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A Qualitative Study of Changes in Expectations Over Time Among Patients with Chronic Low Back Pain Seeking Four CAM Therapies

Chiro.Org Blog: Participants seeking one of four CAM therapies focused most of their expectations and hopes during initial interviews on whether or not the treatment could lessen their pain. In later interviews, where self-care was included in the interview guide, emphasis tended to be broader, shifting from needing to be “fixed” to an emphasis on the body as a work in progress, in need of ongoing attention and care from both the patient and the CAM practitioner. This trend toward attention to management, self-care and wellness, and increased acceptance of pain as chronic, was reported by participants seeking all four therapies. We also noted that this overall shift over time was evaluated in various ways by participants, depending on how they were able to orient their sense of self and understanding of illness toward ongoing management and engagement. […]

Importance of Psychological Factors for the Recovery From a First Episode of Acute Non-specific Neck Pain

Chiro.Org Blog: Previous bio-psycho-social studies have posited that anxiety, depression and catastrophizing are associated with chronicity. However, whether they are merely “associated with” versus “contribute towards” is really still up in the air (JMHO). To test whether these emotional elements are a natural side-effect of chronic pain as opposed to being causal, these researchers worked with 850 patients with acute non-specific neck pain with no history of previous neck or arm pain. […]

Chronic Pain Reconsidered

Chiro.Org Blog: Chronic pain has been traditionally defined by pain duration, but this approach has limited empirical support and does not account for chronic pain’s multi-dimensionality. This study compared duration-based and prospective approaches to defining chronic pain in terms of their ability to predict future pain course and outcomes for primary care patients with three common pain conditions: back pain (n=971), headache (n=1078), or orofacial pain (n=455). […]

Prediction of Pain Outcomes in a Randomized Controlled Trial of Dose-response of Spinal Manipulation for the Care of Chronic Low Back Pain

Chiro.Org Blog: Internal validation of prediction models showed that participant characteristics preceding the start of care were poor predictors of at least 50% improvement and the individual’s future pain intensity. Pain collected shortly after completion of 6 weeks of study intervention predicted future pain the best. […]

Low Back Pain in Primary Care

Chiro.Org Blog: Four out of five patients had had previous episodes, one-fourth were on sick leave, and the LBP considerably limited daily activities. The general practice patients were slightly older and less educated, more often females, and generally worse on all disease-related parameters than chiropractic patients. All differences were statistically significant. […]

Prognostic Factors for Recurrences in Neck Pain Patients Up to 1 Year After Chiropractic Care

Chiro.Org Blog: The results of this study suggest that recurrence of neck pain within 1 year after chiropractic intervention in Swiss chiropractic patients presenting from varied onsets is low. This study found preliminary findings that older age and a previous episode of neck may be useful predictors of neck pain recurrence within 1 year. […]

Spinal Manipulative Therapy and Exercise For Seniors with Chronic Neck Pain

Chiro.Org Blog: Spinal manipulative therapy (SMT) with home exercise resulted in greater pain reduction after 12 weeks of treatment compared with both supervised home exercise (HE) and HE alone. Supervised exercise sessions added little benefit to the HE-alone program. […]

A Randomised Controlled Trial of Preventive Spinal Manipulation With and Without a Home Exercise Program For Patients With Chronic Neck Pain

Chiro.Org Blog: This study hypothesised that participants in the combined intervention group would have less pain and disability and better function than participants from the 2 other groups during the preventive phase of the trial. This hypothesis was not supported by the study results. Lack of a treatment specific effect is discussed in relation to the placebo and patient provider interactions in manual therapies. Further research is needed to delineate the specific and non-specific effects of treatment modalities to prevent unnecessary disability and to minimise morbidity related to NCNP. Additional investigation is also required to identify the best strategies for secondary and tertiary prevention of NCNP. […]

Central Hypersensitivity In Chronic Pain After Whiplash Injury

Chiro.Org Blog: The authors found a hypersensitivity to peripheral stimulation in whiplash patients. Hypersensitivity was observed after cutaneous and muscular stimulation, at both neck and lower limb. Because hypersensitivity was observed in healthy tissues, it resulted from alterations in the central processing of sensory stimuli (central hypersensitivity). Central hypersensitivity was not dependent on a nociceptive input arising from the painful and tender muscles. […]

Chiropractic Cost-Effectiveness Supplement

Chiro.Org Blog: The following is a collection of studies relating to the cost effectiveness and efficacy associated with chiropractic care and the procedures that doctors of chiropractic provide. The American Chiropractic Association, The International Chiropractic Association, The Congress of State Associations, and the Association of Chiropractic Colleges appreciate the opportunity to provide these materials for your review. […]

Algorithms for the Chiropractic Management of Acute and Chronic Spine-Related Pain

Chiro.Org Blog: The complexity of clinical documentation and case management for health care providers has increased along with the rise of managed care. Keeping up with the policies of different insurers and third party administrators can be a daunting task. To address these issues for doctors of chiropractic (DCs) and policymakers, the Council for Chiropractic Guidelines and Practice Parameters (CCGPP) developed three consensus documents. Each of these documents was the outcome of a formal consensus process in which a multidisciplinary Delphi panel consisting of experts in chiropractic and low back pain treatment came to agreement on terminology and treatment parameters for the chiropractic management of spine-related musculoskeletal pain. [1-3] […]

Predictors of Outcome in Neck Pain Patients Undergoing Chiropractic Care: Comparison of Acute and Chronic Patients

Chiro.Org Blog: For the most part, baseline variables were not predictive of outcome in neck pain patients and as a consequence prediction of outcome at 1 week was not possible using the potential predictors measured in this study. Instead, the most consistent predictor of improvement at both 1 and 3 months for both acute and chronic neck pain patients undergoing chiropractic treatment is significant self-reported improvement early on. Importantly, the co-existence of cervical radiculopathy or dizziness in addition to neck pain was not associated with a negative outcome for either acute or chronic patients. […]

What is Different About Spinal Pain?

Chiro.Org Blog: This thesis addressed the question “what is different about spine pain?” Neuroanatomic and neurophysiologic findings from studies in the last twenty years provide preliminary support for the thesis that deep spine pain is different from deep pain arising from peripheral limb structures. […]

Lower Back Trauma (Lumbar Spine and Pelvis)

Chiro.Org Blog: Although it may be easier to teach anatomy by dividing the body into arbitrary parts, a misinterpretation can be created. For instance, we find clinically that the lumbar spine, sacrum, ilia, pubic bones, and hips work as a functional unit. Any disorder of one part immediately affects the function of the other parts. We should also keep in mind that an axial kinematic chain of weight-supporting segments extends from the occipital base to the soles of the feet. Because the number of professional papers concerning the cause and diagnosis of low-back pain is voluminous, emphasis herein is placed on points that the author believes are important but not often emphasized in popular literature. […]

Chronic Spinal Pain and the Role of Spinal Manipulation

Chiro.Org Blog: Chronic pain is a worldwide epidemic. It is characterized as “pain that persists beyond normal tissue healing time” [1] and is physiologically distinct from acute nociceptive pain. The current research estimates the prevalence of chronic pain in the general population to be anywhere from 10–55%, [2] predominantly affecting the adult population. Studies indicate that the prevalence of chronic pain in the over-60 age group is double that for younger adults. [3] Furthermore, over 80% of elderly (over 65) adults suffer from some form of painful chronic joint disease [4] and greater than 85% of the general population will experience some form of chronic myofascial pain during their lifetime. [5] […]