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Chiropractic Treatment Helps Back-Related Leg Pain

Chiropractic Treatment Helps Back-Related Leg Pain

The Chiro.Org Blog


Spinal Manipulation and Home Exercise With Advice for Subacute and Chronic Back-Related Leg Pain: A Trial With Adaptive Allocation

SOURCE:   Annals of Internal Medicine 2014 (Sep 16); 161 (6): 381-391

Gert Bronfort, DC, PhD; Maria A. Hondras, DC, MPH;
Craig A. Schulz, DC, MS; Roni L. Evans, DC, PhD;
Cynthia R. Long, PhD; and Richard Grimm, MD, PhD

University of Minnesota, Northwestern Health Sciences University, and
Berman Center for Outcomes and Clinical Research at the Minneapolis
Medical Research Foundation, Minneapolis, Minnesota, and
Palmer Center for Chiropractic Research, Davenport, Iowa


Chiropractic Treatment Helps Back-Related Leg Pain

FROM:   MedPage Today ~ September 16, 2014

By Shara Yurkiewicz , Staff Writer, MedPage Today

Patients with back-related leg pain who received spinal manipulative therapy (SMT) plus home exercise and advice (HEA) had less leg pain, lower back pain, and disability after 12 weeks than patients who received home exercise and advice alone, researchers reported.

At 1 year, those differences were no longer significant, wrote Gert Bronfort, DC, PhD, at Northwestern Health Sciences University in Bloomington, Minn., and colleagues in a study appearing in Annals of Internal Medicine. But patients experienced more global improvement, higher satisfaction, and lower medication use, the researchers reported.

The findings suggest that SMT in addition to HEA could be a safe and effective conservative, short-term treatment approach for back-related leg pain, the authors said.

“Prior to this study, SMT was considered a viable treatment option of what is known as ‘uncomplicated low back pain,’ which is low back pain without radiating pain to the leg,” authors Bronfort and Roni Evans, DC, PhD, at the University of Minnesota in Minneapolis, wrote in an email to MedPage Today.

“This study shows that for patients without progressive neurological deficits and serious identifiable causes (e.g., spinal fracture, etc.) SMT, coupled with home exercise and advice, may be helpful, and should be considered,” they added.

Review the Abstract:

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Study offers suggestions on what to do when sex is a pain in the back

Source Canada.com
SHERYL UBELACKER, THE CANADIAN PRESS

10188848

Professor Stuart McGill demonstrates the motion of the spine during sex in a handout photo. Contrary to popular belief, spooning is not always the best sex position for those with a bad back, according to new research from the University of Waterloo. THE CANADIAN PRESS/HO-University of Waterloo

For many people, intimacy in the bedroom often takes a back seat to low back pain, say researchers, who have scientifically determined the best sexual positions to prevent spinal muscles from seizing up at an inopportune moment.

In what they believe is the first biomechanical study of its kind, researchers at the University of Waterloo have found that certain positions are better than others for keeping different kinds of back pain at bay.

And they’ve thrown out the long-held belief that spooning — where partners lie sideways curled back to front — is the only pose for back-saving sex.

“Before now, spooning was often recommended by physicians as the one position that fit all. But as we’ve discovered, that is not the case,” said Natalie Sidorkewicz, a PhD candidate and lead author of the paper published Thursday in the journal Spine.

“What that failed to do was recognize that there are all sorts of triggers for back pain,” she said from Waterloo, Ont. “So someone may find relief in one position that may cause pain for someone else.”

To conduct the study, the researchers recruited 10 heterosexual couples, with an average age of about 30, to have sexual intercourse in a controlled laboratory setting.

Each participant was fitted with remote sensors, which tracked how their spines moved when they engaged in five common sex positions. Infrared and electromagnetic motion capture systems — such as those used to animate figures in video games and films — showed how the men’s and women’s spines flexed when they assumed each position.

“So we were able to actually determine what angle the spine is at, at each moment in time that they’re having sex,” said Sidorkewicz, adding that electrodes on participants’ skin also captured activity in their core and hip muscles.

The findings were used to create an atlas, or set of guidelines, that recommends different sex positions and thrusting techniques based on what movements trigger a patient’s pain.
Continue reading Study offers suggestions on what to do when sex is a pain in the back

Miss Correct Posture

Source Neatorama and Google Life Archives

 

miss-perfect-posture

In the 50s and 60s, American chiropractors held a series of rather unusual beauty pageants where contestants were judged and winners picked not only by their apparent beauty and poise, but also their standing posture (backed with X-rays of their spines, of course).

