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Spine-area Pain in Military Personnel

By |May 29, 2018|Veterans|

Spine-area Pain in Military Personnel: A Review of Epidemiology, Etiology, Diagnosis, and Treatment

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SOURCE:   Spine J. 2012 (Sep); 12 (9): 833-842

Steven P. Cohen, MD, Rollin M. Gallagher, MD, MPH, Shelton A. Davis, MD, Scott R. Griffith, MD, Eugene J. Carragee, MD

Pain Management Division, Department of Anesthesiology & Critical Care Medicine,
Johns Hopkins School of Medicine,
Baltimore, MD 21205, USA.



BACKGROUND CONTEXT:   non-battle illnesses and injuries are the major causes of unit attrition in modern warfare. Spine-area pain is a common disabling injury in service members associated with a very low return-to-duty (RTD) rate.

PURPOSE:   To provide an overview of the current understanding of epidemiology, possible causes, and relative prognosis of spine-area pain syndromes in military personnel, including a discussion of various treatment options available in theaters of operation.

STUDY DESIGN:   Literature review.

METHODS:   Search focusing on epidemiology, etiology and associative factors, and treatment of spinal pain using electronic databases, textbooks, bibliographic references, and personal accounts.

RESULTS:   Spine-area pain is the most common injury or complaint “in garrison” and appears to increase during training and combat deployments. Approximately three-quarters involve low back pain, followed by cervical and midback pain syndromes. Some predictive factors associated with spine-area pain are similar to those observed in civilian cohorts, such as psychosocial distress, heavy physical activity, and more sedentary lifestyle. Risk factors specific to military personnel include concomitant psychological trauma, g-force exposure in pilots and airmen, extreme shock and vibration exposure, heavy combat load requirements, and falls incurred during airborne, air assault, and urban dismounted ground operations. Effective forward-deployed treatment has been difficult to implement, but newer strategies may improve RTD rates.

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Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain

By |May 23, 2018|Low Back Pain, Veterans|

Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone
on Pain and Disability Among US Service Members With Low Back Pain.
A Comparative Effectiveness Clinical Trial

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SOURCE:   JAMA Network Open. 2018 (May 18); 1 (1): e180105

Christine M. Goertz, DC, PhD 1; Cynthia R. Long, PhD 1; Robert D. Vining, DC 1; Katherine A. Pohlman, DC, MS 2; Joan Walter, JD, PA 3; Ian Coulter, PhD 4

(1) Palmer College of Chiropractic,
Palmer Center for Chiropractic Research,
Davenport, Iowa

(2) Parker University Research Institute,
Dallas, Texas

(3) Samueli Institute for Information Biology,
Silver Spring, Maryland

(4) RAND Corporation,
Santa Monica, California



Importance   It is critically important to evaluate the effect of nonpharmacological treatments on low back pain and associated disability.

Objective   To determine whether the addition of chiropractic care to usual medical care results in better pain relief and pain-related function when compared with usual medical care alone.

Design, Setting, and Participants   A 3–site pragmatic comparative effectiveness clinical trial using adaptive allocation was conducted from September 28, 2012, to February 13, 2016, at 2 large military medical centers in major metropolitan areas and 1 smaller hospital at a military training site. Eligible participants were active-duty US service members aged 18 to 50 years with low back pain from a musculoskeletal source.

Interventions   The intervention period was 6 weeks. Usual medical care included self-care, medications, physical therapy, and pain clinic referral. Chiropractic care included spinal manipulative therapy in the low back and adjacent regions and additional therapeutic procedures such as rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies.

Main Outcomes and Measures   Coprimary outcomes were low back pain intensity (Numerical Rating Scale; scores ranging from 0 [no low back pain] to 10 [worst possible low back pain]) and disability (Roland Morris Disability Questionnaire; scores ranging from 0–24, with higher scores indicating greater disability) at 6 weeks. Secondary outcomes included perceived improvement, satisfaction (Numerical Rating Scale; scores ranging from 0 [not at all satisfied] to 10 [extremely satisfied]), and medication use. The coprimary outcomes were modeled with linear mixed-effects regression over baseline and weeks 2, 4, 6, and 12.

