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Monthly Archives: February 2017


Psychological and Behavioral Differences Between Low Back Pain Populations

By |February 25, 2017|Biopsychosocial Model, Chiropractic Care|

Psychological and Behavioral Differences Between Low Back Pain Populations: A Comparative Analysis of Chiropractic, Primary and Secondary Care Patients

The Chiro.Org Blog

SOURCE:   BMC Musculoskelet Disord. 2015 (Oct 19); 16: 306

Andreas Eklund, Gunnar Bergström,
Lennart Bodin and Iben Axén

Karolinska Institutet,
Institute of Environmental Medicine,
Unit of Intervention and Implementation Research,
Nobels väg 13, S-171 77,
Stockholm, Sweden.

BACKGROUND:   Psychological, behavioral and social factors have long been considered important in the development of persistent pain. Little is known about how chiropractic low back pain (LBP) patients compare to other LBP patients in terms of psychological/behavioral characteristics.

METHODS:   In this cross-sectional study, the aim was to investigate patients with LBP as regards to psychosocial/behavioral characteristics by describing a chiropractic primary care population and comparing this sample to three other populations using the MPI-S instrument. Thus, four different samples were compared.

A: Four hundred eighty subjects from chiropractic primary care clinics.

B: One hundred twenty-eight subjects from a gainfully employed population (sick listed with high risk of developing chronicity).

C: Two hundred seventy-three subjects from a secondary care rehabilitation clinic.

D: Two hundred thirty-five subjects from secondary care clinics.

The Swedish version of the Multidimensional Pain Inventory (MPI-S) was used to collect data. Subjects were classified using a cluster analytic strategy into three pre-defined subgroups (named adaptive copers, dysfunctional and interpersonally distressed).

RESULTS:   The data show statistically significant overall differences across samples for the subgroups based on psychological and behavioral characteristics. The cluster classifications placed (in terms of the proportions of the adaptive copers and dysfunctional subgroups) sample A between B and the two secondary care samples C and D.

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Biopsychosocial Model Page


A Systematic Review Comparing the Costs of Chiropractic Care to other Interventions for Spine Pain in the United States

By |February 24, 2017|Chiropractic Care, Cost-Effectiveness|

A Systematic Review Comparing the Costs of Chiropractic Care to other Interventions for
Spine Pain in the United States

The Chiro.Org Blog

SOURCE:   BMC Health Serv Res. 2015 (Oct 19) ~ FULL TEXT

Simon Dagenais, O’Dane Brady, Scott Haldeman
and Pran Manga

Spine Research LLC,
540 Main Street #7,
Winchester, MA, 01890, USA.

BACKGROUND:   Although chiropractors in the United States (US) have long suggested that their approach to managing spine pain is less costly than other health care providers (HCPs), it is unclear if available evidence supports this premise.

METHODS:   A systematic review was conducted using a comprehensive search strategy to uncover studies that compared health care costs for patients with any type of spine pain who received chiropractic care or care from other HCPs. Only studies conducted in the US and published in English between 1993 and 2015 were included. Health care costs were summarized for studies examining:

1.   private health plans
2.   workers’ compensation (WC) plans, and
3.   clinical outcomes.

The quality of studies in the latter group was evaluated using a Consensus on Health Economic Criteria (CHEC) list.

RESULTS:   The search uncovered 1,276 citations and 25 eligible studies, including 12 from private health plans, 6 from WC plans, and 7 that examined clinical outcomes. Chiropractic care was most commonly compared to care from a medical physician, with few details about the care received. Heterogeneity was noted among studies in patient selection, definition of spine pain, scope of costs compared, study duration, and methods to estimate costs. Overall, cost comparison studies from private health plans and WC plans reported that health care costs were lower with chiropractic care. In studies that also examined clinical outcomes, there were few differences in efficacy between groups, and health care costs were higher for those receiving chiropractic care. The effects of adjusting for differences in sociodemographic, clinical, or other factors between study groups were unclear.

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Cost-Effectiveness of Chiropractic Page


The Effect of Spinal Manipulation on Deep Experimental Muscle Pain in Healthy Volunteers

By |February 23, 2017|Chiropractic Research, Pain Relief|

The Effect of Spinal Manipulation on Deep Experimental Muscle Pain in Healthy Volunteers

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2015 (Sep 7);   23:   25

Søren O’Neill, Øystein Ødegaard-Olsen and Beate Søvde

Institute of Regional Health Research,
University of Southern Denmark,
Campusvej 55, Odense, 5230 DK Denmark ;

Spine Centre of Southern Denmark,
Lillebælt Hospital, Østre Hougvej 55,
Middelfart, 5500 DK Denmark

BACKGROUND:   High-velocity low-amplitude (HVLA) spinal manipulation is commonly used in the treatment of spinal pain syndromes. The mechanisms by which HVLA-manipulation might reduce spinal pain are not well understood, but often assumed to relate to the reduction of biomechanical dysfunction. It is also possible however, that HVLA-manipulation involves a segmental or generalized inhibitory effect on nociception, irrespective of biomechanical function. In the current study it was investigated whether a local analgesic effect of HVLA-manipulation on deep muscle pain could be detected, in healthy individuals.

METHODS AND MATERIALS:   Local, para-spinal muscle pain was induced by injection of 0.5 ml sterile, hyper-tonic saline on two separate occasions 1 week apart. Immediately following the injection, treatment was administered as either a) HVLA-manipulation or b) placebo treatment, in a randomized cross-over design. Both interventions were conducted by an experienced chiropractor with minimum 6 years of clinical experience. Participants and the researcher collecting data were blinded to the treatment allocation. Pain scores following saline injection were measured by computerized visual analogue pain scale (VAS) (0-100 VAS, 1 Hz) and summarized as a) Pain duration, b) Maximum VAS, c) Time to maximum VAS and d) Summarized VAS (area under the curve). Data analysis was performed as two-way analysis of variance with treatment allocation and session number as explanatory variables.