The contests were a publicity stunt, Reginal Hug, past president of the Association for the History of Chiropractic, told Scott Hensley of NPR, and was meant to burnish the reputation of the profession. The message, he said, was that good posture led to good health and that chiropractors could help with that. “In those days, nobody was concerned about radiation,” Hug added, noting the use of X-rays to check for spinal structures.miss-correct-posture-3

Why not contests for men? Actually, there were some but they weren’t as popular and didn’t last very long. “The guys always slouched,” Hug added.

Like many things that were hot back in the early 20th century (like flagpole sitting, goldfish swallowing and phone booth stuffing), the popularity of the chiropractic beauty pageant waned. The last big contest was held in Chattanooga, Tennessee, in 1969.

 

miss-correct-posture-5

Adherence to Clinical Practice Guidelines Among Three Primary Contact Professions

Adherence to Clinical Practice Guidelines Among Three Primary Contact Professions: A Best Evidence Synthesis of the Literature for the Management of Acute and Subacute Low Back Pain

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc 2014 (Sept);   58(3):   220–237

Lyndon G. Amorin-Woods, B.App.Sci (Chiropractic)
Randy W. Beck, BSc (Hons), DC, PhD, DACNB, FAAFN, FACFN
Gregory F. Parkin-Smith, MTech(Chiro), MBBS, MSc, DrHC
James Lougheed, BA (Hons)
Alexandra P. Bremner, BSc (Hons), DipEd, GradDipAppStats, PhD

Senior Clinical Supervisor, School of Health Professions [Discipline of Chiropractic]
Murdoch University
Enrolled student, Master of Public Health
School of Population Health Faculty of Medicine, Dentistry and Health Sciences
The University of Western Australia
Email: L.Woods@murdoch.edu.au
Postal Address: Murdoch University, South Street Campus
90 South Street, MURDOCH Western Australia 6150
Telephone: +61 8-93601202


Aim:   To determine adherence to clinical practice guidelines in the medical, physiotherapy and chiropractic professions for acute and subacute mechanical low back pain through best-evidence synthesis of the healthcare literature.

Methods:   A structured best-evidence synthesis of the relevant literature through a literature search of relevant databases for peer-reviewed papers on adherence to clinical practice guidelines from 1995 to 2013. Inclusion of papers was based on selection criteria and appraisal by two reviewers who independently applied a modified Downs & Black appraisal tool. The appraised papers were summarized in tabular form and analysed by the authors.

Results:   The literature search retrieved 23 potentially relevant papers that were evaluated for methodological quality, of which 11 studies met the inclusion criteria. The main finding was that no profession in the study consistently attained an overall high concordance rating. Of the three professions examined, 73% of chiropractors adhered to current clinical practice guidelines, followed by physiotherapists (62%) and then medical practitioners (52%).

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Link between vitamin D and dementia risk confirmed

Source University of Exeter

Vitamin D deficiency is associated with a substantially increased risk of dementia and Alzheimer’s disease in older people, according to the most robust study of its kind ever conducted.

An international team, led by Dr David Llewellyn at the University of Exeter Medical School, found that study participants who were severely Vitamin D deficient were more than twice as likely to develop dementia and Alzheimer’s disease.

The team studied elderly Americans who took part in the Cardiovascular Health Study. They discovered that adults in the study who were moderately deficient in vitamin D had a 53 per cent increased risk of developing dementia of any kind, and the risk increased to 125 per cent in those who were severely deficient.

Similar results were recorded for Alzheimer’s disease, with the moderately deficient group 69 per cent more likely to develop this type of dementia, jumping to a 122 per cent increased risk for those severely deficient.

The study was part-funded by the Alzheimer’s Association, and is published in August 6 2014 online issue of Neurology, the medical journal of the American Academy of Neurology. It looked at 1,658 adults aged 65 and over, who were able to walk unaided and were free from dementia, cardiovascular disease and stroke at the start of the study. The participants were then followed for six years to investigate who went on to develop Alzheimer’s disease and other forms of dementia.

Dr Llewellyn said: “We expected to find an association between low Vitamin D levels and the risk of dementia and Alzheimer’s disease, but the results were surprising – we actually found that the association was twice as strong as we anticipated.

