimum pain score 3 on 10 point visual analogue scale, VAS) were recruited according to stringent inclusion criteria. They were evaluated for appropriateness to treat using a high velocity low amplitude manipulative thrust (HVLT) in the lumbar-lumbosacral region. Blood samples were obtained at baseline and following the administration of a series of 6 HVLTs on alternate days over the period of two weeks. The in vitro levels of CC chemokines (CCL2, CCL3 and CCL4) production and plasma levels of an inflammatory biomarker, soluble E-selectin, were determined at baseline and at the termination of treatments two weeks later.

RESULTS:   Compared with asymptomatic controls baseline production of all chemokines was significantly elevated in acute (P=0.004 – <0.0001), and that of CCL2 and CCL4 in chronic LBP patients (P<0.0001). Furthermore, CCL4 production was significantly higher (P<0.0001) in the acute versus chronic LBP group. sE-selectin levels were significantly higher (P=0.003) in chronic but not in acute LBP patients. Following SMT, patient reported outcomes showed significant (P<0.0001) improvements in VAS and ODI scores. This was accompanied by a significant decline in CCL 3 production (P<0.0001) in both groups of patients. Change scores for CCL4 production differed significantly (P<0.0001) only for the acute LBP cohort, and no effect on the production of CCL2 or plasma sE-selectin levels was noted in either group.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page and the:

Chiropractic and Spinal Pain Management

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Workers’ Compensation, Return to Work, and Lumbar Fusion for Spondylolisthesis

By |April 18, 2017|Chronic Low Back Pain|

Workers’ Compensation, Return to Work, and Lumbar Fusion for Spondylolisthesis

The Chiro.Org Blog


SOURCE:   Orthopedics. 2016 (Jan); 39 (1): e1-8

Joshua T. Anderson, BS; Arnold R. Haas, BS, BA;
Rick Percy, PhD; Stephen T. Woods, MD;
Uri M. Ahn, MD; Nicholas U. Ahn, MD

Department of Orthopaedics (JTA, NUA),
University Hospitals Case Medical Center, Cleveland,
Case Western Reserve University School of Medicine (JTA),
Cleveland, and the Ohio Bureau of Workers’ Compensation (ARH, RP, STW),
Columbus, Ohio; and the
New Hampshire NeuroSpine Institute (UMA),
Bedford, New Hampshire


This is an interesting follow-up to a 2011 study drawn from the Ohio Bureau of Workers’ Compensation database.
[Startling New Study Reveals That Back Surgery Fails 74% of the Time]

In the 2011 study, two years AFTER surgery, only 26 percent had returned to work.
That translated to a resounding 74% failure rate!

In this current study, researchers reviewed the files of 686 workers who underwent fusion surgery for spondylolisthesis between 1993 and 2013, revealing that only 29.9% of them ever returned to work (for at least 6 months).   The failure rate (meaning return-to-work) was 70.1%.

Clearly, it’s time to consider more conservative approaches, like early referral for chiropractic care, long before they become chronic pain patients.


The Abstract:

Lumbar fusion for spondylolisthesis is associated with consistent outcomes in the general population. However, workers’ compensation is a risk factor for worse outcomes. Few studies have evaluated prognostic factors within this clinically distinct population. The goal of this study was to identify prognostic factors for return to work among patients with workers’ compensation claims after fusion for spondylolisthesis. The authors used International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes to identify 686 subjects from the Ohio Bureau of Workers’ Compensation who underwent fusion for spondylolisthesis from 1993 to 2013.

