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Prevalence and Tracking of Back Pain From Childhood to Adolescence

Prevalence and Tracking of Back Pain From Childhood to Adolescence

The Chiro.Org Blog


SOURCE:   BMC Musculo Disord. 2011 (May 16); 12: 98 ~ FULL TEXT

Per Kjaer, Niels Wedderkopp, Lars Korsholm,
and Charlotte Leboeuf-Yde

Institute of Sports Science and Clinical Biomechanics,
Part of Clinical Locomotion Network,
University of Southern Denmark,
Campusvej 55, DK-5230, Odense, Denmark


BACKGROUND:   It is generally acknowledged that back pain (BP) is a common condition already in childhood. However, the development until early adulthood is not well understood and, in particular, not the individual tracking pattern. The objectives of this paper are to show the prevalence estimates of BP, low back pain (LBP), mid back pain (MBP), neck pain (NP), and care-seeking because of BP at three different ages (9, 13 and 15 years) and how the BP reporting tracks over these age groups over three consecutive surveys.

METHODS:   A longitudinal cohort study was carried out from the years of 1997 till 2005, collecting interview data from children who were sampled to be representative of Danish schoolchildren. BP was defined overall and specifically in the three spinal regions as having reported pain within the past month. The prevalence estimates and the various patterns of BP reporting over time are presented as percentages.

RESULTS:   Of the 771 children sampled, 62%, 57%, and 58% participated in the three back surveys and 34% participated in all three. The prevalence estimates for children at the ages of 9, 13, and 15, respectively, were for back pain (BP) 33%, 28%, and 48%; for low back pain (LBP) 4%, 22%, and 36%; for MBP 20%, 13%, and 35%; and for neck pain (NP) 10%, 7%, and 15%. Seeking care for BP increased from 6% and 8% at the two youngest ages to 34% at the oldest. Only 7% of the children who participated in all three surveys reported BP each time and 30% of these always reported no pain. The patterns of development differed for the three spinal regions and between genders. Status at the previous survey predicted status at the next survey, so that those who had pain before were more likely to report pain again and vice versa. This was most pronounced for care-seeking.

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An Investigation of Musculoskeletal Dysfunctions in Infants

An Investigation of Musculoskeletal Dysfunctions in Infants Including a Case Series of KISS Diagnosed Children

The Chiro.Org Blog


SOURCE:   J Clin Chiro Peds 2012 (Jun); 13 (1): 958–967

Josefa Langkau and Joyce Miller BS, DC , DABCO, FCC (UK), FEAC, FACO(US)

Josefa Langkau
34 Morley Road,
BH5 2JL, Bournemouth, United Kingdom

Joyce Miller, BS, DC, DABCO, FCC (UK), FEAC, FACO(US)
Associate Professor, Anglo-European College of Chiropractic,
Bournemouth, United Kingdom


Objective:   The purpose of this study was to describe etiology, presentation and treatment of musculoskeletal issues in early infancy by integrating a case series of infants diagnosed with kinematic imbalance due to suboccipital sprain (KISS) and treated in a teaching clinic in the United Kingdom with a critical review of the concept of KISS. The concept has been developed by Heiner Biedermann and medical doctors in Germany and contributed significantly to the development of manual therapy in
children in that country.

Methods:   A literature review was conducted. The search was focused on German studies about KISS syndrome and English studies about musculoskeletal issues in infants. Search strategy: ZDB, ZB MED and PubMed and hand search in German libraries. The data were collected by survey via a data collection system and files in the Anglo European College of Chiropractic (AECC)
teaching clinic.

Results:   The primary differences between the diagnosis and treatment recommended by Biedermann and that in the AECC clinic are 1) the recommended use of x-ray prior to treatment by Biedermann and 2) recommended force used in treatment (4 N at AECC versus 70 N with Biedermann).

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A Survey of Parent Satisfaction with Chiropractic Care of the Pediatric Patient

A Survey of Parent Satisfaction with Chiropractic Care of the Pediatric Patient

The Chiro.Org Blog


SOURCE:   J Clinical Chirop Peds 2014 (Nov); 14 (3): 1167–1171

By Ida Marie Navrud, DC, Joyce Miller, BSc, DC, DABCO, PhD,
Maja Eidsmo Bjørnli, DC, Cathrine Hjelle Feier, DC,
Tale Haugse, DC

Private practice, Norway


Introduction:   Chiropractic is a common parental choice as a therapeutic intervention for numerous pediatric conditions. No studies investigating parent satisfaction with pediatric chiropractic care have been published to date.

