Musculoskeletal Healthcare:
Have we Over-egged the Pudding?
Musculoskeletal Healthcare:
Have we Over-egged the Pudding?
SOURCE: International J Rheumatic Diseases 2019 (Nov); 22 (11): 1957–1960
Christopher G. Maher Mary O’Keeffe Rachelle Buchbinder I. A. Harris
Institute for Musculoskeletal Health,
Sydney, NSW, Australia
|
Editorial Comment: 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.
|
From the FULL TEXT Article:
INTRODUCTION
There are more articles like this @ our:
Headache Page and the:
Low Back Pain Page and the:
Nonpharmacological Treatment of Army Service Members with Chronic Pain Is Associated with Fewer Adverse Outcomes After Transition to the Veterans Health Administration
Nonpharmacological Treatment of Army Service Members with Chronic Pain Is Associated with Fewer Adverse Outcomes After Transition to the Veterans Health Administration
SOURCE: J Gen Intern Med. 2019 (Oct 28) [Epub]
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.
There are more articles like this @ our:
Our Blog is Just a Tool. Learn How To Use It Now
Our Blog is Just a Tool.
Learn How To Use It Now.
SOURCE: A Chiro.Org Editorrial
Every Blog post is an announcement of new material that was just added to one of our many Sections.
I have been compiling (and archiving) peer-reviewed articles since early 1996, and to date we have almost 6,000 Abstracts, and hundreds of Full-Text articles on a wide variety of subjects.
When enough material, relating to a particular topic was collected, it was gathered into a new Topical Page in one of our many Sections.
Each Topical page is located in the Section most associated with that topic. Thus, our Attention Deficit Page is located (is a part of) our Pediatrics Section You get the idea.
Almost ALL of our Sections contain some, or many Topical collections. The LINKS Section is the most extreme example, because it contains 93 different topical pages.
All of the following are “active” Sections that are constantly adding new (and important) materials:
Alternative Healing Abstracts
Case Studies
Chiropractic Assistants
Chiropractic Research
Documentation
The LINKS
Medicare Info
Nutrition
Pediatrics
Radiology
Stroke and Chiropractic Page
What is the Chiropractic Subluxation?
These other valuable Sections are “archival” in nature, and contain valuable tools for you to use freely:
Free Images
New DC’s
Office Forms
R.C. Schafer’s Rehab Monographs
Search Section
How Blog Posts Work
The following is a Graphic “screen grab” of a Blog Post from our Home Page. (more…)
Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain
Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis
SOURCE: Pain Medicine 2019 (Sep 27) [Epub]
Kelsey L Corcoran, DC, Lori A Bastian, MD, Craig G Gunderson, MD, Catherine Steffens, Alexandria Brackett, MA, MLIS, Anthony J Lisi, DC
Kelsey L. Corcoran, DC,
Yale Center for Medical Informatics,
300 George St., Suite 501,
New Haven, CT 06511, USA.
OBJECTIVE: To investigate the current evidence to determine if there is an association between chiropractic use and opioid receipt.
DESIGN: Systematic review and meta-analysis.
METHODS: The protocol for this review was registered on PROSPERO (CRD42018095128). The MEDLINE, PubMed, EMBASE, AMED, CINAHL, and Web of Science databases were searched for relevant articles from database inception through April 18, 2018. Controlled studies, cohort studies, and case-control studies including adults with noncancer pain were eligible for inclusion. Studies reporting opioid receipt for both subjects who used chiropractic care and nonusers were included. Data extraction and risk of bias assessment were completed independently by pairs of reviewers. Meta-analysis was performed and presented as an odds ratio with 95% confidence interval.
RESULTS: In all, 874 articles were identified. After detailed selection, 26 articles were reviewed in full, and six met the inclusion criteria. Five studies focused on back pain and one on neck pain. The prevalence of chiropractic care among patients with spinal pain varied between 11.3% and 51.3%. The proportion of patients receiving an opioid prescription was lower for chiropractic users (range = 12.3–57.6%) than nonusers (range = 31.2–65.9%). In a random-effects analysis, chiropractic users had a 64% lower odds of receiving an opioid prescription than nonusers (odds ratio = 0.36, 95% confidence interval = 0.30–0.43, P < 0.001, I2 = 92.8%).
There are more articles like this @ our:
Awareness of Axial Spondyloarthritis Among Chiropractors and Osteopaths
Awareness of Axial Spondyloarthritis Among Chiropractors and Osteopaths: Findings From a UK Web-based Survey
SOURCE: Rheumatol Adv Pract. 2019 (Sep 30)
Cee Y Yong, Jill Hamilton, Jatinder Benepal, Katie Griffiths, Zoë E Clark, Amanda Rush, Raj Sengupta, Jane Martindale, and Karl Gaffney
Department of Rheumatology,
North West Anglia NHS Foundation Trust,
Huntingdon.
OBJECTIVE: Chiropractors and osteopaths are important professional partners in the management of axial spondyloarthritis (axSpA). In view of recent advances in diagnosis and treatment, we sought to understand their current knowledge and working practices.
METHODS: A Web-based survey was advertised to chiropractors and osteopaths via the Royal College of Chiropractors and the Institute of Osteopathy.
RESULTS: Of 382 completed responses [237 chiropractors (62%) and 145 osteopaths (38%)], all were familiar with AS, but only 63 and 25% were familiar with the terms axSpA and non-radiographic axSpA, respectively. Seventy-seven per cent were confident with inflammatory back pain. Respondents routinely asked about IBD (91%), psoriasis (81%), acute anterior uveitis (49%), peripheral arthritis (71%), genitourinary/gut infection (56%), enthesitis (30%) and dactylitis (20%). Eighty-seven per cent were aware of the association between axSpA and HLA-B27. Only 29% recognized that axSpA was common in women. Forty per cent recommend an X-ray (pelvic in 80%) and, if normal, 27% would recommend MRI of the sacroiliac joints and whole spine. Forty-four per cent were aware of biologic therapies. Forty-three per cent were confident with the process of onward referral to rheumatology via the general practitioner (GP). The principal perceived barrier to onward referral was reluctance by the GP to accept their professional opinion.
There are more articles like this @ our: