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Is EBM Damaging the Social Conscience of Chiropractic?

Commentary: Is EBM Damaging the Social Conscience of Chiropractic?

The Chiro.Org Blog


SOURCE:   Chiropractic J Australia 2016 (Dec); 44 (3): 203–213

Phillip Stuart Ebrall, BAppSc(Chiropr), GradCert (Learn&Teach), PhD

Senior Education Advisor,
Tokyo College of Chiropractic;
Faculty of Medicine,
International Medical University,
Kuala Lumpur


Introduction:   One expression of the social conscience of chiropractic is the provision by chiropractic educational institutions of low-cost or free chiropractic care to disadvantaged communities. It is expected that institutions offer to all patients the same full standard of care that is the hallmark of traditional chiropractic.

Objective:   To explore whether an observed schism occurring within chiropractic education, where a minority of institutions are minimising the major premise of the discipline and replacing it with an emphasis on only the science or literature component of the evidence-based triad, has any potential impact on the quality of care provided particularly within the charitable context.

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Clinical Practice Guidelines for the Noninvasive Management
of Low Back Pain

Clinical Practice Guidelines for the Noninvasive Management of Low Back Pain: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

The Chiro.Org Blog


SOURCE:   Eur J Pain. 2016 (Oct 6).   doi: 10.1002/ejp.931

J.J. Wong, P. Côté, D.A. Sutton, K. Randhawa, H.
Yu, S. Varatharajan, R. Goldgrub, M. Nordin, D.P.

UOIT-CMCC Centre for the Study of
Disability Prevention and Rehabilitation,
University of Ontario Institute of Technology (UOIT)
Canadian Memorial Chiropractic College (CMCC),
Oshawa, ON, Canada.


BACKGROUND: &nbsp Low back pain (LBP) is a major health problem, having a substantial effect on peoples’ quality of life and placing a significant economic burden on healthcare systems and, more broadly, societies. Many interventions to alleviate LBP are available but their cost effectiveness is unclear.

We conducted a systematic review of guidelines on the management of low back pain (LBP) to assess their methodological quality and guide care. We synthesized guidelines on the management of LBP published from 2005 to 2014 following best evidence synthesis principles. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, DARE, National Health Services Economic Evaluation Database, Health Technology Assessment Database, Index to Chiropractic Literature and grey literature. Independent reviewers critically appraised eligible guidelines using AGREE II criteria. We screened 2504 citations; 13 guidelines were eligible for critical appraisal, and 10 had a low risk of bias.

According to high-quality guidelines:

(1) all patients with acute or chronic LBP should receive education, reassurance and instruction on self-management options;

(2) patients with acute LBP should be encouraged to return to activity and may benefit from paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), or spinal manipulation;

(3) the management of chronic LBP may include exercise, paracetamol or NSAIDs, manual therapy, acupuncture, and multimodal rehabilitation (combined physical and psychological treatment); and

(4) patients with lumbar disc herniation with radiculopathy may benefit from spinal manipulation.

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of Low Back Pain

Genetic Risk, Adherence to a Healthy Lifestyle,
and Coronary Disease

Genetic Risk, Adherence to a Healthy Lifestyle,
and Coronary Disease

The Chiro.Org Blog


SOURCE:   N Engl J Med 2016 (Nov 13);   [Epub]

Amit V. Khera, M.D., Connor A. Emdin, D.Phil.,
Isabel Drake, Ph.D., et. al.

Center for Human Genetics Research,
Massachusetts General Hospital,
185 Cambridge St., CPZN 5.252,
Boston, MA 02114


BACKGROUND   Both genetic and lifestyle factors contribute to individual-level risk of coronary artery disease. The extent to which increased genetic risk can be offset by a healthy lifestyle is unknown.

METHODS   Using a polygenic score of DNA sequence polymorphisms, we quantified genetic risk for coronary artery disease in three prospective cohorts — 7,814 participants in the Atherosclerosis Risk in Communities (ARIC) study, 21,222 in the Women’s Genome Health Study (WGHS), and 22,389 in the Malmö Diet and Cancer Study (MDCS) — and in 4,260 participants in the cross-sectional BioImage Study for whom genotype and covariate data were available. We also determined adherence to a healthy lifestyle among the participants using a scoring system consisting of four factors: no current smoking, no obesity, regular physical activity, and a healthy diet.