Method:   All infants aged 0-36 weeks and presenting to a chiropractic teaching clinic on the south coast of England between January 2011 and October 2013 were eligible for inclusion. Parents completed questionnaires, which rated their own and their infant’s characteristics prior to, and at the end of, a course of chiropractic care. Non-parametric tests were used to analyze before and after care scores.

Results:   A total of 395 results were collected in this study. Satisfaction scores of 10/10 (“completely satisfied”) were reported by 75.1% (n=295) of the parents. There was a significant
improvement in parental distress (Median=5.0 before care, Median=2.0 after care, Z=-13.7, p< .001, r =-.49) and infants’ sleep quality (Median=5.0 before care, Median=3.0 after care, Z=-10.5, p<.001, r =-.38). Satisfaction scores were found to have a small correlation with sleep quality (rs =-.21) after care, as well as a moderate correlation with distress (rs =-.31) and improvement scores (rs =.42), p<.01.

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Pregnancy and Chiropractic:
A Narrative Review of the Literature

Pregnancy and Chiropractic:
A Narrative Review of the Literature

The Chiro.Org Blog


SOURCE:   J Chiropractic Med 2007 (Jun); 6 (2): 70–74

Cara L. Borggren

Chiropractic Clinical Resident,
Northwestern Health Sciences University,
College of Chiropractic,
Bloomington, MN.


OBJECTIVE:   The purpose of this article is to review the literature on the topic of chiropractic care during pregnancy.

METHODS:   A PubMed search was performed using the terms pregnancy and chiropractic. Sources were cross-referenced to obtain further articles and research information after reviewing the articles obtained through the search.

RESULTS:   Thirty-three references were used for this review. The current literature reports favorable results on the use of chiropractic care throughout pregnancy.

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A Narrative Review of the Literature

Recognition of Perinatal Stroke in a Chiropractic Practice

Recognition of Perinatal Stroke in a Chiropractic Practice: Case Report and Clinical Challenges Related to a Late Diagnosis

The Chiro.Org Blog


J Clin Chiro Peds 2012 (Jun); 13 (1): 958–967 ~ FULL TEXT

Lise Hestbaek, PhD, Annette Jørgensen, DC, and
Jan Hartvigsen, PhD

Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark


Introduction:   In recent years, improvements in medical techniques and technology have enabled primary health care practitioners to diagnose perinatal strokes in infants far earlier than ever before. This new technology can also support chiropractors, especially those working with pediatric patients, in order to validate their diagnosis when they recognize these initial symptoms.

Objective:   The aim of this paper is to raise awareness and assist doctors of chiropractic in recognizing the physical and behavioral signs of perinatal stroke as they present in a chiropractic office for assessment and treatment. The paper will relate the case of a
7-month-old infant who, after visiting a chiropractic office with apparent hemiparesis and delayed developmental milestones, was post-medically diagnosed as having suffered a presumed perinatal stroke.

Discussion:   Early recognition of perinatal stroke is vital since late diagnosis can lead to a lifetime of debilitating neurological conditions as well as potential increased direct and indirect costs to society. For those who receive a late diagnosis, a chiropractor, as a member of a multidisciplinary team, can play a major role in rehabilitation by supporting the function of the nervous system,
reducing muscle and joint rigidity and optimizing neuronal plasticity.

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Deconstructing Chronic Low Back Pain in the Older Adult –
Part V: Maladaptive Coping

Deconstructing Chronic Low Back Pain in the Older Adult – Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment.
Part V: Maladaptive Coping

The Chiro.Org Blog


SOURCE:   Pain Medicine 2016 (Jan); 17 (1): 64-73 ~ FULL TEXT

Elizabeth A. DiNapoli, Michael Craine, Paul Dougherty,
Angela Gentili, Gary Kochersberger, Natalia E. Morone,
Jennifer L. Murphy, Juleen Rodakowski, Eric Rodriguez,
Stephen Thielke, Debra K. Weiner

Mental Illness Research, Education & Clinical Center,
VA Pittsburgh Healthcare System, Pittsburgh,
Pennsylvania Geriatric Research,
Education & Clinical Center,
VA Pittsburgh Healthcare System, Pittsburgh, PA


OBJECTIVE:   As part of a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults, this article focuses on maladaptive coping – a significant contributor of psychological distress, increased pain, and heightened disability in older adults with CLBP.