Positive return to work status was recorded in patients who returned to work within 2 years of fusion and remained working for longer than 6 months. The criteria for return to work were met by 29.9% (n=205) of subjects. The authors used multivariate logistic regression analysis to identify prognostic factors for return to work.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

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A Qualitative Study of Changes in Expectations Over Time Among Patients with Chronic Low Back Pain Seeking Four CAM Therapies

By |April 16, 2017|Chiropractic Care, Chronic Pain|

A Qualitative Study of Changes in Expectations Over Time Among Patients with Chronic Low Back Pain Seeking Four CAM Therapies

The Chiro.Org Blog


SOURCE:   BMC Complement Altern Med. 2015 (Feb 5); 15: 12

Emery R Eaves, Karen J Sherman, Cheryl Ritenbaugh,
Clarissa Hsu, Mark Nichter, Judith A Turner,
and Daniel C Cherkin

Department of Family and Community Medicine &
School of Anthropology,
University of Arizona,
Tucson, AZ, USA.


BACKGROUND:   The relationship between patient expectations about a treatment and the treatment outcomes, particularly for Complementary and Alternative Medicine (CAM) therapies, is not well understood. Using qualitative data from a larger study to develop a valid expectancy questionnaire for use with participants starting new CAM therapies, we examined how participants’ expectations of treatment changed over the course of a therapy.

METHODS:   We conducted semi-structured qualitative interviews with 64 participants initiating one of four CAM therapies (yoga, chiropractic, acupuncture, massage) for chronic low back pain. Participants just starting treatment were interviewed up to three times over a period of 3 months. Interviews were transcribed verbatim and analyzed using a qualitative mixed methods approach incorporating immersion/crystallization and matrix analysis for a decontexualization and recontextualization approach to understand changes in thematic emphasis over time.

RESULTS:   Pre-treatment expectations consisted of conjecture about whether or not the CAM therapy could relieve pain and improve participation in meaningful activities. Expectations tended to shift over the course of treatment to be more inclusive of broader lifestyle factors, the need for long-term pain management strategies and attention to long-term quality of life and wellness. Although a shift toward greater acceptance of chronic pain and the need for strategies to keep pain from flaring was observed across participants regardless of therapy, participants varied in their assessments of whether increased awareness of the need for ongoing self-care and maintenance strategies was considered a “positive outcome”. Regardless of how participants evaluated the outcome of treatment, participants from all four therapies reported increased awareness, acceptance of the chronic nature of pain, and attention to the need to take responsibility for their own health.

There are more articles like this @ our:

Alternative Medicine Articles Section and the:

Chiropractic and Spinal Pain Page

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Provider and Patient Perspectives on Opioids and Alternative Treatments for Managing Chronic Pain

By |April 15, 2017|Acupuncture, Complementary and Alternative Medicine|

Provider and Patient Perspectives on Opioids and Alternative Treatments for Managing Chronic Pain:
A Qualitative Study

The Chiro.Org Blog


SOURCE:   BMC Fam Pract. 2017 (Mar 24); 17 (1): 164

Lauren S. Penney, Cheryl Ritenbaugh, Lynn L. DeBar,
Charles Elder and Richard A. Deyo

South Texas Veterans Health Care System,
7400 Merton Minter Blvd,
San Antonio, TX, 78229, USA


BACKGROUND:   Current literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. The objective of this study was to identify the practical issues patients and providers face when accessing alternatives to opioids, and how multiple parties view these issues.

METHODS:   Qualitative data were gathered to evaluate the outcomes of acupuncture and chiropractic (A/C) services for chronic musculoskeletal pain (CMP) using structured interview guides among patients with CMP (n = 90) and primary care (medical) providers (PCPs) (n = 25) purposively sampled from a managed care health care system as well as from contracted community A/C providers (n = 14). Focus groups and interviews were conducted patients with CMP with varying histories of A/C use. Plan PCPs and contracted A/C providers took part in individual interviews. All participants were asked about their experiences managing chronic pain and experience with and/or attitudes about A/C treatment. Audio recordings were transcribed and thematically coded. A summarized version of the focus group/interview guides is included in the Additional file 1.

RESULTS:   We identified four themes around opioid use:

(1)   attitudes toward use of opioids to manage chronic pain;
(2)   the limited alternative options for chronic pain management;
(3)   the potential of A/C care as a tool to help manage pain; and
(4)   the complex system around chronic pain management.

