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Monthly Archives: September 2017


What Techniques Might Be Used to Harness Placebo Effects in Non-malignant pain?

By |September 30, 2017|Placebo|

What Techniques Might Be Used to Harness Placebo Effects in Non-malignant pain? A Literature Review and Survey to Develop a Taxonomy

The Chiro.Org Blog


Felicity L Bishop, Beverly Coghlan, Adam WA Geraghty,
Hazel Everitt, Paul Little, Michelle M Holmes,
Dionysis Seretis, George Lewith

Department of Psychology,
Faculty of Social Human and Mathematical Sciences,
University of Southampton,
Southampton, UK.

OBJECTIVES:   Placebo effects can be clinically meaningful but are seldom fully exploited in clinical practice. This review aimed to facilitate translational research by producing a taxonomy of techniques that could augment placebo analgesia in clinical practice.

DESIGN:   Literature review and survey.

METHODS:   We systematically analysed methods which could plausibly be used to elicit placebo effects in 169 clinical and laboratory-based studies involving non-malignant pain, drawn from seven systematic reviews. In a validation exercise, we surveyed 33 leading placebo researchers (mean 12 years’ research experience, SD 9.8), who were asked to comment on and add to the draft taxonomy derived from the literature.

RESULTS:   The final taxonomy defines 30 procedures that may contribute to placebo effects in clinical and experimental research, proposes 60 possible clinical applications and classifies procedures into five domains: the patient’s characteristics and belief (5 procedures and 11 clinical applications), the practitioner’s characteristics and beliefs (2 procedures and 4 clinical applications), the healthcare setting (8 procedures and 13 clinical applications), treatment characteristics (8 procedures and 14 clinical applications) and the patient—practitioner interaction (7 procedures and 18 clinical applications).

There are more articles like this @ our:

The Problem with Placebos/Shams Page


A Typical Week at the St. Louis VA Medical Center

By |September 21, 2017|Veterans|

A Typical Week at the St. Louis VA Medical Center

The Chiro.Org Blog

SOURCE:   ACA Blog ~ 9–19–2017

By Steven Huybrecht, DC

VA St. Louis Healthcare System

I’ve had more than a handful of family and friends ask me, “What’s it like working for the VA in St Louis?” and my response is always the same—“It’s great!” I usually then proceed to give them a rundown of what a typical week looks like as my activities vary from day to day and sometimes from month to month.

An average week is broken down into four different segments:

outpatient clinic,
interdisciplinary pain rehabilitation (IPR) program,
scholarly activities, and
clinical rotations.

The majority of my time is spent in clinic helping veterans manage their pain and develop healthy habits for self-care. However, the time spent outside the clinic has also been beneficial for personal development and education.

On Mondays, Wednesdays and Fridays, I provide chiropractic care in the pain clinic during our normal hours of 8 a.m.- 4 p.m. along with the program director Dr. Pamela Wakefield and attending chiropractor Dr. Glenn Bub. I usually see anywhere from six to eight veterans on an average day, some more clinically complex than others. We have a (relatively) small workspace, but are very busy and have a full schedule on almost every clinic day.

This time is the “bread and butter” of my week where I’m working with veterans who not only have pain issues, but also often have multiple comorbidities. I spent over two years in private practice before starting at the St. Louis VA Healthcare System and have already seen more complexity in my patient population in the first two months of my residency than I saw in those previous two years.

On Tuesdays, in addition to treating veterans I have some scholarly time. One of the recent projects I participated in with two other residents, Nicholas Evertz from Canandaigua, N.Y. and Rachel Mooers from Los Angeles, Calif., was to create a presentation of evidence-based spinal examination procedures. After scouring the literature and cultivating sources, the best tests for diagnosing spinal-related complaints were established. This taught us not only how to critically appraise research, but also how to work together from different sites across the United States.