RESULTS   The relative risk of incident coronary events was 91% higher among participants at high genetic risk (top quintile of polygenic scores) than among those at low genetic risk (bottom quintile of polygenic scores) (hazard ratio, 1.91; 95% confidence interval [CI], 1.75 to 2.09). A favorable lifestyle (defined as at least three of the four healthy lifestyle factors) was associated with a substantially lower risk of coronary events than an unfavorable lifestyle (defined as no or only one healthy lifestyle factor), regardless of the genetic risk category. Among participants at high genetic risk, a favorable lifestyle was associated with a 46% lower relative risk of coronary events than an unfavorable lifestyle (hazard ratio, 0.54; 95% CI, 0.47 to 0.63). This finding corresponded to a reduction in the standardized 10-year incidence of coronary events from 10.7% for an unfavorable lifestyle to 5.1% for a favorable lifestyle in ARIC, from 4.6% to 2.0% in WGHS, and from 8.2% to 5.3% in MDCS. In the BioImage Study, a favorable lifestyle was associated with significantly less coronary-artery calcification within each genetic risk category.

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The Nutrition Page

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and Coronary Disease

Conservative Management of Uncomplicated
Mechanical Neck Pain in a Military Aviator

Conservative Management of Uncomplicated Mechanical Neck Pain in a Military Aviator

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2010 (Jun); 54 (2): 92–99

Bart N. Green, DC, MSEd, Andrew S. Dunn, DC, MEd, MS,
LCDR Solomon M. Pearce, DO, and
Claire D. Johnson, DC, MSEd

Chiropractic Division,
Department of Physical and Occupational Therapy,
Naval Medical Center, San Diego,
Marine Corps Air Station Miramar,
Branch Medical Clinic,
San Diego, CA 92145-2002


Non-radicular neck pain arising from local musculoskeletal structures, known as mechanical neck pain or somatic dysfunction, is highly prevalent in the fighter jet aviator population. The management of this problem includes both therapeutic and aeromedical decisions. In addition to non-steroidal anti-inflammatory medications, waiver guides recommend therapeutic exercise and manipulative therapy as treatments for somatic spine pain in aviators, and such treatments are employed in many military locations. However, there are currently no published studies that describe the use of manipulative therapy for fighter jet aviators. We report the case of an F/A-18 instructor pilot who experienced long-term relief of uncomplicated mechanical neck pain following interdisciplinary management that included manipulation and a home exercise program. Diagnostic considerations, conservative treatment options, and aeromedical concerns are discussed.

KEYWORDS:   aviation; exercise therapy; manipulation; manual therapy; neck pain; spinal


The Full-Text Article:

Introduction

Fighter jet aviators are exposed to large tensile, axial compression, and shear forces when flying, especially during aerial combat maneuvers (ACM). [1] Non-radicular neck pain arising from mechanical structures in the neck (somatic pain) is a common outcome of exposure to high gravitational (G) forces. [2] The weight of the helmet and oxygen mask and the various non-neutral head postures assumed when observing for enemy aircraft contribute to this problem. [1] Spinal disorders can result in disability [3] and conditions that may disqualify pilots from flight duties. [4] Thus, neck pain in the fighter jet aviator population has a negative impact on work performance, productivity, and is a threat to combat readiness. [5]

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Chiropractic Care For Veterans Page

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Mechanical Neck Pain in a Military Aviator

The Effect of Chiropractic Treatment on the Reaction and Response Times of Special Operation Forces Military Personnel

The Effect of Chiropractic Treatment on the Reaction and Response Times of Special Operation Forces Military Personnel: Study Protocol for a Randomized Controlled Trial

The Chiro.Org Blog


SOURCE:   Trials. 2016 (Sep 20); 17 (1): 457

James W. DeVocht, Dean L. Smith, Cynthia R. Long,
Lance Corber, Bridget Kane, Thomas M. Jones and
Christine M. Goertz

Palmer Center for Chiropractic Research,
741 Brady St,
Davenport, IA, 52803, USA.


BACKGROUND:   Chiropractic care is commonly used to treat musculoskeletal conditions and has been endorsed by clinical practice guidelines as being evidence-based and cost-effective for the treatment of patients with low back pain. Gaps in the literature exist regarding the physiological outcomes of chiropractic treatment. Previous pilot work has indicated the possibility of improvements in response time following the application of chiropractic treatment. However, it is unknown whether or not chiropractic treatment is able to improve reaction and response times in specific populations of interest. One such population is the U.S. military special operation forces’ (SOF) personnel.

METHODS:   This study is a randomized controlled trial of 120 asymptomatic volunteer SOF personnel. All participants are examined by a study doctor of chiropractic (DC) for eligibility prior to randomization. The participants are randomly allocated to either a treatment group receiving four treatments of chiropractic manipulative therapy (CMT) over 2 weeks or to a wait-list control group. The wait-list group does not receive any treatment but has assessments at the same time interval as the treatment group. The outcome measures are simple reaction times for dominant hand and dominant foot, choice reaction time with prompts calling for either hand or either foot, response time using Fitts’ law tasks for small movements involving eye-hand coordination, and brief whole body movements using the t-wall, a commercially available product. At the first visit, all five tests are completed so that participants can familiarize themselves with the equipment and protocol. Assessments at the second and the final visits are used for data analysis.

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Does Cervical Spine Manipulation Reduce Pain
in People with Degenerative Cervical Radiculopathy?

Does Cervical Spine Manipulation Reduce Pain in People with Degenerative Cervical Radiculopathy? A Systematic Review of the Evidence, and a Meta-analysis

The Chiro.Org Blog


SOURCE:   Clin Rehabil. 2016 (Feb); 30 (2): 145-155

Liguo Zhu, Xu Wei and Shangquan Wang

Department of Spine,
Wangjing Hospital,
Beijing, People’s Republic of China.


OBJECTIVE:   To access the effectiveness and safety of cervical spine manipulation for cervical radiculopathy.

DATA SOURCES:   PubMed, the Cochrane Central Registry of Controlled Trials (CENTRAL) in the Cochrane Library, EMBASE, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Wanfang data, the website of Chinese clinical trial registry and international clinical trial registry by US National Institutes of Health.

REVIEW METHODS:   Randomized controlled trials that investigated the effects of cervical manipulation compared with no treatment, placebo or conventional therapies on pain measurement in patients with degenerative cervical radiculopathy were searched. Two authors independently evaluated the quality of the trials according to the risk of bias assessment provided by the PEDro (physiotherapy evidence database) scale. RevMan V.5.2.0 software was employed for data analysis. The GRADE approach was used to evaluate the overall quality of the evidence.

RESULTS:   Three trials with 502 participants were included. Meta-analysis suggested that cervical spine manipulation (mean difference 1.28, 95% confidence interval 0.80 to 1.75; P < 0.00001; heterogeneity: Chi2 = 8.57, P = 0.01, I2 = 77%) improving visual analogue scale for pain showed superior immediate effects compared with cervical computer traction. The overall strength of evidence was judged to be moderate quality. One out of three trials reported the adverse events and none with a small sample size.

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Radiculopathy and Chiropractic Page

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in People with Degenerative Cervical Radiculopathy?

The Chiropractic Scope of Practice in the United States

The Chiropractic Scope of Practice in the United States: A Cross-sectional Survey

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2014 (Jul); 37 (6): 363–376

Mabel Chang, DC, MPH

National University of Health Sciences-Florida,
Pinellas Park, FL.


OBJECTIVE:   The purpose of this study was to assess the current status of chiropractic practice laws in the United States. This survey is an update and expansion of 3 original surveys conducted in 1987, 1992, and 1998.

METHODS:   A cross-sectional survey of licensure officials from the Federation of Chiropractic Licensing Boards e-mail list was conducted in 2011 requesting information about chiropractic practice laws and 97 diagnostic, evaluation, and management procedures. To evaluate content validity, the survey was distributed in draft form at the fall 2010 Federation of Chiropractic Licensing Boards regional meeting to regulatory board members and feedback was requested. Comments were reviewed and incorporated into the final survey. A duplicate question was imbedded in the survey to test reliability.

RESULTS:   Partial or complete responses were received from 96% (n = 51) of the jurisdictions in the United States. The states with the highest number of services that could be performed were Missouri (n = 92), New Mexico (n = 91), Kansas (n = 89), Utah (n = 89), Oklahoma (n = 88), Illinois (n = 87), and Alabama (n = 86). The states with the highest number of services that cannot be performed are New Hampshire (n = 49), Hawaii (n = 47), Michigan (n = 42), New Jersey (n = 39), Mississippi (n = 39), and Texas (n = 30).

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Chiropractors Are Spinal Health Care Experts Page

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Cost Analysis Related to Dose-response of Spinal Manipulative Therapy for Chronic Low Back Pain

Cost Analysis Related to Dose-response of Spinal Manipulative Therapy for Chronic Low Back Pain: Outcomes from a Randomized Controlled Trial

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2014 (Jun); 37 (5): 300–311

Darcy A. Vavrek, ND, MS, Rajiv Sharma, PhD,
Mitchell Haas, DC, MA

University of Western States,
Portland, OR.


OBJECTIVE:   The purpose of this analysis is to report the incremental costs and benefits of different doses of spinal manipulative therapy (SMT) in patients with chronic low back pain (LBP).

METHODS:   We randomized 400 patients with chronic LBP to receive a dose of 0, 6, 12, or 18 sessions of SMT. Participants were scheduled for 18 visits for 6 weeks and received SMT or light massage control from a doctor of chiropractic. Societal costs in the year after study enrollment were estimated using patient reports of health care use and lost productivity. The main health outcomes were the number of pain-free days and disability-free days. Multiple regression was performed on outcomes and log-transformed cost data.

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Low Back Pain and Chiropractic Page

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Cost-Effectiveness of Chiropractic Page

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Cost-effectiveness of Spinal Manipulative Therapy, Supervised Exercise, and Home Exercise for Older Adults with Chronic Neck Pain

Cost-effectiveness of Spinal Manipulative Therapy, Supervised Exercise, and Home Exercise for Older Adults with Chronic Neck Pain

The Chiro.Org Blog


SOURCE:   Spine J. 2016 (Nov); 16 (11): 1292–1304

Brent Leininger, DC, MS, Christine McDonough, PT, PhD,
Roni Evans, DC, MS, PhD, Tor Tosteson, ScD,
Anna N.A. Tosteson, ScD, Gert Bronfort, DC, PhD

Integrative Health & Wellbeing Research Program,
Center for Spirituality & Healing,
University of Minnesota,
B296 Mayo Memorial Building,
420 Delaware St SE, Minneapolis, MN 55455, USA


BACKGROUND CONTEXT:   Chronic neck pain is a prevalent and disabling condition among older adults. Despite the large burden of neck pain, little is known regarding the cost-effectiveness of commonly used treatments.

PURPOSE:   This study aimed to estimate the cost-effectiveness of home exercise and advice (HEA), spinal manipulative therapy (SMT) plus HEA, and supervised rehabilitative exercise (SRE) plus HEA.

STUDY DESIGN/SETTING:   Cost-effectiveness analysis conducted alongside a randomized clinical trial (RCT) was performed.

PATIENT SAMPLE:   A total of 241 older adults (≥65 years) with chronic mechanical neck pain comprised the patient sample.

OUTCOME MEASURES:   The outcome measures were direct and indirect costs, neck pain, neck disability, SF–6D-derived quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) over a 1–year time horizon.

METHODS:   This work was supported by grants from the National Center for Complementary and Integrative Health (#F32AT007507), National Institute of Arthritis and Musculoskeletal and Skin Diseases (#P60AR062799), and Health Resources and Services Administration (#R18HP01425). The RCT is registered at ClinicalTrials.gov (#NCT00269308).

A societal perspective was adopted for the primary analysis. A healthcare perspective was adopted as a sensitivity analysis. Cost-effectiveness was a secondary aim of the RCT which was not powered for differences in costs or QALYs. Differences in costs and clinical outcomes were estimated using generalized estimating equations and linear mixed models, respectively. Cost-effectiveness acceptability curves were calculated to assess the uncertainty surrounding cost-effectiveness estimates.