Results   Of the 806 screened patients who were recruited through either clinician referrals or self-referrals, 750 were enrolled (250 at each site). The mean (SD) participant age was 30.9 (8.7) years, 175 participants (23.3%) were female, and 243 participants (32.4%) were nonwhite. Statistically significant site × time × group interactions were found in all models. Adjusted mean differences in scores at week 6 were statistically significant in favor of usual medical care plus chiropractic care compared with usual medical care alone overall for low back pain intensity (mean difference, –1.1; 95% CI, –1.4 to –0.7), disability (mean difference, –2.2; 95% CI, –3.1 to –1.2), and satisfaction (mean difference, 2.5; 95% CI, 2.1 to 2.8) as well as at each site. Adjusted odd ratios at week 6 were also statistically significant in favor of usual medical care plus chiropractic care overall for perceived improvement (odds ratio = 0.18; 95% CI, 0.13–0.25) and self-reported pain medication use (odds ratio = 0.73; 95% CI, 0.54–0.97). No serious related adverse events were reported.

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Chiropractic Care Improves Usual Management for Low Back Pain

By |May 22, 2018|Veterans|

Chiropractic Care Improves Usual Management for Low Back Pain

The Chiro.Org Blog


SOURCE:   Medscape Medical News ~ May 21, 2018


Adding chiropractic care to standard medical management of low back pain (LBP) in a military population reduced patient-reported pain and disability and improved satisfaction scores compared with standard treatment alone, new data show.

The findings, reported by Christine M. Goertz, DC, PhD, from Palmer College of Chiropractic, Davenport, Iowa, and colleagues in an article published online May 18 in JAMA Network Open, confirm results from the team’s pilot study.

In addition, the new data align with recent guidelines from the American College of Physicians that recommend inclusion of spinal manipulation, among other nondrug treatments, as first-line therapy for acute and chronic low-back pain.

For the current study, Goertz and colleagues enrolled 750 active-duty US service members aged 18 to 50 years with LBP from three military facilities in a pragmatic comparative effectiveness trial.

Patients were screened between September 28, 2012, and November 20, 2015, and 250 patients from each of the study sites were allocated to receive usual medical care with chiropractic care (375 participants) or usual medical care alone (375 participants). Usual medical care was defined as any care recommended or prescribed by nonchiropractic military clinicians to treat LBP, including self-management advice, drug treatment, physical therapy, or referral to a pain clinic.

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Changes in Female Veterans’ Neck Pain Following Chiropractic Care at a Hospital for Veterans

By |February 7, 2018|Veterans|

Changes in Female Veterans’ Neck Pain Following Chiropractic Care at a Hospital for Veterans

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SOURCE:   Complement Ther Clin Pract. 2018 (Feb); 30: 91–95

Kelsey L.Corcoran DC, Andrew S.Dunn DC, MEd, MS, Bart N.Green DC, MSEd, PhD, Lance R.Formolo DC, MS, Gregory P.Beehler PhD, MA

Chiropractic Department,
Medical Care Line,
VA Western New York,
3495 Bailey Ave,
Buffalo, NY 14215, USA


OBJECTIVE:   To determine if U.S. female veterans had demonstrable improvements in neck pain after chiropractic management at a Veterans Affairs (VA) hospital.

METHODS:   This was a retrospective cross-sectional study of medical records from female veterans attending a VA chiropractic clinic for neck pain from 2009 to 2015. Paired t-tests were used to compare baseline and discharge numeric rating scale (NRS) and Neck Bournemouth Questionnaire (NBQ) scores with a minimum clinically important difference (MCID) set at a 30% change from baseline.

RESULTS:   Thirty-four veterans met the inclusion criteria and received a mean of 8.8 chiropractic treatments. For NRS, the mean score improvement was 2.7 (95%CI, 1.9–3.5, p < .001). For the NBQ, the mean score improvement was 13.7 (95%CI, 9.9–17.5, p < .001). For the MCID, the average percent improvement was 45% for the NRS and 38% for the NBQ.