Continue reading…

 

Nutritional Factors Affecting Postpartum Depression

Nutritional Factors Affecting Postpartum Depression

The Chiro.Org Blog


SOURCE:   Journal of Clinical Chiropractic Pediatrics 2011 (Jun);   12 (1):   849–860

Lia M. Nightingale, PhD

Assistant Professor, Division of Life Sciences,
Palmer College of Chiropractic,
1000 Brady Street, Davenport, IA 52803, USA.
Email: lia.nightingale@palmer.edu


Pregnancy and lactation represent a period of substantial physiological changes for the mother and increased nutritional requirements to meet these adjustments. A number of nutritional depletions occur during pregnancy. Serum concentrations of iron and folate take months before they normalize to pre-pregnancy levels. Additionally, many micronutrients required during pregnancy interfere with each other, making absorption difficult. Postpartum depression is the primary complication of childbirth, possibly caused by several nutritional and non-nutritional factors. The current review highlights the impact nutrition may have on the etiology of this debilitating disorder, most notably on prevention of inflammation and maintenance of a healthy central nervous system. The most notable nutritional deficiencies associated with postpartum depression include omega-3 fatty acids, folate, iron, and zinc; however, supplementation trials for prevention of postpartum depression are severely lacking. Practical recommendations are given to minimize micronutrient interference and reduce the risk of postpartum depression.

Key Words:   postpartum depression, nutrition, diet, folate, essential fatty acids, iron, zinc

If there are terms in these articles you don’t understand, you can get a definition from the Merriam Webster Medical Dictionary. If you want information about a specific disease, you can access the Merck Manual. You can also search Pub Med for more abstracts on this, or any other health topic.


From the Full-Text Article:

Introduction

Depression is the second leading cause of disability for those of reproductive age. [1] Although all forms of depression are devastating, postpartum depression (PPD) has long-lasting consequences for all family members involved. Postpartum depression is the most common complication of childbirth, defined as having major or minor depressive episodes that occur within 12 months after delivery. [2, 3] Postpartum depression has been associated with impaired mother-child interactions, poorer child development, and more violent behavior in children with mothers displaying PPD. [4-6]

Pregnancy is a time of increased nutritional requirements to support fetal growth and development. There are several lines of thought concerning the cause of PPD, including the link between nutritional intake and risk of depression. Therefore, the goal of this review is to examine maternal depletion of nutrients, assess whether these nutritional factors may play a role in PPD, and summarize simple recommendations to implement in practice.


Prevalence

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Pre-Eclampsia and the Impact on Chiropractic Management
of the Pregnant Patient

Pre-Eclampsia and the Impact on Chiropractic Management
of the Pregnant Patient

The Chiro.Org Blog


SOURCE:   Journal of Clinical Chiropractic Pediatrics 2012 (Dec);   14 (1):   1032–1036

Sharon Gordon, BAppSc(Chiro), DICCP and Sherryn Silverthorne, M Clinical Chiro, RN, RM

Sharon Gordon, BAppSc(Chiro), DICCP
Private Practice, Gippsland, Victoria, Australia

Sherryn Silverthorne, M Clinical Chiro, RN, RM
Private Practice, Melbourne, Victoria, Australia
Corresponding author Email: Sharon.gordon@rmit.edu


Up to 10% of women develop pre-eclampsia during pregnancy. It is a significant cause of mortality, responsible for 10-15% of maternal deaths. Its diagnosis is based on the presence of hypertension, with or without proteinuria and edema. As primary contact health care providers, chiropractors must be aware of the risk factors, clinical signs of pre-eclampsia, and the need to modify their management appropriately. An open internet search was conducted for current guidelines in scientific journal databases, in the diagnosis and management of pre-eclampsia. Although there is little literature outlining the role of the chiropractor in patient management, it is clear that specific history and examination procedures must be performed for appropriate co-management and referral.

Key Words:   pre-eclampsia, eclampsia, toxemia, hypertension, pregnancy, chiropractic


From the Full-Text Article:

Introduction

Pre-eclampsia (also known as toxemia of pregnancy) is one of the major causes of maternal mortality and morbidity. 10%-15% of maternal deaths are directly associated with pre-eclampsia and eclampsia. [1] Up to 10% of pregnant women develop pre-eclampsia. [2] The incidence of pre-eclampsia in the nulliparous woman is cited as being between 3%-7% and for the multiparous woman 1%-3%. [1, 3] This diagnosis is based on the presence of hypertension, proteinuria, with or without edema. As primary contact health care providers, chiropractors must be aware of the risk factors, clinical signs of pre-eclampsia, and the need to modify their management appropriately.


