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Yearly Archives: 2016

Back and Pelvic Pain in an Underserved United States Pregnant Population

By |January 19, 2016|Low Back Pain, Pregnancy|

Back and Pelvic Pain in an Underserved United States Pregnant Population: A Preliminary Descriptive Survey

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther. 2007 (Feb); 30 (2): 130–134

Clayton D. Skaggs, DC, Heidi Prather, DO,
Gilad Gross, MD, James W. George, DC,
Paul A. Thompson, PhD, D. Michael Nelson, MD, PhD

Department of Obstetrics and Gynecology,
Washington University School of Medicine,
St Louis, MO, USA.
skaggsdc@swbell.net

OBJECTIVE:   The objective of this study was to identify the prevalence of back pain and treatment satisfaction in a population of low-socioeconomic pregnant women.

METHODS:   This study used a cross-sectional design to determine the prevalence of self-reported musculoskeletal pain in pregnancy for 599 women. Women completed an author-generated musculoskeletal survey in the second trimester of their pregnancy that addressed pain history, duration, location, and intensity, as well as activities of daily living, treatment frequency, and satisfaction with treatment.

RESULTS:   Sixty-seven percent of the total population reported musculoskeletal pain, and nearly half presented with a multi-focal pattern of pain that involved 2 or more sites. Twenty-one percent reported severe pain intensity rated on a numerical rating scale. Eighty percent of women experiencing pain slept less than 4 hours per night and 75% of these women took pain medications. Importantly, 85% of the women surveyed perceived that they had not been offered treatment for their musculoskeletal disorders.

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A Non-surgical Approach to the Management of Lumbar Spinal Stenosis

By |January 17, 2016|Spinal Stenosis|

A Non-surgical Approach to the Management of Lumbar Spinal Stenosis: A Prospective Observational Cohort Study

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SOURCE:   BMC Musculoskelet Disord. 2006 (Feb 23); 7: 16

Donald R Murphy, Eric L Hurwitz,
Amy A Gregory, and Ronald Clary

Rhode Island Spine Center,
Pawtucket, RI 02860, USA.

BACKGROUND:   While it is widely held that non-surgical management should be the first line of approach in patients with lumbar spinal stenosis (LSS), little is known about the efficacy of non-surgical treatments for this condition. Data are needed to determine the most efficacious and safe non-surgical treatment options for patients with LSS. The purpose of this paper is to describe the clinical outcomes of a novel approach to patients with LSS that focuses on distraction manipulation (DM) and neural mobilization (NM).

METHODS:   This is a prospective consecutive case series with long term follow up (FU) of fifty-seven consecutive patients who were diagnosed with lumbar spinal stenosis (LSS). Two were excluded because of absence of baseline data or failure to remain in treatment to FU. Disability was measured using the Roland Morris Disability Questionnaire (RM) and pain intensity was measured using the Three Level Numerical Rating Scale (NRS). Patients were also asked to rate their perceived percentage improvement.

RESULTS:   The mean patient-rated percentage improvement from baseline to the end to treatment was 65.1%. The mean improvement in disability from baseline to the end of treatment was 5.1 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability from baseline to the end of treatment was seen in 66.7% of patients. The mean improvement in “on average” pain intensity was 1.6 points. This did not reach the threshold for clinical meaningfulness. The mean improvement in “at worst” pain was 3.1 points. This was considered to be clinically meaningful. The mean duration of FU was 16.5 months. The mean patient-rated percentage improvement from baseline to long term FU was 75.6%. The mean improvement in disability was 5.2 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability was seen in 73.2% of patients. The mean improvement in “on average” pain intensity from baseline to long term FU was 3.0 points. This was considered to be clinically meaningful. The mean improvement in “at worst” pain was 4.2 points. This was considered to be clinically meaningful. Only two patients went on to require surgery. No major complications to treatment were noted.

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Overtreating Chronic Back Pain: Time to Back Off?

By |January 16, 2016|Evidence-based Medicine, Low Back Pain|

Overtreating Chronic Back Pain: Time to Back Off?

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SOURCE:   J Am Board Fam Med. 2009 (Jan); 22 (1): 62–68

Richard A. Deyo, M.D., M.P.H., Sohail K. Mirza, M.D., M.P.H.,
Judith A. Turner, Ph.D., and Brook I. Martin, M.P.H.

Department of Medicine,
Oregon Health and Science University,
Portland, OR, USA.
deyor@ohsu.edu

Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. Some of these have become widely used for indications that are not well validated, leading to uncertainty about efficacy and safety, increasing complication rates, and marketing abuses.

Recent studies document a

629% increase in Medicare expenditures for epidural steroid injections;

a 423% increase in expenditures for opioids for back pain;

a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries;

and a 220% increase in spinal fusion surgery rates.

The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain.

 

From the FULL TEXT Article:

Introduction

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Effects of Upper and Lower Cervical Spinal Manipulative Therapy on Blood Pressure

By |January 14, 2016|Blood Pressure|

Effects of Upper and Lower Cervical Spinal Manipulative Therapy on Blood Pressure and Heart Rate Variability in Volunteers and Patients With Neck Pain: A Randomized Controlled, Cross-Over, Preliminary Study

The Chiro.Org Blog

SOURCE:   J Chiro Med 2015 (Mar); 14 (1): 1–9 ~ FULL TEXT

Ni Ni Win, MBBS, PhD, Anna Maria S. Jorgensen, PhD,
Yu Sui Chen, PhD, and Michael T. Haneline, DC, MPH

Senior Lecturer, International Medical University,
Chiropractic, School of Health Sciences,
Kuala Lumpur, Malaysia

OBJECTIVE:   The aims of this study were to examine autonomic nervous system responses by using heart rate variability analysis (HRV), hemodynamic parameters and numeric pain scale (NPS) when either upper (C1 and C2) or lower (C6 and C7) cervical segments were manipulated in volunteers, and whether such response would be altered in acute mechanical neck pain patients after spinal manipulative therapy (SMT).

METHODS:   A randomized controlled, cross-over, preliminary study was conducted on 10 asymptomatic normotensive volunteers and 10 normotensive patients complaining of acute neck pain. HRV, blood pressure (BP) and heart rate (HR), and NPS were recorded after upper cervical and lower cervical segments SMT in volunteer and patient groups.

RESULTS:   The standard deviation of average normal to normal R-R intervals (SDNN) increased (83.54 ± 22 vs. 105.41 ± 20; P = .02) after upper cervical SMT. The normalized unit of high frequency (nuHF), which shows parasympathetic activity, was predominant (40.18 ± 9 vs. 46.08 ± 14) after upper cervical SMT (P = .03) with a significant decrease (109 ± 10 vs. 98 ± 5) in systolic BP (P = .002). Low frequency to high frequency (LF/HF) ratio, which shows predominance of sympathetic activity increased (1.05 ± 0.7 vs. 1.51 ± 0.5; P = .02) after lower cervical SMT in the healthy volunteers group. However, there was an increase in SDNN (70.48 ± 18 vs. 90.23 ± 20; P = .02 and 75.19 ± 16 vs 97.52 ± 22; P = .01), a decrease in LF/HF ratio (1.33 ± 0.3 vs. 0.81 ± 0.2; P = .001 and 1.22 ± 0.4 vs. 0.86 ± 0.3; P = .02), which was associated with decreased systolic BP (105 ± 10 vs. 95 ± 9; P = .01 and 102 ± 9 vs. 91 ± 10; P = .02) and NPS scores (3 ± 1 vs. 0; P = .01 and 3 ± 1 vs. 1 ± 1; P = .03) following both upper and lower cervical SMT in the patient’s group. The baseline HR was 67 ± 9 vs 64 ± 5 (upper cervical) and 65 ± 7 vs 69 ± 11 (lower cervical) in both the healthy volunteer’ and patient’ groups.

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Morbidity and Mortality of Major Adult Spinal Surgery. A Prospective Cohort Analysis of 942 Consecutive Patients

By |January 12, 2016|Iatrogenic Injury|

Morbidity and Mortality of Major Adult Spinal Surgery. A Prospective Cohort Analysis of 942 Consecutive Patients

The Chiro.Org Blog

SOURCE:   Spine J. 2012 (Jan);   12 (1):   22–34

John T. Street, Brian J. Lenehan, Christian P. DiPaola et. al

Combined Neurosurgical and Orthopedic Spine Program,
Vancouver General Hospital,
818 West 10th Ave.,
Vancouver, British Columbia, Canada

BACKGROUND CONTEXT:   To date, most reports on the incidence of adverse events (AEs) in spine surgery have been retrospective and dependent on data abstraction from hospital-based administrative databases. To our knowledge, there have been no previous rigorously performed prospective analysis of all AEs occurring in the entire population of patients presenting to an academic quaternary referral center.

PURPOSE:   To determine the mortality and true incidence and severity of morbidity (major and minor, medical and surgical) in adults undergoing complex spinal surgery, both trauma and elective, in a quaternary referral center. To examine the influence of the introduction of a dedicated weekly multidisciplinary rounds, and a formal abstraction tool, on the recording of this prospective perioperative morbidity data. To examine the validity and inter- and intraobserver reliability of a dedicated Spine AdVerse Events Severity system, version 2 (SAVES V2) AE abstraction tool.

STUDY DESIGN:   Ours is an academic quaternary referral center serving a population of 4.5 million people. Beginning in April 2008, a spine-specific AE-recording instrument, entitled SAVES V2, was introduced at our center for reporting, categorization, and classification of AEs. The use of this system remains an ongoing prospective study.

PATIENT SAMPLE:   All adult patients admitted to the spine service of a quaternary referral center for a 12-month period.

OUTCOME MEASURES:   A validity and an inter- and intraobserver reliability examination of the SAVES V2 system, as used at our institution. Morbidity and inhospital deaths, unplanned second surgeries during index admission, wound infections requiring reoperation, and readmissions during the same calendar year. We also examined in detail all intraoperative and nonsurgical postoperative AEs, as well as hospital length of stay (LOS).