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The Effect of Chiropractic Treatment on the Reaction and Response Times of Special Operation Forces Military Personnel

By |November 19, 2016|Veterans|

The Effect of Chiropractic Treatment on the Reaction and Response Times of Special Operation Forces Military Personnel: Study Protocol for a Randomized Controlled Trial

The Chiro.Org Blog


SOURCE:   Trials. 2016 (Sep 20); 17 (1): 457

James W. DeVocht, Dean L. Smith, Cynthia R. Long,
Lance Corber, Bridget Kane, Thomas M. Jones and
Christine M. Goertz

Palmer Center for Chiropractic Research,
741 Brady St,
Davenport, IA, 52803, USA.


BACKGROUND:   Chiropractic care is commonly used to treat musculoskeletal conditions and has been endorsed by clinical practice guidelines as being evidence-based and cost-effective for the treatment of patients with low back pain. Gaps in the literature exist regarding the physiological outcomes of chiropractic treatment. Previous pilot work has indicated the possibility of improvements in response time following the application of chiropractic treatment. However, it is unknown whether or not chiropractic treatment is able to improve reaction and response times in specific populations of interest. One such population is the U.S. military special operation forces’ (SOF) personnel.

METHODS:   This study is a randomized controlled trial of 120 asymptomatic volunteer SOF personnel. All participants are examined by a study doctor of chiropractic (DC) for eligibility prior to randomization. The participants are randomly allocated to either a treatment group receiving four treatments of chiropractic manipulative therapy (CMT) over 2 weeks or to a wait-list control group. The wait-list group does not receive any treatment but has assessments at the same time interval as the treatment group. The outcome measures are simple reaction times for dominant hand and dominant foot, choice reaction time with prompts calling for either hand or either foot, response time using Fitts’ law tasks for small movements involving eye-hand coordination, and brief whole body movements using the t-wall, a commercially available product. At the first visit, all five tests are completed so that participants can familiarize themselves with the equipment and protocol. Assessments at the second and the final visits are used for data analysis.

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A Cross-sectional Analysis of Clinical Outcomes Following Chiropractic Care in Veterans With and Without Post-traumatic Stress Disorder

By |July 21, 2016|Veterans|

A Cross-sectional Analysis of Clinical Outcomes Following Chiropractic Care in Veterans With and Without Post-traumatic Stress Disorder

The Chiro.Org Blog


SOURCE:   Mil Med. 2009 (Jun); 174 (6): 578–583

Andrew S. Dunn; Steven R. Passmore;
Jeanmarie Burke; David Chicoine

Chiropractic Service,
VA of Western New York Healthcare System,
3495 Bailey Avenue,
Buffalo, NY 14215, USA.


This study was a cross-sectional analysis of clinical outcomes for 130 veteran patients with neck or low back complaints completing a course of care within the chiropractic clinic at the VA of Western New York in 2006. Multivariate analysis of variance (MANOVA) was utilized, comparing baseline and discharge scores for both the neck and low back regions and for those patients with and without post-traumatic stress disorder (PTSD). Patients with PTSD (n = 21) experienced significantly lower levels of score improvement than those without PTSD (n = 119) on self-reported outcome measures of neck and low back disability. These findings, coupled with the theorized relationships between PTSD and chronic pain, suggest that the success of conservative forms of management for veteran patients with musculoskeletal disorders may be limited by the presence of PTSD. Further research is warranted to examine the potential contributions of PTSD on chiropractic clinical outcomes with this unique patient population.


From the FULL TEXT Article:

INTRODUCTION

A diagnosis of post-traumatic stress disorder (PTSD) can be conveyed when a person has been exposed to a traumatic event that could be perceived as threatening or that actually threatened the physical integrity of the individual or others, and his or her response involved fear, helplessness, or horror. [1] The person must also persistently re-experience the perception of the trauma and avoid reminders of the event while displaying symptoms of increased arousal (sleeplessness, irritability, outbursts) for at least 1 month, which disrupts their social, occupational, or other levels of functioning. [1]

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