Andreas Eklund ,Irene Jensen,Charlotte Leboeuf-Yde,Alice Kongsted,Mattias Jonsson, Peter Lövgren,Jakob Petersen-Klingberg,Christian Calvert,Iben Axén
Institute of Environmental Medicine,
Unit of Intervention and Implementation Research for Worker Health,
A recent single blinded placebo controlled study, conducted by the Mansoura Faculty of Medicine, conclusively demonstrates that maintenance care provides significant benefits for those with chronic low back pain.
BACKGROUND: Chiropractic maintenance care is effective as secondary/tertiary prevention of non-specific low back pain (LBP), but the potential effect moderation by psychological characteristics is unknown. The objective was to investigate whether patients in specific psychological sub-groups had different responses to MC with regard to the total number of days with bothersome pain and the number of treatments.
METHOD: Data from a two-arm randomized pragmatic multicenter trial with a 12–month follow up, designed to investigate the effectiveness of maintenance care, was used. Consecutive patients, 18–65 years of age, with recurrent and persistent LBP seeking chiropractic care with a good effect of the initial treatment were included. Eligible subjects were randomized to either maintenance care (prescheduled care) or to the control intervention, symptom-guided care. The primary outcome of the trial was the total number of days with bothersome LBP collected weekly for 12 months using an automated SMS system. Data used to classify patients according to psychological subgroups defined by the West Haven-Yale Multidimensional Pain Inventory (adaptive copers, interpersonally distressed and dysfunctional) were collected at the screening visit.
RESULTS: A total of 252 subjects were analyzed using a generalized estimating equations linear regression framework. Patients in the dysfunctional subgroup who received maintenance care reported fewer days with pain (–30.0; 95% CI: –36.6, –23.4) and equal number of treatments compared to the control intervention. In the adaptive coper subgroup, patients who received maintenance care reported more days with pain (10.7; 95% CI: 4.0, 17.5) and more treatments (3.9; 95% CI: 3.5, 4.2). Patients in the interpersonally distressed subgroup reported equal number of days with pain (–0.3; 95% CI: –8.7, 8.1) and more treatments (1.5; 95% CI: 0.9, 2.1) on maintenance care.
Peter C Emary, DC, MSc, Amy L Brown, DC, Douglas F Cameron, DC, and Alexander F Pessoa, DC
Cambridge, ON, Canada.
OBJECTIVE: To evaluate costs and consequences of a new back pain service provided by chiropractors integrated into a Community Health Centre in Cambridge, Ontario. The study sample included 95 consecutive patients presenting between January 2014 to January 2016 with a mixture of sub-acute and chronic back pain.
METHODS: A secondary cost-utility analysis was performed and conducted from the perspective of the healthcare institution. Cost-utility was calculated as cost per quality-adjusted life year (QALY) gained over a time horizon of 90 days.
RESULTS: According to the EuroQol 5 Domain questionnaire, nearly 70% of patients improved. The mean number of treatment sessions was 8.4, and an average of 0.21 QALYs were gained at an average cost per QALY of $1,042. Seventy-seven percent of patients did not visit their primary care provider over the 90-day period, representing potential cost savings to the institution of between $2,022.23 and $6,135.82.
Private practice of Chiropractic,
Mt. Waverly, Victoria Australia
Objective: To discuss the management of a 12-year-old female patient with previously diagnosed chronic asthma.
Clinical Features: The duration and severity of this case are noted.
Intervention and Outcome: Positive resolution of the case, primarily through a regime of chiropractic spinal care and other natural measures suggests that a drugless or reduced drug exposure may be efficacious for some patients.
Our long time friend and supporter Dr. Jeanne Ohm has passed away.
Jeanne was executive coordinator for the International Chiropractic Pediatric Association [www.icpa4kids.com] and executive editor of Pathways to Family Wellness Magazine
Jeanne was also the author of many articles on pregnancy, birth, children, and chiropractic, many of which can be found in our Pediatrics Section.
