2020 – Page 4 – Chiropractic Resource Organization

Impact of Chiropractic Care on Use of Prescription Opioids

By Frank M. Painter|March 14, 2020|Spinal Pain|

Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain

SOURCE: Pain Med. 2020 (Mar 6) [Epub]

James M. Whedon, DC, MS, Andrew W. J. Toler, MS, Louis A. Kazal, MD, Serena Bezdjian, PhD, Justin M. Goehl, DC, MS et al.

Southern California University of Health Sciences,
Whittier, California.

OBJECTIVE: Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain.

DESIGN AND SETTING: We employed a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012-2017.

SUBJECTS: We included adults aged 18-84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain. We identified two cohorts of subjects: Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care.

METHODS: We performed adjusted time-to-event analyses to compare recipients and nonrecipients with regard to the risk of filling an opioid prescription. We stratified the recipient populations as: acute (first chiropractic encounter within 30 days of diagnosis) and nonacute (all other patients).

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SPINAL PAIN MANAGEMENT Page

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Diagnostic Accuracy of Videofluoroscopy

By Frank M. Painter|March 12, 2020|Videofluoroscopy, Whiplash|

Diagnostic Accuracy of Videofluoroscopy for Symptomatic Cervical Spine Injury Following Whiplash Trauma

The Chiro.Org Blog

SOURCE: Int J Environ Res Public Health. 2020 (Mar 5); 17 (5): E1693

Michael D. Freeman, Evan A. Katz, Scott L. Rosa, Bryan G. Gatterman, Ellen M. F. Strömmer, and Wendy M. Leith

CAPHRI School for Public Health and Primary Care,
Faculty of Health, Medicine, and Life Sciences,
Maastricht University, 6211 LM
Maastricht, The Netherlands.

BACKGROUND: Intervertebral instability is a relatively common finding among patients with chronic neck pain after whiplash trauma. Videofluoroscopy (VF) of the cervical spine is a potentially sensitive diagnostic tool for evaluating instability, as it offers the ability to examine relative intervertebral movement over time, and across the entire continuum of voluntary movement of the patient. At the present time, there are no studies of the diagnostic accuracy of VF for discriminating between injured and uninjured populations.

METHODS: Symptomatic (injured) study subjects were recruited from consecutive patients with chronic (>6 weeks) post-whiplash pain presenting to medical and chiropractic offices equipped with VF facilities. Asymptomatic (uninjured) volunteers were recruited from family and friends of patients. An ethical review and oversight were provided by the Spinal Injury Foundation, Broomfield, CO.

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Radiology Page and the:

Whiplash Page

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Treatment of Patients with Low Back Pain

By Frank M. Painter|March 5, 2020|Cost-Effectiveness of Chiropractic|

Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation

The Chiro.Org Blog

SOURCE: Healthcare (Basel). 2020 (Feb 24); 8 (1): E44

Nima Khodakarami

Department of Health Policy and Management,
Texas A&M University,
College Station, TX 77843, USA.

FROM:
Americans’ Perceptions of Chiropractic 2015

Low back pain (LBP) is a pandemic and costly musculoskeletal condition in the United States (U.S.). Patients with LBP may endure surgery, injections, and expensive visits to emergency departments. Some suggest that using physical therapy (PT) or chiropractic in the earlier stage of LBP reduces the utilization of expensive health services and lowers the treatment costs. Given that there are costs and benefits with each of these treatments, the remaining question is in a short period of time which of these treatments is optimal. The purpose of this study was to investigate the cost-effectiveness of chiropractic versus PT in the U.S. A decision tree analytic model was used for estimating the economic outcomes. The findings showed that the total average cost in the chiropractic group was $48.56 lower than the PT group. The findings also showed that the daily adjusted life years (DALY) in the chiropractic group was 0.0043 higher than the PT group. Chiropractic care was shown to be a cost-effective alternative compared with PT for adults with at least three weeks of LBP over six months.

KEYWORDS: Keywords: chiropractic; physical therapy; treatment outcome; low back pain; therapy; economics; patient satisfaction; recurrence; health care costs; illness

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Benefits and Harms of Spinal Manipulative Therapy

By Frank M. Painter|February 28, 2020|Adverse Events|

Benefits and Harms of Spinal Manipulative Therapy for the Treatment of Chronic Low Back Pain: Systematic Review and Meta-analysis of Randomised Controlled Trials

The Chiro.Org Blog

SOURCE: British Medical Journal 2019 (Mar 13)

Sidney M Rubinstein, Annemarie de Zoete, Marienke van Middelkoop, Willem J J Assendelft, Michiel R de Boer, and Maurits W van Tulder

Department of Health Sciences,
Faculty of Science,
Vrije Universiteit Amsterdam,
De Boelelaan 1085, 1081HV
Amsterdam, Netherlands

OBJECTIVE: To assess the benefits and harms of spinal manipulative therapy (SMT) for the treatment of chronic low back pain.

