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Monthly Archives: October 2017

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Regular Use of Medication for Musculoskeletal Pain and Risk of Long-term Sickness Absence

By |October 31, 2017|Chiropractic Care, Chronic Pain|

Regular Use of Medication for Musculoskeletal Pain and Risk of Long-term Sickness Absence: A Prospective Cohort Study Among the General Working Population

The Chiro.Org Blog


SOURCE:   Eur J Pain. 2017 (Feb); 21 (2): 366–373

E. Sundstrup, M.D. Jakobsen, S.V. Thorsen, L.L. Andersen

National Research Centre for the Working Environment,
Copenhagen, Denmark.

Physical Activity and Human Performance group, SMI,
Department of Health Science and Technology,
Aalborg University, Denmark.


BACKGROUND:   The aim was to determine the prospective association between use of pain medication – due to musculoskeletal pain in the low back, neck/shoulder and hand/wrist – and long-term sickness absence.

METHODS:   Cox-regression analysis was performed to estimate the prospective association between regular use of pain medication and long-term sickness absence (LTSA; at least 6 consecutive weeks) among 9,544 employees from the general working population (Danish Work Environment Cohort Study 2010) and free from LTSA during 2009-2010. The fully adjusted model was controlled for age, gender, body mass index, smoking, leisure physical activity, job group, physical activity at work, psychosocial work environment, pain intensity, mental health and chronic disease.

There are more articles like this @ our:

Chiropractic and Pain Management Page

and the:

Prescription Rights and Expanded Practice Page

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Use of Integrative Medicine in the
United States Military Health System

By |October 29, 2017|Chiropractic Care, Integrative Medicine|

Use of Integrative Medicine in the
United States Military Health System

The Chiro.Org Blog


SOURCE:   Evid Based Comp Alternat Med. 2017 (Jun 13)

Cathaleen Madsen, Megan Vaughan, and
Tracey Pérez Koehlmoos

Uniformed Services University of the Health Sciences,
Bethesda, MD, USA.


Integrative medicine (IM) is a model of care which uses both conventional and nonconventional therapies in a “whole person” approach to achieve optimum mental, physical, emotional, spiritual, and environmental health, and is increasingly popular among patients and providers seeking to relieve chronic or multifactorial conditions. The US Department of Defense (DoD) shows particular interest in and usage of IM for managing chronic conditions including the signature “polytrauma triad” of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD) among its beneficiaries in the Military Health System (MHS).

These modalities range from conventional nondrug, nonsurgical options such as cognitive-behavioral therapy to nonconventional options such as acupuncture, chiropractic, and mind-body techniques. These are of particular interest for their potential to relieve symptoms without relying on opiates, which impair performance and show high potential for abuse while often failing to provide full relief.

This review describes the use of IM in the MHS, including definitions of the model, common therapies and potential for use, and controversy surrounding the practice. More research is needed to build a comprehensive usage analysis, which in turn will inform sound clinical and financial practice for the MHS and its beneficiaries.


From the FULL TEXT Article:

Introduction

Integrative medicine (IM) is a current healthcare paradigm which promotes a “whole person” approach to health through coordinated use of appropriate therapies originating both inside and outside of conventional medicine. Though often conflated with complementary and alternative medicine (CAM), changes in the definition of these terms make this conflation technically inaccurate.

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Chiropractic Care For Veterans Page

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

By |October 28, 2017|Chronic Low Back Pain, Chronic Neck Pain, Chronic Pain|

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 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 acupuncture and chiropractic (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 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:

Chiropractic and Spinal Pain Management

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Feeling Stiffness in the Back

By |October 25, 2017|Low Back Pain|

Feeling Stiffness in the Back: A Protective Perceptual Inference in Chronic Back Pain

The Chiro.Org Blog


SOURCE:   Sci Rep. 2017 (Aug 29);   7 (1):   9681

Tasha R. Stanton, G. Lorimer Moseley,
Arnold Y. L. Wong & Gregory N. Kawchuk

The Sansom Institute for Health Research,
School of Health Sciences & Pain Adelaide Consortium,
The University of South Australia,
Adelaide, SA, Australia.


