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What Have We Learned From Ten Years of Trajectory Research in Low Back Pain?

By |May 25, 2016|Low Back Pain, Research|

What Have We Learned From Ten Years of Trajectory Research in Low Back Pain?

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord. 2016 (May 21); 17 (1): 220

Alice Kongsted, Peter Kent, Iben Axen,
Aron S. Downie, and Kate M. Dunn

The Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark.
a.kongsted@nikkb.dk


BACKGROUND:   Non-specific low back pain (LBP) is often categorised as acute, subacute or chronic by focusing on the duration of the current episode. However, more than twenty years ago this concept was challenged by a recognition that LBP is often an episodic condition. This episodic nature also means that the course of LBP is not well described by an overall population mean. Therefore, studies have investigated if specific LBP trajectories could be identified which better reflect individuals’ course patterns. Following a pioneering study into LBP trajectories published by Dunn et al. in 2006, a number of subsequent studies have also identified LBP trajectories and it is timely to provide an overview of their findings and discuss how insights into these trajectories may be helpful for improving our understanding of LBP and its clinical management.

DISCUSSION:   LBP trajectories in adults have been identified by data driven approaches in ten cohorts, and these have consistently demonstrated that different trajectory patterns exist. Despite some differences between studies, common trajectories have been identified across settings and countries, which have associations with a number of patient characteristics from different health domains. One study has demonstrated that in many people such trajectories are stable over several years. LBP trajectories seem to be recognisable by patients, and appealing to clinicians, and we discuss their potential usefulness as prognostic factors, effect moderators, and as a tool to support communication with patients.

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Can the Nervous System Be Hacked?

By |June 4, 2015|Research|

Source NY Times

Vagus nerve stimulation that affects the immune system has wide implications for non-drug therapy in conditions such as Rheumatoid Arthritis.

By

One morning in May 1998, Kevin Tracey converted a room in his lab at the Feinstein Institute for Medical Research in Manhasset, N.Y., into a makeshift operating theater and then prepped his patient — a rat — for surgery. A neurosurgeon, and also Feinstein Institute’s president, Tracey had spent more than a decade searching for a link between nerves and the immune system. His work led him to hypothesize that stimulating the vagus nerve with electricity would alleviate harmful inflammation. “The vagus nerve is behind the artery where you feel your pulse,” he told me recently, pressing his right index finger to his neck.

The vagus nerve and its branches conduct nerve impulses — called action potentials — to every major organ. But communication between nerves and the immune system was considered impossible, according to the scientific consensus in 1998. Textbooks from the era taught, he said, “that the immune system was just cells floating around. Nerves don’t float anywhere. Nerves are fixed in tissues.” It would have been “inconceivable,” he added, to propose that nerves were directly interacting with immune cells.

Nonetheless, Tracey was certain that an interface existed, and that his rat would prove it. After anesthetizing the animal, Tracey cut an incision in its neck, using a surgical microscope to find his way around his patient’s anatomy. With a hand-held nerve stimulator, he delivered several one-second electrical pulses to the rat’s exposed vagus nerve. He stitched the cut closed and gave the rat a bacterial toxin known to promote the production of tumor necrosis factor, or T.N.F., a protein that triggers inflammation in animals, including humans.

“We let it sleep for an hour, then took blood tests,” he said. The bacterial toxin should have triggered rampant inflammation, but instead the production of tumor necrosis factor was blocked by 75 percent. “For me, it was a life-changing moment,” Tracey said. What he had demonstrated was that the nervous system was like a computer terminal through which you could deliver commands to stop a problem, like acute inflammation, before it starts, or repair a body after it gets sick. “All the information is coming and going as electrical signals,” Tracey said. For months, he’d been arguing with his staff, whose members considered this rat project of his harebrained. “Half of them were in the hallway betting against me,” Tracey said.

Inflammatory afflictions like rheumatoid arthritis and Crohn’s disease are currently treated with drugs — painkillers, steroids and what are known as biologics, or genetically engineered proteins. But such medicines, Tracey pointed out, are often expensive, hard to administer, variable in their efficacy and sometimes accompanied by lethal side effects. His work seemed to indicate that electricity delivered to the vagus nerve in just the right intensity and at precise intervals could reproduce a drug’s therapeutic — in this case, anti-inflammatory — reaction. His subsequent research would also show that it could do so more effectively and with minimal health risks.

Tracey’s efforts have helped establish what is now the growing field of bioelectronics. He has grand hopes for it. “I think this is the industry that will replace the drug industry,” he told me. Today researchers are creating implants that can communicate directly with the nervous system in order to try to fight everything from cancer to the common cold. “Our idea would be manipulating neural input to delay the progression of cancer,” says Paul Frenette, a stem-cell researcher at the Albert Einstein College of Medicine in the Bronx who discovered a link between the nervous system and prostate tumors.

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Chiropractic identity, role and future: a survey of North American chiropractic students

By |February 3, 2015|Research|

Source Chiropractic and Manual Therapies

Jordan A Gliedt, Cheryl Hawk, Michelle Anderson, Kashif Ahmad, Dinah Bunn,Jerrilyn Cambron, Brian Gleberzon, John Hart, Anupama Kizhakkeveettil, Stephen M Perle, Michael Ramcharan, Stephanie Sullivan and Liang Zhang

Abstract

Background

The literature pertaining to chiropractic students’ opinions with respect to the desired future status of the chiropractic physician is limited and is an appropriate topic worthy of study. A previous pilot study was performed at a single chiropractic college. This current study is an expansion of this pilot project to collect data from chiropractic students enrolled in colleges throughout North America.

Objective

The purpose of this study is to investigate North American chiropractic students’ opinions concerning professional identity, role and future.

Methods

A 23-item cross-sectional electronic questionnaire was developed. A total of 7,455 chiropractic students from 12 North American English-speaking chiropractic colleges were invited to complete the survey. Survey items encompassed demographics, evidence-based practice, chiropractic identity and setting, and scope of practice. Data were collected and descriptive statistical analysis was performed.

Results

A total of 1,247 (16.7% response rate) questionnaires were electronically submitted. Most respondents agreed (34.8%) or strongly agreed (52.2%) that it is important for chiropractors to be educated in evidence-based practice. A majority agreed (35.6%) or strongly agreed (25.8%) the emphasis of chiropractic intervention is to eliminate vertebral subluxations/vertebral subluxation complexes. A large number of respondents (55.2%) were not in favor of expanding the scope of the chiropractic profession to include prescribing medications with appropriate advanced training. Most respondents estimated that chiropractors should be considered mainstream health care practitioners (69.1%). Several respondents (46.8%) think that chiropractic research should focus on the physiological mechanisms of chiropractic adjustments.

Conclusion

The chiropractic students in this study showed a preference for participating in mainstream health care, report an exposure to evidence-based practice, and desire to hold to traditional chiropractic theories and practices. The majority of students would like to see an emphasis on correction of vertebral subluxation, while a larger percent found it is important to learn about evidence-based practice. These two key points may seem contradictory, suggesting cognitive dissonance. Or perhaps some students want to hold on to traditional theory (e.g., subluxation-centered practice) while recognizing the need for further research to fully explore these theories. Further research on this topic is needed.

WFC publishes suggested reading list of research papers

By |January 27, 2015|Research|

Source The World Federation of Chiropractic

The World Federation of Chiropractic (WFC) is pleased to announce the debut of an important, online, free service for the chiropractic profession and the public it serves – a Suggested Reading List of key research papers.

When you want an overview of research on a chiropractic topic, for yourself, for patients or to advocate for the profession, wouldn’t it be nice to have access to relevant papers collected in one location?

“That is the vision for this WFC project,” says WFC President Dr Greg Stewart of Canada. “The project is being led by Dr Greg Kawchuk of the University of Alberta, Chair of the WFC Research Council, who has brought together expert curators  from within the Research Council and abroad. We owe them a great debt for the expertise and hard work that has produced this exciting new service.”

