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Looking Ahead: Chronic Spinal Pain Management

Chiro.Org Blog: Health care practitioners involved in the triage and management of patients with persistent spinal pain will need to become more vigilant about individualizing and coordinating care for each patient, to achieve the best possible outcomes. For example, Cecchi et al concluded that patients with chronic (persistent) lower baseline pain (LBP)-related disability predicted “nonresponse” to standard physiotherapy, but not to spinal manipulation (an intervention commonly employed by chiropractors [7-9]), implying that spinal manipulation should be considered as a first-line conservative treatment. [9] We note that spinal manipulation is now suggested as the first-line intervention by Deyo, [10] since not a single study examined in a recent systematic review found that spinal manipulation was less effective than conventional care. […]

Spinal Manipulation and Home Exercise With Advice for Subacute and Chronic Back-related Leg Pain

Chiro.Org Blog: Of the 192 enrolled patients, 191 (99%) provided follow-up data at 12 weeks and 179 (93%) at 52 weeks. For leg pain, SMT plus HEA had a clinically important advantage over home exercise and advice (HEA) (difference, 10 percentage points [95% CI, 2 to 19]; P=0.008) at 12 weeks but not at 52 weeks (difference, 7 percentage points [CI, -2 to 15]; P=0.146). Nearly all secondary outcomes improved more with SMT plus HEA at 12 weeks, but only global improvement, satisfaction, and medication use had sustained improvements at 52 weeks. No serious treatment-related adverse events or deaths occurred.   For patients with back-related leg pain (BRLP), SMT plus home exercise and advice (HEA) was more effective than HEA alone after 12 weeks, but the benefit was sustained only for some secondary outcomes at 52 weeks. […]

Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence

Chiro.Org Blog: After controlling for demographic factors and multiple severity indicators, patients suffering nonspecific work-related LBP who received health services mostly or only from a chiropractor had a lower risk of recurrent disability than the risk of any other provider type. Even without an improvement in days until recurrent disability, our findings seem to support the use of chiropractor services, as chiropractor services generally cost less than services from other providers. […]

Do Participants with Low Back Pain who Respond to Spinal Manipulative Therapy Differ Biomechanically From Nonresponders, Untreated Controls or Asymptomatic Controls?

Chiro.Org Blog: Our results demonstrate that those reporting post-SMT improvement in disability have coherent changes in multiple, objective measures of spinal biomechanics. This same coherence does not exist for asymptomatic controls or no-treatment symptomatic controls. Our data further support a differential effect of SMT on a specific constellation of biomechanical outcomes that are not responsive in all patients with LBP. This work provides a foundation from which to investigate the heterogeneous nature of LBP, the mechanisms underlying differential therapeutic response, and the biomechanical characteristics defining the responders at baseline. […]

National Clinical Guidelines for Non-surgical Treatment of Patients with Recent Onset Low Back Pain or Lumbar Radiculopathy

Chiro.Org Blog: Two multidisciplinary working groups developed two national clinical guidelines for non-surgical treatment in adult patients with non-specific low back pain (LBP) and lumbar radiculopathy (LR) of less than 12 weeks’ duration under the Danish Health Authority. The recommendations are based on limited evidence or on consensus, but are well aligned with recommendations from similar international guidelines. The guideline working groups strongly recommend that research efforts in relation to all aspects of the management of LBP and, in particular, LR be intensified. […]

Amount of Health Care and Self-care Following a Randomized Clinical Trial Comparing Flexion-distraction with Exercise Program for Chronic Low Back Pain

Chiro.Org Blog: Participants in the physical therapy group demonstrated on average significantly more visits to any health care provider and to a general practitioner during the year after trial care (p < 0.05). No group differences were noted in the number of visits to a chiropractor or physical therapist. Self-care was initiated by nearly every participant in both groups.   During a one-year follow-up, participants previously randomized to physical therapy attended significantly more health care visits than those participants who received chiropractic care. […]

Cortical Changes in Chronic Low Back Pain

Chiro.Org Blog: There is increasing evidence that chronic pain problems are characterised by alterations in brain structure and function. Chronic back pain is no exception. There is a growing sentiment, with accompanying theory, that these brain changes contribute to chronic back pain, although empirical support is lacking. This paper reviews the structural and functional changes of the brain that have been observed in people with chronic back pain. […]

Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain

Chiro.Org Blog: “Among patients with acute low back pain, spinal manipulative therapy was associated with improvements in pain and function with only transient minor musculoskeletal harms.” […]

Take the Guideline Challenge

Chiro.Org Blog: The American Osteopathic Association developed guidelines for low back pain, which includes spinal manipulation, in 2010 and then updated them in 2016. [2] The American Physical Therapy Association has had low back pain guidelines since 2012. [3] In March, the chiropractic profession also took a leadership role in this area when the American Chiropractic Association adopted both the American College of Physician’s recent low back pain guideline [4], as well as the Clinical Compass (formerly CCGPP) [5] Clinical Practice Guideline: Chiropractic Care for Low Back Pain. [6] […]

Elevated Production of Nociceptive CC-chemokines and sE-selectin in Patients with Low Back Pain and the Effects of Spinal Manipulation: A Non-randomized Clinical Trial

Chiro.Org Blog: The production of chemotactic cytokines is significantly and protractedly elevated in LBP patients. Changes in chemokine production levels, which might be related to SMT, differ in the acute and chronic LBP patient cohorts. […]

Do Older Adults with Chronic Low Back Pain Differ from Younger Adults in Regards to Baseline Characteristics and Prognosis?

Chiro.Org Blog: A total of 14,479 participants were included in the study. Of these 3,087 (21%) patients were older adults, 6,071 (42%) were middle aged and 5,321 (37%) were young adults. At presentation older adults were statistically different to the middle aged and younger adults for most characteristics measured (e.g. less intense back pain, more leg pain and more depression); however, the differences were small. The change in pain and disability over 12 months did not differ between age groups. […]

Pain Location Matters: The Impact of Leg Pain on Health Care Use, Work Disability and Quality of Life in Patients with Low Back Pain

Chiro.Org Blog: Patients with self-reported leg pain below the knee utilise more health care are more likely to be unemployed and have poorer quality of life than those with LBP only 12 months following primary care consultation. The presence of leg pain warrants early identification in primary care to explore if targeted interventions can reduce the impact and consequences of leg pain. […]

A Comparison of Chiropractic Manipulation Methods and Usual Medical Care for Low Back Pain

A Comparison of Chiropractic Manipulation Methods and Usual Medical Care for Low Back Pain: A Randomized Controlled Clinical Trial

The Chiro.Org Blog

SOURCE:   J Altern Complement Med. 2014 (May);   20 (5):   A22–23 Michael Schneider, Mitchell Haas, Joel Stevans, Ronald Glick, Doug Landsittel

University of Pittsburgh, Pittsburgh, PA, USA

Purpose:   […]

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain

Chiro.Org Blog: Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). […]

Individual Courses of Low Back Pain in Adult Danes

Chiro.Org Blog: In this study, it was evident that when applying the more ‘severe’ definitions of LBP (‘>30 days’, ‘seeking care’, and ‘non-trivial’) as risk factors for future LBP of the same definitions, the associations were stronger than for ‘year’ and ‘month’. We therefore suggest that composite measures of LBP outcomes should be further explored in future epidemiologic studies of risk factors and less attention should be paid to the LBP definitions ‘year’ and ‘month’, which may include both slight LBP with low clinical impact and severe disabling LBP. […]