DESIGN: Systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES: Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Physiotherapy Evidence Database (PEDro), Index to Chiropractic Literature, and trial registries up to 4 May 2018, including reference lists of eligible trials and related reviews.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials examining the effect of spinal manipulation or mobilisation in adults (≥18 years) with chronic low back pain with or without referred pain. Studies that exclusively examined sciatica were excluded, as was grey literature. No restrictions were applied to language or setting.

REVIEW METHODS: Two reviewers independently selected studies, extracted data, and assessed risk of bias and quality of the evidence.

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ADVERSE EVENTS Page

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The Myth of the Placebo Response

By Frank M. Painter|February 26, 2020|Placebo|

The Myth of the Placebo Response

The Chiro.Org Blog

SOURCE: Frontiers in Pychiatry 2019 (Aug 16); 10: 577

Wayne Jonas, MD

Department of Family Medicine,
Uniformed Services University,
Bethesda, MD, United States.

The placebo response is a myth. It does not exist in reality, and continuing to name it is hindering the optimal application of science to healing in medicine. On the surface, it is obvious that, when defined as a biological response to an inert pill (like a sugar pill), the idea of a “response” to a placebo is impossible. Inert treatments by definition do not produce responses. So why do we continue to ponder why people get better from taking inert substances and base our acceptance of legitimate treatments on demonstrating that they go beyond that response? The problem arises because we have flawed assumptions of the value that reductionistic science and the demonstration of specific effects has for healing. To support those flawed assumptions, we support the idea of “the placebo response.” This causes confusion among patients, clinicians, regulators, and even scientists.

Legitimate medical treatments have become defined as those that do more than produce a placebo response. An entire pharmaceutical industry and its regulators attempt to control and profit by proving that small molecules produce a clinical effect greater than the placebo response. Billions of dollars are made when that is proven, often even when the size of the response in the active over the placebo group is miniscule. The fact is people heal and that inherent healing capacity is both powerful and influenced by mental, social, and contextual factors that are embedded in every medical encounter since the idea of treatment began. In this chapter, I argue that our understanding of healing and ability to enhance it will be accelerated if we stop using the term “placebo response” and call it what it is – the meaning response, and its special application in medicine called the healing response.

KEYWORDS: healing; myth; placebo; response; traditional

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PROBLEMS WITH PLACEBOS Page

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Outcome Measures for Assessing the Effectiveness

By Frank M. Painter|February 17, 2020|Migraine|

Outcome Measures for Assessing the Effectiveness of Non-pharmacological Interventions in Frequent Episodic or Chronic Migraine: A Delphi Study

The Chiro.Org Blog

SOURCE: BMJ Open. 2020 (Feb 12); 10 (2): e029855

Kerstin Luedtke, Annika Basener, Stephanie Bedei, Rene Castien, Aleksander Chaibi, et al

Pain and Exercise Research,
Universitat zu Lubeck Sektion Medizin,
Lubeck, Germany
kerstin.luedtke@uni-luebeck.de

OBJECTIVES: The aim of this Delphi survey was to establish an international consensus on the most useful outcome measures for research on the effectiveness of non-pharmacological interventions for migraine. This is important, since guidelines for pharmacological trials recommend measuring the frequency of headaches with 50% reduction considered a clinically meaningful effect. It is unclear whether the same recommendations apply to complementary (or adjunct) non-pharmacological approaches, whether the same cut-off levels need to be considered for effectiveness when used as an adjunct or stand-alone intervention, and what is meaningful to patients.

SETTING: University-initiated international survey.

PARTICIPANTS: The expert panel was chosen based on publications on non-pharmacological interventions in migraine populations and from personal contacts. 35 eligible researchers were contacted, 12 agreed to participate and 10 completed all 3 rounds of the survey. To further explore how migraine patients viewed potential outcome measures, four migraine patients were interviewed and presented with the same measurement tools as the researchers.

PROCEDURES: The initial Delphi round was based on a systematic search of the literature for outcome measures used in non-pharmacological interventions for headache.

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HEADACHE Page

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Yearly Archives: 2020

Impact of Chiropractic Care on Use of Prescription Opioids

Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain

Diagnostic Accuracy of Videofluoroscopy

Diagnostic Accuracy of Videofluoroscopy for Symptomatic Cervical Spine Injury Following Whiplash Trauma

Treatment of Patients with Low Back Pain

Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation

Benefits and Harms of Spinal Manipulative Therapy

Benefits and Harms of Spinal Manipulative Therapy for the Treatment of Chronic Low Back Pain: Systematic Review and Meta-analysis of Randomised Controlled Trials

The Myth of the Placebo Response

The Myth of the Placebo Response

Outcome Measures for Assessing the Effectiveness

Outcome Measures for Assessing the Effectiveness of Non-pharmacological Interventions in Frequent Episodic or Chronic Migraine: A Delphi Study