METHODS:   A modified Delphi technique was used to develop a maladaptive coping algorithm and table providing the rationale for the various components of the algorithm. A seven-member content expert panel and a nine-member primary care panel were involved in the iterative development of the materials. While the algorithm was developed keeping in mind resources available within the Veterans Health Administration (VHA) facilities, panelists were not exclusive to the VHA, and therefore, materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributors’ clinical practice.

RESULTS:   We present a treatment algorithm and supporting table to be used by providers treating older adults who have CLBP and engage in maladaptive coping strategies. A case of an older adult with CLBP and maladaptive coping is provided to illustrate the approach to management.

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Part V: Maladaptive Coping

Deconstructing Chronic Low Back Pain in the Older Adult –
Part IV: Depression

Deconstructing Chronic Low Back Pain in the Older Adult – Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment.
Part IV: Depression

The Chiro.Org Blog


SOURCE: Pain Medicine 2015 (Nov); 16 (11): 2098-2108 ~ FULL TEXT

Joseph A. Carley, Jordan F. Karp, Angela Gentili,
Zachary A. Marcum, M. Carrington Reid, Eric Rodriguez,
Michelle I. Rossi, Joseph Shega, Stephen Thielke,
Debra K. Weiner

Departments of Psychiatry,
University of Pittsburgh,
Pittsburgh, PA, USA


OBJECTIVE:   To present the fourth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of twelve important contributors to pain and disability in older adults with CLBP. This article focuses on depression.

METHODS:   The evaluation and treatment algorithm, a table articulating the rationale for the individual algorithm components, and stepped-care drug recommendations were developed using a modified Delphi approach. The Principal Investigator, a three-member content expert panel, and a nine-member primary care panel were involved in the iterative development of these materials. The algorithm was developed keeping in mind medications and other resources available within Veterans Health Administration (VHA) facilities. As panelists were not exclusive to the VHA, the materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributor’s clinical practice.

RESULTS:   We present an algorithm and supportive materials to help guide the care of older adults with depression, an important contributor to CLBP. The case illustrates an example of a complex clinical presentation in which depression was an important contributor to symptoms and disability in an older adult with CLBP.

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Part IV: Depression

Deconstructing Chronic Low Back Pain in the Older Adult –
Part III: Fibromyalgia Syndrome

Deconstructing Chronic Low Back Pain in the Older Adult – Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part III: Fibromyalgia Syndrome

The Chiro.Org Blog


SOURCE:   Pain Medicine 2015 (Sep); 16 (9): 1709-1719 ~ FULL TEXT

Gita Fatemi, Meika A. Fang, Paula Breuer, Paul E. Cherniak,
Angela Gentili, Joseph T. Hanlon, Jordan F. Karp,
Natalia E. Morone, Eric Rodriguez, Michelle I. Rossi,
Kenneth Schmader, Debra K. Weiner

VA Greater Los Angeles Healthcare System,
Los Angeles, California


OBJECTIVE:   To present the third in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of 12 important contributors to pain and disability in older adults with CLBP. This article focuses on fibromyalgia syndrome (FMS).

METHODS:   A modified Delphi approach was used to create the evaluation and treatment algorithm, the table discussing the rationale behind each of the algorithm components, and the stepped-care drug recommendations. The team involved in the creation of these materials consisted of a principal investigator, a 5-member content expert panel, and a 9-member primary care panel. The evaluation and treatment recommendations were based on availability of medications and other resources within the Veterans Health Administration (VHA) facilities. However, non-VHA panelists were also involved in the development of these materials, which can be applied to both VA and civilian settings. The illustrative clinical case was taken from the clinical practice of the principal investigator.

RESULTS:   Following expert consultations and a review of the literature, we developed an evaluation and treatment algorithm with supporting materials to aid in the care of older adults with CLBP who have concomitant FMS. A case is presented that demonstrates the complexity of pain evaluation and management in older patients with CLBP and concomitant FMS.

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Part III: Fibromyalgia Syndrome

Deconstructing Chronic Low Back Pain in the Older Adult –
Part II: Myofascial

Deconstructing Chronic Low Back Pain in the Older Adult – Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment.
Part II: Myofascial Pain

The Chiro.Org Blog


SOURCE:   Pain Medicine 2015 (Jul); 16 (7): 1282-1289 ~ FULL TEXT

Anthony J. Lisi, Paula Breuer, Rollin M. Gallagher,
Eric Rodriguez, Michelle I. Rossi, Kenneth Schmader,
Joel D. Scholten, Debra K. Weiner

VA Connecticut Healthcare System
2Rehabilitation and Prosthetics Services,
Veterans Health Administration.
3University of Bridgeport College of Chiropractic


OBJECTIVE:   To present an algorithm of sequential treatment options for managing myofascial pain (MP) in older adults, along with a representative clinical case.