The initial version of the Suggested Reading List goes live today at www.wfcsuggestedreadinglist.com  with 10 key papers curated in each of 21 subject areas.  These subject areas include cost-effectiveness of care, biomechanical and neurophysiological mechanisms of action, safety, pediatrics, wellness and many others. Each listed paper includes the published abstract and link to the original publication when available. Importantly, the site is searchable and visitors can leave suggestions for new topics and papers.

“This is just the beginning of this project,” explains Dr Kawchuk.  “We are already working on round two which will add new topic areas such as nutrition and public health.

This project has been possible because of generous sponsorship from NCMIC and Standard Process, two of the WFC’s long-standing and most supportive partners.

The WFC, whose members are 90 national associations of chiropractors worldwide including both the ACA and ICA in the USA, has been a non-governmental organization or NGO in official relations with the World Health Organization since 1997.  Its next major Congress is in Athens, Greece May 13-16, 2015. For more information visit www.wfc.org .

Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey

By |February 13, 2014|Research|

Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey


SOURCE:  BMC Complementary and Alternative Medicine 2014, 14:51 ~ FULL TEXT

Marion McGregor, Aaron A Puhl, Christine Reinhart, H Stephen Injeyan and David Soave


Background


As health care has increased in complexity and health care teams have been offered as a solution, so too is there an increased need for stronger interprofessional collaboration. However the intraprofessional factions that exist within every profession challenge interprofessional communication through contrary paradigms. As a contender in the conservative spinal health care market, factions within chiropractic that result in unorthodox practice behaviours may compromise interprofessional relations and that profession’s progress toward institutionalization. The purpose of this investigation was to quantify the professional stratification among Canadian chiropractic practitioners and evaluate the practice perceptions of those factions.

Methods


A stratified random sample of 740 Canadian chiropractors was surveyed to determine faction membership and how professional stratification could be related to views that could be considered unorthodox to current evidence-based care and guidelines. Stratification in practice behaviours is a stated concern of mainstream medicine when considering interprofessional referrals.

Results


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The sacroiliac joint is the most likely source of low back pain after lumbar fusion

By |September 18, 2013|Research|

Etiology of Chronic Low Back Pain in Patients Having Undergone Lumbar Fusion

Pain Medicine Volume 12, Issue 5, pages 732–739, May 2011

Michael J. DePalma MD , Jessica M. Ketchum PhD, Thomas R. Saullo MD

Abstract

Objective.  To estimate the prevalence of lumbar internal disc disruption, zygapohyseal joint pain, sacroiliac joint pain, and soft tissue irritation by fusion hardware in post-fusion low back pain patients compared with non-fused patients utilizing diagnostic spinal procedures.

Design.  Retrospective chart review.

Setting.  University spine center.

Patient Sample.  Patients presenting to a community-based, multidisciplinary, academic spine center (65.9% female, mean age 54.4 years, median pain duration 12 months).

Interventions.  Charts of consecutive low back pain cases completing diagnostic spinal procedures including provocation discography and zygapohyseal joint, sacroiliac joint, and fusion hardware blockade were retrospectively reviewed.

Outcome Measures.  Based on the results of discography and/or diagnostic blockades, subjects were classified with internal disc disruption, zygapohyseal joint pain, sacroiliac joint pain, or fusion hardware related pain.

Results.  The diagnoses of 28 fusion cases identified from 170 low back pain patients undergoing diagnostic procedures included 12 with sacroiliac joint pain, seven with internal disc disruption, five with zygapohyseal joint pain, and four due to soft tissue irritation from fusion hardware. No significant differences were noted in zygapohyseal joint mediated pain with and without fusion history. Mean ages of patients were similar with and without fusion history for cases diagnosed as internal disc disruption.

Conclusion.  In patients’ recalcitrant to non-interventional care, the sacroiliac joint is the most likely source of low back pain after lumbar fusion followed by internal disc disruption, zygapohyseal joint pain, and soft tissue irritation due to fusion hardware. Sacroiliac joint pain is more common after fusion, while internal disc disruption is more common in non-fusion patients.