RESULTS:   Twenty-nine healthy adults (mean age 24.5 years) participated, 13 women and 16 men. Complete data was available for 28 participants. Analysis of variance revealed no statistically significant difference between active and placebo manipulation on any of the four pain measures.

There are more articles like this @ our:

Chiropractic and Spinal Pain Page and the:

Subluxation Neurology Section


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

By |February 22, 2017|Chiropractic Care, 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:   The primary aim of this study was to compare manual and mechanical methods of spinal manipulation (Activator) for patients with acute and sub-acute low back pain. These are the two most common methods of spinal manipulation used by chiropractors, but there is insufficient evidence regarding their comparative effectiveness against each other. Our secondary aim was to compare both methods with usual medical care.

Methods:   In a randomized comparative effectiveness trial, we randomized 107 participants with acute and sub-acute low back pain to: 1) usual medical care; 2) manual side-posture manipulation; and 3) mechanical manipulation (Activator). The primary outcome was self-reported disability (Oswestry) at four weeks. Pain was rated on a 0 to 10 numerical rating scale. Pain and disability scores were regressed on grouping variables adjusted for baseline covariates.

Results:   Manual manipulation demonstrated a clinically important and statistically significant reduction of disability and pain compared to Activator (adjusted mean difference=7.9 and 1.3 points respectively, P< .05) and compared to usual medical care (7.0 and 1.8 points respectively, P<.05). There were no significant adjusted mean differences between Activator and usual medical care in disability and pain (0.9 and 0.5 points respectively, P>.05).

There are more articles like this @ our:

Low Back Pain and Chiropractic


The Death Knell for the Prescription Rights Movement?

By |February 16, 2017|Prescription Rights|

The Death Knell for the Prescription Rights Movement?

The Chiro.Org Blog

SOURCE:   A Chiro.Org Editorial

This blog has posted extensively on the nascent prescription rights movement since early 2010.

The recent release (2-14-17) of American College of Physician’s new study ”Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain” appears to raise an evidence-based obstacle in the path to adding Rx rights to our profession.

In essence it recommends AGAINST prescribing drugs, although in a nod to prescribers, it does state:

“If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants”

A review of this complete study and its supporting documents, in particular the new review titled: ” Systemic Pharmacologic Therapies for Low Back Pain” clearly reveals that:

— nonsteroidal anti-inflammatory drugs had smaller benefits for chronic low back pain than previously observed

— skeletal muscle relaxants are effective for short-term pain relief in acute low back pain but caused sedation.

If a majority of DCs choose to pursue prescription rights, that is their privilege. Based on Organized Medicine’s reactions against this movement in key States, this looks to be an extended and expensive uphill battle.

I can’t help but wonder: If DCs expended the same amount effort in developing relationships by referring needy patients for drug-based co-management, whether they might achieve wider professional acceptance, cooperation and increased market-share via embracing our status as a non-drug provider?


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

By |February 15, 2017|Guidelines, Low Back Pain|

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians

The Chiro.Org Blog

SOURCE:   Ann Intern Med. 2017 (Feb 14) [Epub] ~ FULL TEXT

Amir Qaseem, MD, PhD, MHA; Timothy J. Wilt, MD, MPH;
Robert M. McLean, MD; Mary Ann Forciea, MD;
for the Clinical Guidelines Committee of the American College of Physicians (*)

From the American College of Physicians
and Penn Health System,
Philadelphia, Pennsylvania;
Minneapolis Veterans Affairs Medical Center,
Minneapolis, Minnesota; and
Yale School of Medicine,
New Haven, Connecticut.

The American College of Physicians (ACP) released updated guidelines this week that recommend the use of noninvasive, non-drug treatments for low back pain before resorting to drug therapies, which were found to have limited benefits. One of the non-drug options cited by ACP is spinal manipulation.

Chiropractors, who diagnose and treat musculoskeletal disorders, are experts in spinal manipulation.

On May 1, 2017, the New York Times published an editorial by Aaron E. Carroll, M.D., that mentions the new guideline in a generally positive light. The article appeared in a major, mainstream publication read by millions of people. “Spinal manipulation — along with other less traditional therapies like heat, meditation and acupuncture — seems to be as effective as many other more medical therapies we prescribe, and as safe, if not safer,” he wrote.

Talking points on new ACP guideline:

  • The chiropractic profession has advocated for decades that conservative care choices such as chiropractic be the first line of treatment for low-back pain. Now, with this new guideline, the medical profession is recognizing the benefits of conservative care for this common problem.
  • Thanks to this guideline, it’s possible more medical doctors will choose to refer their patients with low-back pain to chiropractors.
  • The ACP guideline was adopted by the American Chiropractic Association, which also adopted the Clinical Compass guidelines on chiropractic for LBP at its HOD meeting in March.

DESCRIPTION: &nbsp The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain.

METHODS: &nbsp Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain. Updated searches were performed through November 2016. Clinical outcomes evaluated included reduction or elimination of low back pain, improvement in back-specific and overall function, improvement in health-related quality of life, reduction in work disability and return to work, global improvement, number of back pain episodes or time between episodes, patient satisfaction, and adverse effects.

TARGET AUDIENCE AND PATIENT POPULATION: &nbsp The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute, subacute, or chronic low back pain.

RECOMMENDATION 1:   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). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation).

WARNING:   Before following Recommendation #1,
please review the

Contra-indications to NSAIDS use


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Guidelines Section