METHODS:   A modified Delphi process was used to synthesize evidence-based recommendations. A multidisciplinary expert panel developed the algorithm, which was subsequently refined through an iterative process of input from a primary care physician panel.

RESULTS:   We present an algorithm and supportive materials to help guide the care of older adults with MP, an important contributor to chronic low back pain (CLBP). Addressing any perpetuating factors should be the first step of managing myofascial pain (MP). Patients should be educated on self-care approaches, home exercise, and the use of safe analgesics when indicated. Trigger point deactivation can be accomplished by manual therapy, injection therapy, dry needling, and/or acupuncture.

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Part II: Myofascial

Deconstructing Chronic Low Back Pain in the Older Adult –
Part I: Hip Osteoarthritis

Deconstructing Chronic Low Back Pain in the Older Adult – Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment.
Part I: Hip Osteoarthritis

The Chiro.Org Blog


SOURCE:   Pain Medicine 2015 (May); 16 (5): 886-897 ~ FULL TEXT

Debra K. Weiner, Meika Fang, Angela Gentili,
Dr. Gary Kochersberger, Zachary A. Marcum,
Michelle I. Rossi, Todd P. Semla, Joseph Shega

Geriatric Research, Education and Clinical Center,
VA Pittsburgh Healthcare System,
Pittsburgh, Pennsylvania, USA.


OBJECTIVE:   To present the first in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of twelve important contributors to pain and disability in older adults with CLBP. This article focuses on hip osteoarthritis (OA).

METHODS:   The evaluation and treatment algorithm, a table articulating the rationale for the individual algorithm components, and stepped-care drug recommendations were developed using a modified Delphi approach. The Principal Investigator, a five-member content expert panel and a nine-member primary care panel were involved in the iterative development of these materials. The algorithm was developed keeping in mind medications and other resources available within Veterans Health Administration (VHA) facilities. As panelists were not exclusive to the VHA, the materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributor’s clinical practice.

RESULTS:   We present an algorithm and supportive materials to help guide the care of older adults with hip OA, an important contributor to CLBP. The case illustrates an example of complex hip-spine syndrome, in which hip OA was an important contributor to disability in an older adult with CLBP.

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Part I: Hip Osteoarthritis

Deconstructing Chronic Low Back Pain in the Older Adult –
Introduction

Deconstructing Chronic Low Back Pain in the Older Adult – Shifting the Paradigm from the Spine to the Person – Introduction

The Chiro.Org Blog


SOURCE:   Pain Medicine 2015 (May); 16 (5): 881-885 ~ FULL TEXT

Debra K. Weiner

Geriatric Research, Education & Clinical Center,
VA Pittsburgh Healthcare System,
University of Pittsburgh,
Pittsburgh, PA, USA.


Over the past decade, the estimated prevalence of low back pain (LBP) among older adults (typically defined as those ≥age 65) has more than doubled [1], and the utilization of advanced spinal imaging (e.g., computerized tomography (CT), magnetic resonance imaging [MRI]) and procedures guided by this imaging (e.g., epidural corticosteroids, spinal surgery) have continued to skyrocket. [1-3]

Treatment outcomes, however, have not improved apace. Why? Part of the answer lies in the fact that treatment may in part be misdirected.

This issue of Pain Medicine contains the first in a series of articles on how to systematically and comprehensively rethink our approach to evaluating and designing management for older adults with chronic low back pain (CLBP). The series is entitled “Deconstructing Chronic Low Back Pain in the Older Adult: Step-by-Step Evidence and Expert-Based Recommendations for Evaluation and Treatment” and the article in this issue focuses on hip osteoarthritis (OA), an important potential contributor to CLBP in older adults.

KEYWORDS:   Back Pain; Chronic Low Back Pain; Chronic Pain; Elderly; Geriatric; Homeostenosis; Low Back Pain; Lumbar; Magnetic Resonance Imaging; Older Adults; Pain Management; Treatment Outcome


From the FULL TEXT Article:

Current Practice

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Introduction

BJ Palmer Adjusting in 1924

RECOIL!!!