There are more articles like this @ our:

Chiropractic Care For Veterans Page


Chiropractic Spinal Manipulation and the Risk for Acute Lumbar Disc Herniation

By |September 19, 2017|Disc Derangement, Disc Injury|

Chiropractic Spinal Manipulation and the Risk for Acute Lumbar Disc Herniation: A Belief Elicitation Study

The Chiro.Org Blog

SOURCE:   European Spine Journal 2017 (Sep 18)

Cesar A. Hincapie, J. David Cassidy,
Pierre Côté, Raja Rampersaud
Alejandro R. Jadad, George A. Tomlinson

Injury Prevention Research Office, Division of Neurosurgery,
Li Ka Shing Knowledge Institute, St. Michael’s Hospital,
Toronto, Canada

Background   Chiropractic spinal manipulation treatment (SMT) is common for back pain and has been reported to increase the risk for lumbar disc herniation (LDH), but there is no high quality evidence about this. In the absence of good evidence, clinicians can have knowledge and beliefs about the risk. Our purpose was to determine clinicians’ beliefs regarding the risk for acute LDH associated with chiropractic SMT.

Methods   Using a belief elicitation design, 47 clinicians (16 chiropractors, 15 family physicians and 16 spine surgeons) that treat patients with back pain from primary and tertiary care practices were interviewed. Participants’ elicited incidence estimates of acute LDH among a hypothetical group of patients with acute low back pain treated with and without chiropractic SMT, were used to derive the probability distribution for the relative risk (RR) for acute LDH associated with chiropractic SMT.

Results   Chiropractors expressed the most optimistic belief (median RR 0.56; IQR 0.39–1.03); family physicians expressed a neutral belief (median RR 0.97; IQR 0.64–1.21); and spine surgeons expressed a slightly more pessimistic belief (median RR 1.07; IQR 0.95–1.29). Clinicians with the most optimistic views believed that chiropractic SMT reduces the incidence of acute LDH by about 60% (median RR 0.42; IQR 0.29–0.53). Those with the most pessimistic views believed that chiropractic SMT increases the incidence of acute LDH by about 30% (median RR 1.29; IQR 1.11–1.59).

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

and the:

Disc Herniation and Chiropractic Page


Founder’s Day:   Chiropractic Turns 122 Today

By |September 18, 2017|Uncategorized|

Founder’s Day:   Chiropractic Turns 122 Today

The Chiro.Org Blog

Harvey Lillard (L)               D.D. Palmer (R)

The Story of Chiropractic

The year was 1895, the same year that x-rays were discovered. At that time, Health Care was provided by a diverse group of unregulated and unlicensed professions, including osteopaths, magnetic healers, and “medical” doctors.   In those days, most medical education consisted of working as an “apprentice” for a medical doctor, and learning the craft by observation.

D.D. Palmer, the Father of Chiropractic, was a magnetic healer,
with a huge practice in Davenport, Iowa.   He had doubts about the
“germ theory” as the complete explanation for the cause of all disease.

After all, if germs kill… shouldn’t we all be dead?   He asked himself:

how it was that 2 brothers could work in the same shop, eat the same food, sleep in the same bed, and that one would succumb to a disease while the other one would not”?

His theory evolved that it was not just the “seed” (or germ) which was the sole cause of dis-ease.   He felt that the “soil”, or the recuperative power of the body (which he later referred to as “innate intelligence”, and we now call homeostasis) was the missing component of the equation, which defines the continuum between health and “dis-ease”.

One day D.D. was talking with Harvey Lillard, the man who owned the janitor service in his building.   Harvey was deaf.   He mentioned to D.D. that years before, while lifting a heavy weight, he felt something “snap” at the base of his neck.   Shortly thereafter his hearing started to fade.

D.D. was intrigued, and asked Harvey if he could have permission examine his back.   What D.D. “felt” (we refer to this art as “palpation) was that one of the upper thoracic bones was sticking out much more than the one above or below it.   He explained to Harvey that he felt that this “bone out of place
could be causing pressure on his spinal cord, and that this could be the
reason that Harvey was now deaf.


A Structured Protocol of Evidence-based Conservative Care Compared with Usual Care for Acute Nonspecific Low Back Pain

By |September 16, 2017|Chiropractic Research, Randomized Controlled Trial|

A Structured Protocol of Evidence-based Conservative Care Compared with Usual Care for Acute Nonspecific Low Back Pain: A Randomized Clinical Trial

The Chiro.Org Blog

SOURCE:   Arch Phys Med Rehabil. 2012 (Jan); 93 (1): 11–20

Gregory F. Parkin-Smith, MTech(Chiro), MSc, DrHC,
Ian J. Norman, BSc, MSc, PhD,
Emma Briggs, BSc, PhD, RN,
Elizabeth Angier, BSc, MSc(Chiro),
Timothy G. Wood, BSc, MTech(Chiro),
James W. Brantingham, DC, PhD

School of Chiropractic & Sports Science,
Murdoch University,
Perth, Australia.