Despite widespread dissatisfaction with opioid medications for pain management, many practical barriers challenged access to other options. Most of the participants’ perceived acupuncture and chiropractic (A/C) care as helpful for short term pain relief. We identified that problems with timing, expectations, and plan coverage limited A/C care potential for pain relief treatment.

There are more articles like this @ our:

Acupuncture Section

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Characteristics of Chiropractic Practitioners, Patients, and Encounters in Massachusetts and Arizona

By |April 13, 2017|Chiropractic Care|

Characteristics of Chiropractic Practitioners, Patients, and Encounters in Massachusetts and Arizona

The Chiro.Org Blog


J Manipulative Physiol Ther. 2005 (Nov); 28 (9): 645–653

Robert D. Mootz, DC, Daniel C. Cherkin, PhD,
Carson E. Odegard, DC, MPH, David M. Eisenberg, MD,
James P. Barassi, DC, Richard A. Deyo, MD, MPH

State of Washington,
Department of Labor and Industries,
Olympia 98504-4321, USA


OBJECTIVE:   To describe chiropractic care using data collected at the time of each patient visit.

METHODS:   Random samples of chiropractors licensed in Arizona and Massachusetts were recruited to participate in interviews about their training, demographics, and practice characteristics. Interviewees were then recruited to record information about patient condition, evaluation, care, and visit disposition on 20 consecutive patient visits.

RESULTS:   Data for 2,550 chiropractic patient visits were recorded. Care for low back, head and neck pain accounted for almost three quarters of visits. Extremity conditions and wellness care accounted for approximately half of the remaining visits. Spinal and soft tissue examinations were the most frequently reported diagnostic procedures (80% and 56% of visits, respectively), and high-velocity spinal manipulation techniques were the most frequently reported therapeutic procedures (almost 85% of visits). Rehabilitation exercises, thermal modalities, electric stimulation, and counseling/education/self-care were each performed during approximately 25% of visits. Approximately 85% of patients seen were self-referred, whereas only approximately 5% came from medical physicians. Approximately 35% of visits had an expected source of payment directly from the patient. Approximately 80% of visits ended with a plan for the patient to return at a specified time.

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Do Older Adults with Chronic Low Back Pain Differ from Younger Adults in Regards to Baseline Characteristics and Prognosis?

By |April 11, 2017|Chiropractic Care, Low Back Pain|

Do Older Adults with Chronic Low Back Pain Differ from Younger Adults in Regards to Baseline Characteristics and Prognosis?

The Chiro.Org Blog


SOURCE:   Eur J Pain. 2017 (Mar 14) [Epub]

Manogharan S, Kongsted A, Ferreira ML, Hancock MJ.

Faculty of Medicine and Health Science,
Macquarie University,
Sydney, NSW, Australia


BACKGROUND:   Low back pain (LBP) in older adults is poorly understood because the vast majority of the LBP research has focused on the working aged population. The aim of this study was to compare older adults consulting with chronic LBP to middle aged and young adults consulting with chronic LBP, in terms of their baseline characteristics, and pain and disability outcomes over 1 year.

METHODS:   Data were systematically collected as part of routine care in a secondary care spine clinic. At initial presentation patients answered a self-report questionnaire and underwent a physical examination. Patients older than 65 were classified as older adults and compared to middle aged (45-65 years old) and younger adults (17-44 years old) for 10 baseline characteristics. Pain intensity and disability were collected at 6 and 12 month follow-ups and compared between age groups.

RESULTS:   A total of 14,479 participants were included in the study. Of these 3,087 (21%) patients were older adults, 6,071 (42%) were middle aged and 5,321 (37%) were young adults. At presentation older adults were statistically different to the middle aged and younger adults for most characteristics measured (e.g. less intense back pain, more leg pain and more depression); however, the differences were small. The change in pain and disability over 12 months did not differ between age groups.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

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