Objective

To review the diagnostic criteria, risk factors and complications of pre-eclampsia, and discuss how this may affect chiropractic management of the pregnant patient.


Methods

Continue reading Pre-Eclampsia and the Impact on Chiropractic Management
of the Pregnant Patient

Tracking Low Back Problems in a Major Self-Insured Workforce:
Toward Improvement in the Patient’s Journey

Tracking Low Back Problems in a Major Self-Insured Workforce:
Toward Improvement in the Patient’s Journey

The Chiro.Org Blog


SOURCE:   J Occup Environ Med. 2014 (Jun);   56 (6):   604-620

Allen, Harris PhD; Wright, Marcia PharmD; Craig, Terri PharmD; Mardekian, Jack PhD; Cheung, Raymond PhD; Sanchez, Robert PhD; Bunn, William B. III MD, JD, MPH; Rogers, William PhD

From the Harris Allen Group, LLC (Dr Allen), Brookline, Mass; US Medical Affairs (Dr Wright), Pfizer Integrated Health, Overland Park, Kans; Pfizer Primary Care Medical Affairs (Dr Craig), Lincoln, Nebr; Pfizer Inc (Dr Mardekian), New York; Pfizer Integrated Health (Drs Cheung and Sanchez), New York; Health, Safety, Security & Productivity, Navistar, Inc (Dr Bunn)


This comprehensive new study from the Journal of Occupational and Environmental Medicine reveals that chiropractic care costs significantly less than other forms of low back care, and appears to comply with guideline recommendations more closely than than any of the other 4 comparison groups.

The authors came to these conclusions after an exhaustive analysis of an integrated database belonging to a giant, self-insured Fortune 500 manufacturer covering nine years of claims They evaluated the direct and indirect costs of LBP for all employees, looking in-depth at personnel characteristics, and medical, behavioral health, pharmaceutical, Workers Comp costs, disability, absenteeism, and lost productivity during the 2001 to 2009 period.

Thanks to Dynamic Chiropractic for some of the following comments. Make sure to read their full article!

The study had four objectives:

  1. Identify all active employees reporting a back problem diagnosis during the study period.
  2. Define and classify their initial patterns of medical care and use of Rx medication.
  3. Track the effect of these patterns on direct and indirect cost outcomes.
  4. Further stratify these treatment patterns by measures of congruence with the previously described guideline aspects for LBP care and determine the effect on cost outcomes.

Through their database review, the authors identified five specific care patterns that were typical of employee experiences

  1. Information and Advice (“TalkInfo”):
           information gathering, office visit consults, lab tests, imaging (X-ray, ultrasound, CT, or MRI)
           but no other procedures.
           (59 percent of employees).

  2. Complex Medical Management (Complex MM):
           physician visits for nerve blocks, surgeries, or comparable procedures
           (2 percent of employees).

  3. Chiropractic (Chiro):
           more than one visit to a DC.
           (11 percent of employees)

  4. Physical therapy (PT):
           more than one visit to a PT.
           (11 percent of employees)

  5. “Dabble”:
           episodes with at most one visit for physician, chiropractic, or PT care,
           or at most one visit to two or more of these categories.
           (17 percent of employees)

The average overall costs for care were a real eye opener

Low Back/Neuro (three-year total)

Continue reading Tracking Low Back Problems in a Major Self-Insured Workforce:
Toward Improvement in the Patient’s Journey

Energy Drinks and Adolescents –
What Should Health Practitioners Know?

Energy Drinks and Adolescents –
What Should Health Practitioners Know?

The Chiro.Org Blog


SOURCE:   Journal of Clinical Chiropractic Pediatrics 2012 (Dec);   13 (1): 1042-1044

Sharon Gordon, BAppSc(Chiro), DICCP

Private practice, Gippsland, Victoria, Australia.
Email: Sharon.gordon@rmit.edu.au


Energy Drinks are readily available in supermarkets throughout the world. There are currently no restrictions or guidelines on safe consumption by children. Energy drink consumption by adolescents is on the rise, as companies continue to aggressively market their product to this demographic. It has become socially acceptable for children to consume these drinks, as there is a perception that the products are safe. In addition, they have become a popular accessory in the youth extreme-sport culture. Overall, research on adolescent energy drink consumption is lacking, however side effects similar to that seen in adults, have been reported in the adolescent population. The chiropractor must be aware of these side effects, including how they may relate to presenting symptoms, and educate their patients on the dangers of energy drink consumption.