OBJECTIVE:   To compare a protocol of evidence-based conservative care with usual care for acute nonspecific low back pain (LBP) of less than 6 weeks’ duration.

DESIGN:   Parallel-group randomized trial.

SETTING:   Three practices in the United Kingdom.

PARTICIPANTS:   Convenience sample of 149 eligible patients were invited to participate in the study, with 118 volunteers being consented and randomly allocated to a treatment group.

INTERVENTIONS:   The experimental group received evidence-based treatments for acute nonspecific LBP as prescribed in a structured protocol of care developed for this study. The control group received usual conservative care. Participants in both groups could receive up to 7 treatments over a 4-week period.

MAIN OUTCOME MEASURES:   Oswestry Low Back Disability Index (ODI), visual analog scale (VAS), and Patient Satisfaction Questionnaire, alongside estimation of clinically meaningful outcomes.

RESULTS:   Total dropout rate was 14% (n=16), with 13% of data missing. Missing data were replaced using a multiple imputation method. Participants in both groups received an average of 6 treatments. There was no statistically significant difference in disability (ODI) scores at the end of week 4 (P=.33), but there was for pain (VAS) scores (P< .001). Interestingly, there were statistically significant differences between the 2 groups for both disability and pain measures at the midpoint of the treatment period (P<.001). Patient satisfaction with care was equally high (85%) in both groups. Minimally clinically important differences in scores and number needed to treat scores (NNT<6) indicated that the experimental treatment (protocol of care) offered a clinically meaningful benefit over the control treatment (usual care), particularly at the midpoint of the treatment period.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page


Recommendations to the Musculoskeletal Health Network

By |September 14, 2017|Chiropractic Care, Spinal Pain|

Recommendations to the Musculoskeletal Health Network, Health Department of Western Australia related to the Spinal Pain Model of Care made on behalf of the Chiropractors Association of Australia (Western Australian Branch)

The Chiro.Org Blog

SOURCE:   Topics in Integrative Health Care 2014 (Jun 30); 5 (2)

Lyndon G. Amorin-Woods, BAppSci(Chiropractic),
Gregory F. Parkin-Smith, MTech(Chiro), MBBS, MSc, DrHC,
Vern Saboe, DC, DACAN, FACO,
Anthony L. Rosner, Ph.D., LL.D.[Hon.], LLC

The 2009 Spinal Model of Care published by the Western Australian Health Department via the Musculoskeletal Health Network would benefit from an update. Best-evidence synthesis and cost-risks-benefits estimations suggest that such guidelines should provide:

(1)   the early assessment of patients with non-malignant spinal pain (particularly low back) by a musculoskeletal clinician, be it a chiropractor, musculoskeletal physician, osteopath or musculoskeletal physiotherapist with referral within the early stages of the disorder; and

(2)   the provision of manipulative therapy, where indicated, as a first-line treatment while also providing rehabilitation, health promotion, and contemporary wellness/wellbeing management with the intention of avoiding chronicity.

Emerging workforce capacity suggests that early assessment and evidence-based management of non-malignant spinal pain is feasible, leading to better patient outcomes. The authors and the association are hopeful that providing this submission in open access may prove useful for advocates of the chiropractic profession in other jurisdictions.

From the FULL TEXT Article:


The importance of addressing spinal pain in the Australian community in a cost effective and clinically appropriate manner is illustrated in a series of studies emerging from the Global Burden of Disease 2010 Project. [1] It is well-known that musculoskeletal conditions, such as low back pain, neck pain and arthritis, affect more than 1.7 billion people worldwide and are set to become more prevalent with a growing, ageing, developed world population. [2] Australian chiropractors may occupy a pivotal role in the cost effective management of these clinical presentations.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

and the:

Chiropractic and Spinal Pain Management