Does feeling back stiffness actually reflect having a stiff back? This research interrogates the long-held question of what informs our subjective experiences of bodily state. We propose a new hypothesis: feelings of back stiffness are a protective perceptual construct, rather than reflecting biomechanical properties of the back.

This has far-reaching implications for treatment of pain/stiffness but also for our understanding of bodily feelings. Over three experiments, we challenge the prevailing view by showing that feeling stiff does not relate to objective spinal measures of stiffness and objective back stiffness does not differ between those who report feeling stiff and those who do not. Rather, those who report feeling stiff exhibit self-protective responses: they significantly overestimate force applied to their spine, yet are better at detecting changes in this force than those who do not report feeling stiff.

This perceptual error can be manipulated: providing auditory input in synchrony to forces applied to the spine modulates prediction accuracy in both groups, without altering actual stiffness, demonstrating that feeling stiff is a multisensory perceptual inference consistent with protection. Together, this presents a compelling argument against the prevailing view that feeling stiff is an isomorphic marker of the biomechanical characteristics of the back.


From the FULL TEXT Article:

Introduction

Bodily feelings constitute a fundamental aspect of self-awareness and provide critical homeostatic functions – e.g., feeling cold makes one seek warmth [1]; feeling pain makes one seek protection [2]; feeling parched makes one drink. [3] We assume that these bodily feelings reflect the biological state of our body tissues – a ‘read-out’, so to speak, of somatosensory and visceral input – particularly when the feeling is located somewhere in the body, as it is for pain or stiffness. There is growing evidence for pain however, that it is highly modulated by a wide range of cognitive and contextual variables. [4, 5] For example, visually manipulating the perceived size of one’s hand alters the pain experienced in experimental contexts [6] and during movement of a chronically painful limb [7], and illuminating a blue or red light in synchrony with delivering a noxious cold stimulus can transform the feeling evoked from uncomfortably cold to painfully hot. [5]

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Low Back Pain and Chiropractic Page

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Tissue Loading Created During Spinal Manipulation in Comparison to Loading Created by Passive Spinal Movements

By |October 24, 2017|Adverse Events, Disc Derangement|

Tissue Loading Created During Spinal Manipulation in Comparison to Loading Created by Passive Spinal Movements

The Chiro.Org Blog


SOURCE:   Sci Rep. 2016 (Dec 1);   6:   38107

Martha Funabashi, Gregory N. Kawchuk, Albert H. Vette,
Peter Goldsmith, and Narasimha Prasad

Department of Physical Therapy,
University of Alberta,
Edmonton, AB, Canada


Spinal manipulative therapy (SMT) creates health benefits for some while for others, no benefit or even adverse events. Understanding these differential responses is important to optimize patient care and safety. Toward this, characterizing how loads created by SMT relate to those created by typical motions is fundamental. Using robotic testing, it is now possible to make these comparisons to determine if SMT generates unique loading scenarios. In 12 porcine cadavers, SMT and passive motions were applied to the L3/L4 segment and the resulting kinematics tracked. The L3/L4 segment was removed, mounted in a parallel robot and kinematics of SMT and passive movements replayed robotically. The resulting forces experienced by L3/L4 were collected. Overall, SMT created both significantly greater and smaller loads compared to passive motions, with SMT generating greater anterioposterior peak force (the direction of force application) compared to all passive motions. In some comparisons, SMT did not create significantly different loads in the intact specimen, but did so in specific spinal tissues. Despite methodological differences between studies, SMT forces and loading rates fell below published injury values. Future studies are warranted to understand if loading scenarios unique to SMT confer its differential therapeutic effects.


From the FULL TEXT Article:

Introduction

Spinal manipulative therapy (SMT) is a clinical intervention for low back pain which, by some estimates, is the most frequently used form of complementary and alternative medicine (CAM). [1] Similarly, SMT is also one of the most studied CAM interventions with over 250 systematic reviews and 550 randomized controlled trials since 2000.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

and the:

Disc Herniation and Chiropractic Page

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