Key Words:   energy drink, caffeine, adolescent, chiropractic


Objective

To review the literature on energy drink consumption amongst adolescents, and discuss the physiological effects that may present to the chiropractic office.


Methods

Scientific journal databases were searched, including PubMed, Medline, Proquest, Cochrane, CINAHL, Medscape, and Index to Chiropractic Literature. An open internet search was also performed.


Discussion

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What Should Health Practitioners Know?

Low Back Pain – part of a whiteboard visual lecture series

Source DocMikeEvans

Costs of Routine Care for Infant Colic in the UK and Costs of Chiropractic Manual Therapy as a Management Strategy Alongside a RCT for this Condition

Costs of Routine Care for Infant Colic in the UK and Costs of Chiropractic Manual Therapy as a Management Strategy Alongside a RCT for this Condition

The Chiro.Org Blog


SOURCE:   Journal of Clinical Chiropractic Pediatrics 2013 (Jun);   14 (1):   1063–1069

Joyce Miller, DC, FAC O, FCC, FEAC (Paeds)

Associate Professor, Anglo-European College of Chiropractic,
Lead Tutor in Advanced Professional Practice (Paediatrics),
Bournemouth University, United Kingdom
Email: jmiller@aecc.ac.uk


Background:   There is a small body of published research (six research studies and a Cochrane review) suggesting that manual therapy is effective in the treatment of infant colic. Research from the UK has shown that the costs of NHS treatment are high (£65million [USD100 million] in 2001) with no alleviation of the condition.

Objectives:   The objectives of this study were to: investigate the cost of the inconsolable nocturnal crying infant syndrome which is popularly known as infant colic in the first 20 weeks of life, estimate the costs of different types of treatment commonly chosen by parents for a colicky infant for a week of care or an episode of care, investigate the cost of chiropractic manual therapy intervention aimed at reducing the hours of infant crying alongside a randomised controlled trial (RCT) showing effectiveness of treatment

Design:   Economic evaluation incorporating a RCT

Methods:   A cost analysis was conducted using data from a RCT conducted in a three-armed single-blinded trial that randomized excessively crying infants into one of three groups: a) routine chiropractic manual therapy (CMT), b) CMT with parent blinded or c) no treatment control group with parent blinded. These costs were compared with costs of caring for infant colic from Unit Costs of Health and Social Care, UK, 2011. It has been widely estimated that 21% of infants in the UK present annually to primary care for excessive crying and this calculated to 167,000 infants (to the nearest 1,000) used in the cost analysis as there were 795,249 infants in the UK in mid-2010 according to the UK Office of National Statistics, 2011.

Results:   100 infants completed the RCT and this resulted in treatment costs of £58/child ($93). An additional cost of GP care of £27.50 was added for initial evaluation of the general health of the child and suitability for chiropractic management, totaling £85.50 per child in the RCT. Clinical outcomes are published elsewhere, but care showed both statistically and clinically significant efficacy in reduced crying time by an average of 2.6 hours resulting in a crying time of less than two hours a day (reaching “normal” levels which could be classified as non-colic behavior). Cost per child’s care was £85.50 extrapolated to £14,278,500 for the full cohort of 167,000. If chiropractic care had been given privately, costs were calculated as £164/child per episode of care and this equalled £27,388,000 for the entire cohort. Medical costs through a normal stream of care amounted to £1089.91 per child or £182,014,970 for the cohort (including all costs of care, not just NHS). No benefits of effectiveness were accrued from any of those types of treatment. If the Morris NHS data were extrapolated to 2010, applying wage inflation, the cost would be £118 million (USD180 million) yearly. An episode of an average of four treatments of chiropractic manual therapy with documented efficacy of CMT cost from 8% to 24% of NHS care or routine care.

Conclusion:   chiropractic manual therapy was a cost-effective option in this study. A much larger randomized study of routine medical care versus routine chiropractic care is recommended to determine whether there is confirmation of these findings.