Lewis E Kazis, Omid Ameli, James Rothendler, Brigid Garrity, Howard Cabral, Christine McDonough, et. al.
Department of Health Law,
Policy and Management,
Boston University School of Public Health,
Boston, Massachusetts, USA
OBJECTIVE: This study examined the association of initial provider treatment with early and long-term opioid use in a national sample of patients with new-onset low back pain (LBP).
DESIGN: A retrospective cohort study of patients with new-onset LBP from 2008 to 2013.
SETTING: The study evaluated outpatient and inpatient claims from patient visits, pharmacy claims and inpatient and outpatient procedures with initial providers seen for new-onset LBP.
PARTICIPANTS: 216,504 individuals aged 18 years or older across the USA who were diagnosed with new-onset LBP and were opioid-naïve were included. Participants had commercial or Medicare Advantage insurance.
EXPOSURES: The primary independent variable is type of initial healthcare provider including physicians and conservative therapists (physical therapists, chiropractors, acupuncturists).
MAIN OUTCOME MEASURES: Short-term opioid use (within 30 days of the index visit) following new LBP visit and long-term opioid use (starting within 60 days of the index date and either 120 or more days’ supply of opioids over 12 months, or 90 days or more supply of opioids and 10 or more opioid prescriptions over 12 months).
RESULTS: Short-term use of opioids was 22%. Patients who received initial treatment from chiropractors or physical therapists had decreased odds of short-term and long-term opioid use compared with those who received initial treatment from primary care physicians (PCPs) (adjusted OR (AOR) (95% CI) 0.10 (0.09 to 0.10) and 0.15 (0.13 to 0.17), respectively). Compared with PCP visits, initial chiropractic and physical therapy also were associated with decreased odds of long-term opioid use in a propensity score matched sample (AOR (95% CI) 0.21 (0.16 to 0.27) and 0.29 (0.12 to 0.69), respectively).
A decade after being asked to study how chiropractic care may increase fitness among troops with lower back pain, the Defense Department has submitted its report to Congress.
The answer? It works.
But service members still shouldn’t expect the treatment to be available at every military health facility.
And as for military family members, retirees and their families, the benefit, along with other alternative therapies, remains uncovered by Tricare.
Earlier this month, Acting Assistant Secretary of Defense for Manpower and Reserve Affairs James Stewart sent a final report to Congress (PDF) on three clinical trials conducted in the last 10 years at military health facilities by Rand Corp., Palmer College of Chiropractic and the Samueli Institute to determine whether chiropractic care can ease lower back pain in troops, help service members stop smoking and increase readiness.
The $7.5 million study was ordered under the fiscal 2010 National Defense Authorization Act, signed into law on Oct. 28, 2009. According to the report released Sept. 6, the trials showed some positive results.
The first clinical trial, to determine whether chiropractic care reduced pain and helped troops stop smoking, showed statistically significant improvement for service members with back pain who received chiropractic care alongside regular medical care.
The second trial, to test whether chiropractic care had any effect on the reaction and response times of special operations troops, showed that a single session had an immediate effect on motor response.
But the trials also found that chiropractic care had no real influence on smoking cessation, nor did the acceleration of response time among special operators last after the initial effect.
The third trial — on whether chiropractic care improves fitness among troops with back pain — showed that those who received such care saw a 5% increase in isometric strength, as opposed to a 6% decrease in strength among the control group, made up of service members who also had lower back pain but didn’t receive chiropractic care.
Endurance also increased 14% in the chiropractic group, compared with a 10% decrease in the control group, according to the third trial.
“Based on the results, the investigators concluded that chiropractic care improves key fitness characteristics among active-duty service members with lower back pain and could lead to improved military readiness in such individuals,” the report notes.
While Congress passed a law in 2000 requiring the Defense Department to offer chiropractic care for active-duty personnel and activated Reserve and National Guard members, it is available in only 65 of the DoD’s 54 military hospitals and 377 clinics.