METHODS:   Data on all patients undergoing surgery over a 12-month period were prospectively collected using a perioperative morbidity abstraction tool at weekly dedicated mortality and morbidity rounds. This tool allows identification of each specific AE and grades the severity. Before the introduction of this system, and using the hospital inpatient database, our documented perioperative morbidity rate (major and minor, medical and surgical) was 23%. Diagnosis, operative data, hospital data, major and minor complications both medical and surgical, and deaths were recorded.

RESULTS:   One hundred percent of all patients discharged from the unit had complete data available for analysis. Nine hundred forty-two patients with an age range of 16 to 90 years (mean, 54 years; mode, 38 years) were identified. There were 552 males and 390 females. Around 58.5% of patients had undergone elective surgery. Thirty percent of patients were American Spinal Injury Association class D or worse on admission.

The average hospital length of stay was 13.5 days (range, 1-221 days).

  • Eight hundred twenty-two (87%) patients had at least one documented complication.
  • Thirty-nine percent of these adversely affected hospital length of stay.
  • There were 14 mortalities during the study period.
  • The rate of intraoperative surgical complication was 10.5% (4.5% incidental durotomy and 1.9% hardware malposition requiring revision and 2.2% blood loss >2 L).
  • The incidence of postoperative complication was 73.5%
    (wound complications, 13.5%; delerium, 8%; pneumonia, 7%; neuropathic pain, 5%; dysphagia, 4.5%; and neurological deterioration, 3%).

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Chiropractic Spinal Manipulative Therapy for Cervicogenic Headache

By |January 9, 2016|Headache|

Chiropractic Spinal Manipulative Therapy for Cervicogenic Headache: A Study Protocol of a Single-blinded Placebo-controlled Randomized Clinical Trial

The Chiro.Org Blog

SOURCE:   Springerplus. 2015 (Dec 16);   4:   779

Aleksander Chaibi, Jurate Šaltyte Benth, Peter J. Tuchin, and Michael Bjørn Russell

Head and Neck Research Group,
Research Centre, Akershus University Hospital,
1478 Lørenskog, Norway ;

Institute of Clinical Medicine,
Akershus University Hospital, University of Oslo,
1474 Nordbyhagen, Norway

Cervicogenic headache (CEH) is a secondary headache which affects 1.0-4.6% of the population. Although the costs are unknown, the health consequences are substantial for the individual; especially considering that they often suffers chronicity. Pharmacological management has no or only minor effect on CEH. Thus, we aim to assess the efficacy of chiropractic spinal manipulative therapy (CSMT) for CEH in a single-blinded placebo-controlled randomized clinical trial (RCT). According to the power calculations, we aim to recruit 120 participants to the RCT. Participants will be randomized into one of three groups; CSMT, placebo (sham manipulation) and control (usual non-manual management). The RCT consists of three stages: 1 month run-in, 3 months intervention and follow-up analyses at the end of intervention and 3, 6 and 12 months. Primary end-point is headache frequency, while headache duration, headache intensity, headache index (frequency × duration × intensity) and medicine consumption are secondary end-points. Primary analysis will assess a change in headache frequency from baseline to the end of intervention and to follow-up, where the groups CSMT and placebo and CSMT and control will be compared. Due to two group-comparisons, the results with p values below 0.025 will be considered statistically significant. For all secondary end-points and analyses, the significance level of 0.05 will be used. The results will be presented with the corresponding p values and 95 % confidence intervals. To our knowledge, this is the first prospective manual therapy three-armed single-blinded placebo-controlled RCT to be conducted for CEH. Current RCTs suggest efficacy in headache frequency, duration and intensity. However a firm conclusion requires clinical single-blinded placebo-controlled RCTs with few methodological shortcomings. The present study design adheres to the recommendations for pharmacological RCTs as far as possible and follows the recommended clinical trial guidelines by the International Headache Society.

Trial registration ClinicalTrials.gov identifier: NCT01687881, 2 December 2012.

KEYWORDS:   Cervicogenic headache; Chiropractic; Headache; Manual therapy; Protocol; Randomized controlled trial; Spinal manipulation

 

From the FULL TEXT Article:

Background

The prevalence of cervicogenic headache (CEH) is low and varies from 1.0 to 4.6 % in the general population, depending on the applied diagnostic criteria, i.e. 1.0 % if 6 and 4.6 % if 5 diagnostic criteria of the Cervicogenic Headache International Study Group are fulfilled, and 2.5 % if the criteria of the International Headache Society (IHS) are applied (Table 1) (Nilsson 1995a; Pareira Monteriro 1995; Sjaastad et al. 1998; Sjaastad and Bakketeig 2008; Headache Classification Subcommittee of the International Headache Society 2013). Headache disorders have substantial health and socio-economic costs (Vos et al. 2012). However, no studies have exclusively investigated the costs for CEH.

Table 1. Diagnostic criteria for cervicogenic headache by the Cervicogenic Headache International Study Group

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