From the Full-Text Article:

Introduction

As effective treatment for children with infant colic remains elusive, the costs of managing the condition is gaining increasing attention. Although it is uncommon for clinicians to be quizzed about the cost-effectiveness of their treatments, [1] particularly where the clinicians’ services are covered by a national health plan, it is increasingly appropriate to ask this question, when prudence in health care expenditure is required.

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Chiropractic and Breastfeeding Dysfunction:
A Literature Review

Chiropractic and Breastfeeding Dysfunction:
A Literature Review

The Chiro.Org Blog


SOURCE:   Journal of Clinical Chiropractic Pediatrics 2014 (Mar);   14 (2)

Lauren M. Fry, BAppSc (CompMed-Chiro), MClinChiro

Lauren M. Fry, BAppSc(CompMed-Chiro), MClinChiro, private practice, Elwood, Victoria, Australia
Contact: laurenfry85@gmail.com


Objective:   Breastfeeding an infant has many long and short-term health benefits. Chiropractic care, as part of a multidisciplinary team, has the potential to assist with biomechanical causes of breastfeeding dysfunction. The purpose of this study was to review the literature and explore what evidence there is to support this theory.

Methods:   Database searches were performed (PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health and Index to Chiropractic Literature) and hand searches to identify relevant studies. Inclusion criteria were: written in the English language in a peer-reviewed journal, involving infant human participants and a focus on chiropractic treatment for breastfeeding (dysfunction).

Results:   Ten articles were reviewed; 5 case studies, 3 case series, 1 clinical trial and 1 narrative.

Conclusions:   Limited evidence exists to support chiropractic treatment for infants with breastfeeding dysfunction. Of the 6 case studies, 3 case series and 1 clinical trial found in this report there was a trend towards resolution of breastfeeding issues with chiropractic treatment of biomechanical imbalances. More meticulous, higher evidence studies are needed to provide further evidence of this.

Key Words:   breastfeeding, chiropractic, infant, spinal manipulation.


From the Full-Text Article:

Introduction

Breastfeeding, particularly exclusively for the first 6 months, has been associated with numerous beneficial short and long term health outcomes for an infant. [1, 2] Breast milk has been shown to contain secretory IgA antibodies, lactoferrin, oligosaccharides, numerous cytokines and growth factors which all aid in an infant’s immune response. [3, 4] Purported short term benefits to the infant are a decreased risk of many childhood illnesses. [5] Incidence of gastro-intestinal infections, otitis media, other respiratory tract infections and asthma, even in those with a strong family history, may be decreased in infants who are breastfed. [6, 7]

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A Literature Review

Adverse Reactions of Medications in Children:
The Need for Vigilance, A Case Study

Adverse Reactions of Medications in Children:
The Need for Vigilance, A Case Study

The Chiro.Org Blog


SOURCE:   Journal of Clinical Chiropractic Pediatrics 2014 (Mar);   14 (2)

Edward Holmes [1], DC and Joyce Miller, BSc, DC, DABCO, FCC [2]

1 – Edward Homes, DC, private practice, Bournemouth, United Kingdom

2 – Joyce Miller, BSc, DC, DABCO, FCC, Associate Professor,
Anglo-European College of Chiropractic, Bournemouth, United Kingdom.
Contact: jmiller@aecc.ac.uk


Summary:   This study demonstrates that adverse drug reactions do potentially pose a public health risk within the pediatric population and all healthcare providers need to be mindful of this risk. Adverse events to medication within this population are prevalent particularly in children under the age of two. Chiropractors must therefore be aware of adverse drug reactions and recognize symptoms within their patient population.

Key terms:   off label use; non-prescription drugs, child, pediatrics, drug toxicity guidelines, adverse medication reactions in children


From the Full-Text Article:

Introduction

A 19-week-old premature infant presented to a chiropractic teaching clinic with a ‘poor feeding pattern, recent slowing in weight gain and increase in crying’ over a three week period. The mother stated that this had started following a respiratory infection which occurred two months ago, with an associated rash that spread from her abdomen to the back of her neck, face and head. At least six weeks previously her GP had prescribed a cold remedy for the day (Calcold®) and Calpol® Night for the evening for the respiratory infection, and cortisone cream when a rash developed two weeks later. The medications seemed to help the child sleep, in fact she seemed to sleep much more during the day and night, which was put down to illness. However this did not change in the ensuing weeks after the respiratory infection abated. The mother continued with the Calpol® Night at the recommendation of the GP along with a change to Calpol® (instead of Calcold®) in the day, since it seemed to have helped with sleep. We examined a lethargic infant with an erythematous rash covering the trunk, head and neck who had decreased almost two centiles on her growth chart in the previous several weeks, and although not losing weight, she was nevertheless not gaining weight. Without another obvious etiology, was there an association between the medication and the child’s signs and symptoms?

