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Potential Treatment Effect Modifiers for Manipulative Therapy for Children Complaining of Spinal Pain

By |April 29, 2020|Spinal Pain Management|

Potential Treatment Effect Modifiers for Manipulative Therapy for Children Complaining of Spinal Pain. Secondary Analyses of a Randomised Controlled Trial

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SOURCE:   Chiropractic & Manual Therapies 2019 (Dec 10)

Kristina Boe Dissing, Werner Vach, Jan Hartvigsen, Niels Wedderkopp & Lise Hestbæk

Department of Sports Science and Clinical Biomechanics,
Faculty of Health Sciences,
University of Southern Denmark,
Campusvej 55, DK-5230 Odense M, Denmark.


BACKGROUND:   In children, spinal pain is transitory for most, but up to 20% experience recurrent and bothersome complaints. It is generally acknowledged that interventions may be more effective for subgroups of those affected with low back pain. In this secondary analysis of data from a randomized clinical trial, we tested whether five indicators of a potential increased need for treatment might act as effect modifiers for manipulative therapy in the treatment of spinal pain in children. We hypothesized that the most severely affected children would benefit more from manipulative therapy.

METHOD:   This study was a secondary analysis of data from a randomised controlled trial comparing advice, exercises and soft tissue treatment with and without the years complaining of spinal pain. A text message system (SMS) and clinical examinations were used for data collection (February 2012 to April 2014).Five pre-specified potential effect modifiers were explored:

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Outcomes Indicators and a Risk Classification System for Spinal Manipulation Under Anesthesia

By |March 24, 2018|Spinal Pain Management|

Outcomes Indicators and a Risk Classification System for Spinal Manipulation Under Anesthesia: A Narrative Review and Proposal

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SOURCE:   Chiropractic & Manual Therapies 2018 (Mar 8); 26: 9

Dennis DiGiorgi, John L. Cerf, and Daniel S. Bowerman

Consultant Practice
Whitestone, NY, USA.


Over a period of decades chiropractors have utilized spinal manipulation under anesthesia (SMUA) to treat chronic back and neck pain. As an advanced form of manual therapy, SMUA is reserved for the patient whose condition has proven refractory to office-based manipulation and other modes of conservative care. Historically, the protocols and guidelines put forth by chiropractic MUA proponents have served as the clinical compass for directing MUA practice.

With many authors and MUA advocates having focused primarily on anticipated benefit, the published literature contains no resource dedicated to treatment precautions and contraindications. Also absent from current relevant literature is acknowledgement or guidance on the preliminary evidence that may predict poor clinical outcomes with SMUA. This review considers risk and unfavorable outcomes indicators in therapeutic decision making for spinal manipulation under anesthesia.

A new risk classification system is proposed that identifies patient safety and quality of care interests for a procedure that remains without higher-level research evidence. A scale which categorizes risk and outcome potential for SMUA is offered for the chiropractic clinician, which aims to elevate the standard of care and improve patient selection through the incorporation of specific indices from existing medical literature.

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Chiropractic Management of Postoperative Spine Pain

By |March 21, 2018|Spinal Pain Management|

Chiropractic Management of Postoperative Spine Pain: A Report of 3 Cases

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SOURCE:   J Chiropractic Medicine 2013 (Sep);   12 (3):   168–175

Christopher M. Coulisa, and Anthony J. Lisi

VA Connecticut Healthcare System,
West Haven, CT;
University of Bridgeport College of Chiropractic,
Bridgeport, CT.


OBJECTIVE:   The purpose of this case series is to describe chiropractic care including spinal manipulation for 3 patients with postsurgical spine pain.

CLINICAL FEATURES:   Three patients with postsurgical spine pain (1 cervical fusion, 1 lumbar discectomy, and 1 lumbar laminectomy) presented for chiropractic treatment at a major US medical center. Treatment included spinal manipulation and/or flexion-distraction mobilization based on patient response to joint loading strategies.

INTERVENTION AND OUTCOMES:   Two patients were treated with high-velocity, low-amplitude spinal manipulation; and 1 patient was treated with flexion-distraction mobilization. Treatment frequency and duration were 4 treatments over 4 weeks for case 1, 17 treatments over 7 years for case 2, and 5 treatments over 5 weeks for case 3. Subjective improvement was noted using numeric pain scores and functional changes; and upon completion, the patients reported being “satisfied” with their overall outcome. One episode of transient benign soreness was noted by 1 patient. No additional adverse events or effects were noted.

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