Back and Pelvic Pain in an Underserved United States
Pregnant Population

Back and Pelvic Pain in an Underserved United States Pregnant Population: A Preliminary Descriptive Survey

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2007 (Feb); 30 (2): 130–134

Clayton D. Skaggs, DC, Heidi Prather, DO,
Gilad Gross, MD, James W. George, DC,
Paul A. Thompson, PhD, D. Michael Nelson, MD, PhD

Department of Obstetrics and Gynecology,
Washington University School of Medicine,
St Louis, MO, USA.
skaggsdc@swbell.net


OBJECTIVE:   The objective of this study was to identify the prevalence of back pain and treatment satisfaction in a population of low-socioeconomic pregnant women.

METHODS:   This study used a cross-sectional design to determine the prevalence of self-reported musculoskeletal pain in pregnancy for 599 women. Women completed an author-generated musculoskeletal survey in the second trimester of their pregnancy that addressed pain history, duration, location, and intensity, as well as activities of daily living, treatment frequency, and satisfaction with treatment.

RESULTS:   Sixty-seven percent of the total population reported musculoskeletal pain, and nearly half presented with a multi-focal pattern of pain that involved 2 or more sites. Twenty-one percent reported severe pain intensity rated on a numerical rating scale. Eighty percent of women experiencing pain slept less than 4 hours per night and 75% of these women took pain medications. Importantly, 85% of the women surveyed perceived that they had not been offered treatment for their musculoskeletal disorders.

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Pregnant Population

A Non-surgical Approach to the Management of Lumbar Spinal Stenosis

A Non-surgical Approach to the Management of
Lumbar Spinal Stenosis: A Prospective
Observational Cohort Study

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord. 2006 (Feb 23); 7: 16

Donald R Murphy, Eric L Hurwitz,
Amy A Gregory, and Ronald Clary

Rhode Island Spine Center,
Pawtucket, RI 02860, USA.


BACKGROUND:   While it is widely held that non-surgical management should be the first line of approach in patients with lumbar spinal stenosis (LSS), little is known about the efficacy of non-surgical treatments for this condition. Data are needed to determine the most efficacious and safe non-surgical treatment options for patients with LSS. The purpose of this paper is to describe the clinical outcomes of a novel approach to patients with LSS that focuses on distraction manipulation (DM) and neural mobilization (NM).

METHODS:   This is a prospective consecutive case series with long term follow up (FU) of fifty-seven consecutive patients who were diagnosed with lumbar spinal stenosis (LSS). Two were excluded because of absence of baseline data or failure to remain in treatment to FU. Disability was measured using the Roland Morris Disability Questionnaire (RM) and pain intensity was measured using the Three Level Numerical Rating Scale (NRS). Patients were also asked to rate their perceived percentage improvement.

RESULTS:   The mean patient-rated percentage improvement from baseline to the end to treatment was 65.1%. The mean improvement in disability from baseline to the end of treatment was 5.1 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability from baseline to the end of treatment was seen in 66.7% of patients. The mean improvement in “on average” pain intensity was 1.6 points. This did not reach the threshold for clinical meaningfulness. The mean improvement in “at worst” pain was 3.1 points. This was considered to be clinically meaningful. The mean duration of FU was 16.5 months. The mean patient-rated percentage improvement from baseline to long term FU was 75.6%. The mean improvement in disability was 5.2 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability was seen in 73.2% of patients. The mean improvement in “on average” pain intensity from baseline to long term FU was 3.0 points. This was considered to be clinically meaningful. The mean improvement in “at worst” pain was 4.2 points. This was considered to be clinically meaningful. Only two patients went on to require surgery. No major complications to treatment were noted.

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Overtreating Chronic Back Pain: Time to Back Off?

Overtreating Chronic Back Pain:
Time to Back Off?

The Chiro.Org Blog


SOURCE:   J Am Board Fam Med. 2009 (Jan); 22 (1): 62–68

Richard A. Deyo, M.D., M.P.H., Sohail K. Mirza, M.D., M.P.H.,
Judith A. Turner, Ph.D., and Brook I. Martin, M.P.H.

Department of Medicine,
Oregon Health and Science University,
Portland, OR, USA.
deyor@ohsu.edu


Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. Some of these have become widely used for indications that are not well validated, leading to uncertainty about efficacy and safety, increasing complication rates, and marketing abuses.

Recent studies document a

629% increase in Medicare expenditures for epidural steroid injections;

a 423% increase in expenditures for opioids for back pain;

a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries;

and a 220% increase in spinal fusion surgery rates.

The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain.


From the FULL TEXT Article:

Introduction

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