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The Need for Vigilance, A Case Study

What Happened To The ‘Bio’ In The Bio-psycho-social Model of Low Back Pain?

What Happened To The ‘Bio’ In The Bio-psycho-social Model of Low Back Pain?

The Chiro.Org Blog


SOURCE:   Eur Spine J. 2011 (Dec);   20 (12):   2105-2110

Mark J. Hancock, Chris G. Maher, Mark Laslett, Elaine Hay, and Bart Koes

Faculty of Health Sciences, University of Sydney, PO Box 170,
Lidcombe 1825, NSW, Australia. mark.hancock@sydney.edu.au


Purpose   Over 20 years ago the term non-specific low back pain became popular to convey the limitations of our knowledge of the pathological source of most people’s low back pain. Knowledge of underlying pathology has advanced little since then, despite limited improvements in outcomes for patients with low back pain.

Methods   This paper discusses potential misunderstandings related to diagnostic studies in the field of low back pain and argues that future diagnostic studies should include and investigate pathological sources of low back pain.

Results   Six potential misunderstandings are discussed.

  1. Until diagnosis is shown to improve outcomes it is not worth investigating;
  2. without a gold standard it is not possible to investigate diagnosis of low back pain;
  3. the presence of pathology in some people without low back pain means it is not important;
  4. dismissal of the ability to diagnose low back pain in clinical guidelines is supported by the same level of evidence as recommendations for therapy;
  5. suggesting use of a diagnostic test in research is misinterpreted as endorsing its use in current clinical practice;
  6. we seem to have forgotten the ‘bio’ in biopsychosocial low back pain.

Conclusions   We believe the misunderstandings presented in this paper partly explain the lack of investigation into pathology as an important component of the low back pain experience. A better understanding of the biological component of low back pain in relation, and in addition, to psychosocial factors is important for a more rational approach to management of low back pain.

Keywords:   Low back pain, Diagnosis, Back pain

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Biopsychosocial Model Page


From the FULL TEXT Article

Introduction

Continue reading What Happened To The ‘Bio’ In The Bio-psycho-social Model of Low Back Pain?

Joint Assessment – P.A.R.T.S.

Joint Assessment – P.A.R.T.S.

The Chiro.Org Blog


SOURCE:   Topics in Clinical Chiropractic 2000;   7 (3):   1–10

Thomas F. Bergmann, DC, Bradley A. Finer, DC, DACAN

Professor, Clinical Science Division
Northwestern Health Sciences University
College of Chiropractic
Bloomington, Minnesota


Purpose:   An approach to systematically perform clinical work-up for chiropractic subluxation is proposed. Literature on assessment approaches is reviewed and a discussion is presented.

Method:   A qualitative review of clinical and scientific literature related to assessment methodologies for subluxation was performed.

Summary:   Variation in assessment techniques exists for identification of spinal and other articular joint dysfunction. Useful scientific data also are limited to only a few approaches. and there is a need for a more systematic assessment approach profession wide.

Key words:   articular range oj motion, chiropractic, Medicare, palpation, physical examination, subluxation

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What is The Chiropractic Subluxation? Page


From the FULL TEXT Article

Background

Doctors of chiropractic are portals of entry to the health care system for many patients seeking health care services. As such, they must maintain broad and thorough assessment/diagnostic skills. Before employing any therapy, a clinician must first determine if there is a need for treatment. Therefore, the clinical information that any primary contact provider would want, including a case history, physical examination, clinical laboratory findings, radiographic findings, and any other tests necessary to check for suspected health problems, is needed. Having gathered and interpreted this information, it must be processed in order to arrive at a sound clinical conclusion. The role of this assessment process in the chiropractic office is to determine whether the patient should receive chiropractic care only, chiropractic care in concert with other forms of health care, or a referral to another health care professional for some other form of stand-alone management such as acute, crisis care. This article suggests the need for, and possible form of, a standardized assessment procedure for use by chiropractic clinicians.


INTRODUCTION

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