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Chronic Neck Pain and Chiropractic Page

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Spine Care as a Framework for the Chiropractic Identity

Spine Care as a Framework for the Chiropractic Identity

The Chiro.Org Blog


SOURCE:   Journal of Chiropractic Humanities 2016 (Nov 4)

Michael Schneider, DC, PhD, Donald Murphy, DC,
Jan Hartvigsen, DC, PhD

Department of Physical Therapy,
University of Pittsburgh,
Pittsburgh, PA


Objective   The purpose of this commentary is to provide an argument for the role and identity of chiropractors as spine care providers within the context of the greater health care system.

Discussion   Surveys of the general public and chiropractors indicate that the majority of patients seek chiropractic services for back and neck pain. Insurance company utilization data confirm these findings. Regulatory and legal language found in chiropractic practice acts reveals that most jurisdictions define the chiropractic scope of practice as based on a foundation of spine care. Educational accrediting and testing organizations have been shaped around a chiropractic education that produces graduates who focus on the diagnosis and treatment of spine and musculoskeletal disorders. Spine care is thus the common denominator and theme throughout all aspects of chiropractic practice, legislation, and education globally.

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

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. 2016 (Aug 26) [Epub]

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.

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Chiropractic and Pain Management Page

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Parker University Inaugurates William E. Morgan, D.C.
As Their New President

Parker University Inaugurates William E. Morgan, D.C. as Their New President

The Chiro.Org Blog


SOURCE:   Yahoo! News ~ November 2, 2016


DALLAS, TX–(Marketwired – November 02, 2016) – The Board of Trustees, Faculty, Staff, Students, and Alumni of Parker University are pleased to announce and celebrate the inauguration of their new president, William E. Morgan, DC. As the seventh president of Parker University, Dr. Morgan will begin his term presiding over an expanding roster of both programs and students as Parker University pursues its mission of comprehensive education dedicated to research, service, and education.

The inauguration was held at 1:30pm on the Parker University main campus in Dallas, Texas at the Standard Process Student Activity Center on October 7, 2016. General Walter E. Boomer was present as a special guest of the president, who invited him to make a special presentation on his behalf.

General Boomer is a retired four-star general and assistant commandant of the United States Marine Corps and a business executive. He led all Marines in Operations Desert Shield and Desert Storm during the Gulf War. He later served as the Chairman and CEO of Rogers Corporation, retiring in 2004. He is the current lead director of Baxter International. General Boomer is a 1960 graduate of Duke University; he later earned a master’s degree from American University.


About Dr. Morgan, Seventh President of Parker University

In 1998, Dr. Morgan was chosen to establish the first chiropractic clinic at the National Naval Medical Center in Bethesda, Maryland, which later became Walter Reed National Military Medical Center. In 2015, Walter Reed recognized Dr. Morgan with its highest honor for clinical excellence, the Master Clinician’s Award.

During the last 18 years at the military’s most prestigious medical centers, he practiced in an integrative setting providing chiropractic care to the injured troops returning from the wars in Iraq and Afghanistan.

Continue reading Parker University Inaugurates William E. Morgan, D.C.
As Their New President

Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society

Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society

The Chiro.Org Blog


SOURCE:   Ann Int Medicine 2007 (Oct 2);   147 (7):   478–491

Roger Chou, MD; Amir Qaseem, MD, PhD, MHA;
Vincenza Snow, MD; Donald Casey, MD, MPH, MBA;
J. Thomas Cross, Jr, MD, MPH; Paul Shekelle, MD, PhD;
Douglas K. Owens, MD, MS

Clinical Efficacy Assessment Subcommittee
of the American College of Physicians
and the American College of Physicians/
American Pain Society Low Back Pain Guidelines Panel*


Review the complete Guideline for the Evaluation and Management of Low Back Pain: Evidence Review
(482 page Adobe Acrobat file)

From the FULL TEXT Article:

The Abstract

Recommendation 1:   Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence).

Recommendation 2:   Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence).

Recommendation 3:   Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence).

Recommendation 4:   Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate–quality evidence).

Recommendation 5:   Clinicians should provide patients with evidence–based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self–care options (strong recommendation, moderate–quality evidence).

WARNING:   Before following Recommendation #6,
please review the
Contra-indications to NSAIDS use

.

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Clinical Decision Rule for Primary Care Patient with Acute Low Back Pain at Risk of Developing Chronic Pain

Clinical Decision Rule for Primary Care Patient with Acute Low Back Pain at Risk of Developing Chronic Pain

The Chiro.Org Blog


SOURCE:   Spine J. 2015 (Jul 1); 15 (7): 1577–1586

Wolf E. Mehling, MD, Mark H. Ebell, MD, MS,
Andrew L. Avins, MD, MPH, Frederick M. Hecht, MD

Department of Family Medicine,
University of California-San Francisco,
1545 Divisadero St,
San Francisco, CA 94115, USA


BACKGROUND CONTEXT:   Primary care clinicians need to identify candidates for early interventions to prevent patients with acute pain from developing chronic pain.

PURPOSE:   We conducted a 2-year prospective cohort study of risk factors for the progression to chronic pain and developed and internally validated a clinical decision rule (CDR) that stratifies patients into low-, medium-, and high-risk groups for chronic pain.

STUDY DESIGN/SETTING:   This is a prospective cohort study in primary care.

PATIENT SAMPLE:   Patients with acute low back pain (LBP, ≤30 days duration) were included.

OUTCOME MEASURES:   Outcome measures were self-reported perceived nonrecovery and chronic pain.

METHODS:   Patients were surveyed at baseline, 6 months, and 2 years. We conducted bivariate and multivariate regression analyses of demographic, clinical, and psychosocial variables for chronic pain outcomes, developed a CDR, and assessed its performance by calculating the bootstrapped areas under the receiver-operating characteristic curve (AUC) and likelihood ratios.

RESULTS:   Six hundred five patients enrolled: 13% had chronic pain at 6 months and 19% at 2 years. An eight-item CDR was most parsimonious for classifying patients into three risk levels. Bootstrapped AUC was 0.76 (0.70-0.82) for the 6-month CDR. Each 10-point score increase (60-point range) was associated with an odds ratio of 11.1 (10.8-11.4) for developing chronic pain. Using a less than 5% probability of chronic pain as the cutoff for low risk and a greater than 40% probability for high risk, likelihood ratios were 0.26 (0.14-0.48) and 4.4 (3.0-6.3) for these groups, respectively.

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

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

The Chiro.Org Blog


SOURCE:   F1000Res. 2016 (Oct 11); 5. pii: F1000

Massimo Allegri, Silvana Montella, Fabiana Salici,
Adriana Valente, Maurizio Marchesini, Christian Compagnone,
Marco Baciarello, Maria Elena Manferdini, and Guido Fanelli

Department of Surgical Sciences,
University of Parma,
Parma, Italy


Chronic low back pain (CLBP) is a chronic pain syndrome in the lower back region, lasting for at least 3 months. CLBP represents the second leading cause of disability worldwide being a major welfare and economic problem. The prevalence of CLBP in adults has increased more than 100% in the last decade and continues to increase dramatically in the aging population, affecting both men and women in all ethnic groups, with a significant impact on functional capacity and occupational activities. It can also be influenced by psychological factors, such as stress, depression and/or anxiety. Given this complexity, the diagnostic evaluation of patients with CLBP can be very challenging and requires complex clinical decision-making.

Answering the question “what is the pain generatoramong the several structures potentially involved in CLBP is a key factor in the management of these patients, since a mis-diagnosis can generate therapeutical mistakes. Traditionally, the notion that the etiology of 80% to 90% of LBP cases is unknown has been mistaken perpetuated across decades. In most cases, low back pain can be attributed to specific pain generator, with its own characteristics and with different therapeutical opportunity. Here we discuss about radicular pain, facet joint pain, sacro-iliac pain, pain related to lumbar stenosis, discogenic pain. Our article aims to offer to the clinicians a simple guidance to identify pain generators in a safer and faster way, relying a correct diagnosis and further therapeutical approach.

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A Guide for Diagnosis and Therapy