Department of Physical Therapy,
School of Rehabilitation Sciences,
Shiraz University of Medical Sciences,
BACKGROUND: In patients with chronic nonspecific low back pain (NCLBP), brain function changes due to the neuroplastic changes in different regions.
AIM: The current study aimed to evaluate the brain metabolite changes after spinal manipulation, using proton magnetic resonance spectroscopy (1H-MRS).
METHODS: In the current study, 25 patients with NCLBP aged 20-50 years were enrolled. Patients were randomly assigned to lumbopelvic manipulation or sham. Patients were evaluated before and 5 weeks after treatment by the Numerical Rating Scale (NRS), the Oswestry Disability Index (ODI), and 1H-MRS.
RESULTS: After treatment, severity of pain and functional disability were significantly reduced in the treatment group vs. sham group (p < 0.05). After treatment, N-acetyl aspartate (NAA) in thalamus, insula, dorsolateral prefrontal cortex (DLPFC) regions, as well as choline (Cho) in the thalamus, insula, and somatosensory cortex (SSC) regions, had increased significantly in the treatment group compared with the sham group (p < 0.05). A significant increase was further observed in NAA in thalamus, anterior cingulate cortex (ACC), and SCC regions along with Cho metabolite in thalamus and SCC regions after treatment in the treatment group compared with the baseline measures (p < 0.05). Also, a significant increase was observed in Glx (glutamate and glutamine) levels of thalamus (p = 0.03). There was no significant difference in terms of brain metabolites at baseline and after treatment in the sham group.
Institute of Environmental Medicine,
Unit of Intervention and Implementation Research for Worker Health,
Nobels väg 13, 171 77,
Background Maintenance Care is a traditional chiropractic approach, whereby patients continue treatment after optimum benefit is reached. A review conducted in 1996 concluded that evidence behind this therapeutic strategy was lacking, and a second review from 2008 reached the same conclusion. Since then, a systematic research program in the Nordic countries was undertaken to uncover the definition, indications, prevalence of use and beliefs regarding Maintenance Care to make it possible to investigate its clinical usefulness and cost-effectiveness. As a result, an evidence-based clinical study could be performed. It was therefore timely to review the evidence.
Method Using the search terms “chiropractic OR manual therapy” AND “Maintenance Care OR prevention”, PubMed and Web of Science were searched, and the titles and abstracts reviewed for eligibility, starting from 2007. In addition, a search for “The Nordic Maintenance Care Program” was conducted. Because of the diversity of topics and study designs, a systematic review with narrative reporting was undertaken.
Results Fourteen original research articles were included in the review. Maintenance Care was defined as a secondary/tertiary preventive approach, recommended to patients with previous pain episodes, who respond well to chiropractic care. Maintenance Care is applied to approximately 30% of Scandinavian chiropractic patients. Both chiropractors and patients believe in the efficacy of Maintenance Care. Four studies investigating the effect of chiropractic Maintenance Care were identified, with disparate results on pain and disability of neck and back pain. However, only one of these studies utilized all the existing evidence when selecting study subjects and found that Maintenance Care patients experienced fewer days with low back pain compared to patients invited to contact their chiropractor ‘when needed’. No studies were found on the cost-effectiveness of Maintenance Care.
The purpose of this paper is to develop a scientific foundation and formalize the notion of stability as it pertains to the spine, and then discuss some implications of stability for advancing spine rehabilitation and clinical practice. The intention was to write a reader-friendly synthesis where only minimal references were provided. This invited review will complement my last review written for this journal 10 years ago. Over the intervening time we have established the UW-CMCC Chiropractic Research Clinic and have been conducting research with CMCC researchers. While we have been investigating the biomechanical effects of manipulation, we will need to perform additional experiments to provide a synthesis of sufficient utility for chiropractic practice. Look forward to this report in another couple of years.
Christopher G. Maher Mary O’Keeffe Rachelle Buchbinder I. A. Harris
Institute for Musculoskeletal Health,
Sydney, NSW, Australia
This paper details significant issues with the current allopathic approach to managing musculoskeletal (MSK) complaints. The authors pull no punches, and are to be commended. We have discussed some the underflying issues previously.
The reality is that medical schools do not devote enough time to reviewing the MSK system. In 1998 the Journal of Bone and Joint Surgery decried this problem, and numerous articles followed over the next 11 years, when I finally lost interest in compiling them.
You may want to review that review the series of 12 more articles on the subject, but I prefer the idea of offering chiropractic as a referral option for busy MDs who are swamped with patients with MSK comlaints, who often don’t respond well to pain killers or passive therapies. Think how much happier those MDs will be when their patients thank them for making the referral.
Esther L. Meerwijk, PhD, MSN , Mary Jo Larson, PhD, MPA, Eric M. Schmidt, PhD, Rachel Sayko Adams, PhD, MPH, Mark R. Bauer, MD, Grant A. Ritter, PhD, Chester Buckenmaier III, MD, and Alex H. S. Harris, PhD, MS
VA Health Services Research & Development,
Center for Innovation to Implementation (Ci2i),
VA Palo Alto Health Care System,
Menlo Park, CA, USA.
BACKGROUND: Potential protective effects of nonpharmacological treatments (NPT) against long-term pain-related adverse outcomes have not been examined.
OBJECTIVE: To compare active duty U.S. Army service members with chronic pain who did/did not receive NPT in the Military Health System (MHS) and describe the association between receiving NPT and adverse outcomes after transitioning to the Veterans Health Administration (VHA).
DESIGN AND PARTICIPANTS: A longitudinal cohort study of active duty Army service members whose MHS healthcare records indicated presence of chronic pain after an index deployment to Iraq or Afghanistan in the years 2008-2014 (N = 142,539). Propensity score-weighted multivariable Cox proportional hazard models tested for differences in adverse outcomes between the NPT group and No-NPT group.
EXPOSURES: NPT received in the MHS included acupuncture/dry needling, biofeedback, chiropractic care, massage, exercise therapy, cold laser therapy, osteopathic spinal manipulation, transcutaneous electrical nerve stimulation and other electrical manipulation, ultrasonography, superficial heat treatment, traction, and lumbar supports.
MAIN MEASURES: Primary outcomes were propensity score-weighted proportional hazards for the following adverse outcomes: (a) diagnoses of alcohol and/or drug disorders; (b) poisoning with opioids, related narcotics, barbiturates, or sedatives; (c) suicide ideation; and (d) self-inflicted injuries including suicide attempts. Outcomes were determined based on ICD-9 and ICD-10 diagnoses recorded in VHA healthcare records from the start of utilization until fiscal year 2018.
KEY RESULTS: The propensity score-weighted proportional hazards for the NPT group compared to the No-NPT group were 0.92 (95% CI 0.90-0.94, P < 0.001) for alcohol and/or drug use disorders; 0.65 (95% CI 0.51-0.83, P < 0.001) for accidental poisoning with opioids, related narcotics, barbiturates, or sedatives; 0.88 (95% CI 0.84-0.91, P < 0.001) for suicide ideation; and 0.83 (95% CI 0.77-0.90, P < 0.001) for self-inflicted injuries including suicide attempts.