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About Frank M. Painter

I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been, and remains, my favorite hobby.

Acute Inflammatory Response via Neutrophil Activation Protects Against the Development of Chronic Pain

By |June 12, 2022|Chiropractic Care, Chronic Pain Management|

Acute Inflammatory Response via Neutrophil Activation Protects Against the Development of Chronic Pain

The Chiro.Org Blog


SOURCE:   Science Translational Medicine 2022 (May 11)

Marc Parisien, Lucas V Lima, Concetta Dagostino, Nehme El-Hachem, Gillian L Drury, et. al.

Faculty of Dental Medicine and Oral Health Sciences,
Department of Anesthesia, Faculty of Medicine,
Alan Edwards Centre for Research on Pain,
McGill University,
Montreal, Quebec H3A 1G1, Canada.



Editorial Comment:

This novel new study suggests that prolonged NSAIDs use may be a cause of persistent pain. The authors stated:

Analysis of pain trajectories of human subjects reporting acute back pain in the UK Biobank identified elevated risk of pain persistence for subjects taking NSAIDs. Thus, despite analgesic efficacy at early time points, the management of acute inflammation may be counterproductive for long-term outcomes of LBP sufferers.”

FROM:   Pain Research Forum


Neutrophils Put the Brakes on Acute Pain Becoming Chronic

Neutrophils help prevent the transition from acute to chronic pain after injury.
Dampening their activity with anti-inflammatory drugs, like ibuprofen or diclofenac, can prolong pain duration
.


by Fred Schwaller on 25 May 2022

In the last few weeks, several news outlets like The New York Times and The Guardian have published provocative stories warning their readers that taking analgesics, like ibuprofen, can lead to the development of chronic back pain.

There is more like this @ our:

LOW BACK PAIN and the:

CHRONIC NECK PAIN and the:

SPINAL PAIN MANAGEMENT

(more…)

Characteristics, Expectations, Experiences of Care, and Satisfaction of Patients Receiving Chiropractic Care in a French University Hospital in Toulouse (France) Over One Year: A Case Study

By |June 10, 2022|Cost-Effectiveness of Chiropractic, Patient Satisfaction|

Characteristics, Expectations, Experiences of Care, and Satisfaction of Patients Receiving Chiropractic Care in a French University Hospital in Toulouse (France) Over One Year: A Case Study

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord 2022 (Mar 9); 23 (1): 229

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Mallard F, Lemeunier N, Mior S, Pecourneau V, and Côté P

Division of Graduate Studies,
Canadian Memorial Chiropractic College (CMCC),
Toronto, Ontario, Canada.



FROM: ChiroUp (2021)


Background:   In October 2017, a partnership was established between the University Hospital of Toulouse and the French Chiropractic College, “Institut Franco-Européen de Chiropraxie” (IFEC). Before 2017, chiropractors did not practice in hospitals in France. Chiropractic students and chiropractors are now integrated in an interdisciplinary medical team at University Hospital. Our study aimed to describe the characteristics of patients who received chiropractic care at the University Hospital of Toulouse, their expectations, experiences of care, and satisfaction.

Method:   A prospective case study was conducted. Patients referred for chiropractic care in the French University Hospital of Toulouse from January to December 2020 were eligible to participate. Participants provided the following data: demographics, previous chiropractic care treatments, pain location, intensity (NRS) and duration, disability (NDI, ODI), health-related quality of life (SF-12) and depressive symptomatology (PHQ-9). We conducted semi-structured interviews to explore their expectations, barriers and facilitators impacting their experience of care, and satisfaction.

Method:   Seventeen participants were recruited and seven were interviewed. All participants had chronic pain with a median pain intensity of 05/10 (IQR 04-06) on the NRS scale. Nine of 17 participants presented with multiple pain locations. Thirteen of seventeen participants presented with low back pain and eight with neck pain. The median SF-12 health-related quality of life score was 50/100 (IQR 28.5-60.5) for physical health, and 52/100 (IQR 43-62) for mental health. The PHQ-9 median score of depressive symptomatology was 7.7/27 (IQR 2.0-12.5). Overall, participants were satisfied with their care and the collaboration between chiropractors and physicians. Participants expected a caring communication with the chiropractic team. Their experience was facilitated by their trust in their physician. Patients perceived the turnover of chiropractic students as a barrier to their satisfaction.

There is more like this @ our:

COST-EFFECTIVENESS Section and the:

PATIENT SATISFACTION Section and the:

INITIAL PROVIDER/FIRST CONTACT Section

(more…)

Spinal Manipulative Therapy in Older Adults with Chronic Low Back Pain: An Individual Participant Data Meta-analysis

By |June 5, 2022|Chiropractic Care, Chiropractic Management, Chronic Low Back Pain|

Spinal Manipulative Therapy in Older Adults with Chronic Low Back Pain: An Individual Participant Data Meta-analysis

The Chiro.Org Blog


SOURCE:   European Spine Journal 2022 (May 28) [EPUB]

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Alan Jenks, Annemarie de Zoete, Maurits van Tulder, Sidney M Rubinstein, International IPD-SMT group

Faculty of Science,
Department of Health Sciences,
Vrije Universiteit,
Gebouw MF, Flexruimte,
Van der Boechorststraat 7,
1081 BT, Amsterdam,
The Netherlands.



Purpose:   Many systematic reviews have reported on the effectiveness of spinal manipulative therapy (SMT) for low back pain (LBP) in adults. Much less is known about the older population regarding the effects of SMT.

Objective:   To assess the effects of SMT on pain and function in older adults with chronic LBP in an individual participant data (IPD) meta-analysis.

Setting:   Electronic databases from 2000 until June 2020, and reference lists of eligible trials and related reviews.

Design and subjects:   Randomized controlled trials (RCTs) which examined the effects of SMT in adults with chronic LBP compared to interventions recommended in international LBP guidelines.

Methods:   Authors of trials eligible for our IPD meta-analysis were contacted to share data. Two review authors conducted a risk of bias assessment. Primary results were examined in a one-stage mixed model, and a two-stage analysis was conducted in order to confirm findings.

Main outcomes and measures:   Pain and functional status examined at 4, 13, 26, and 52 weeks.

Results:   10 studies were retrieved, including 786 individuals, of which 261 were between 65 and 91 years of age. There is moderate-quality evidence that SMT results in similar outcomes at 4 weeks (pain: mean difference [MD] – 2.56, 95% confidence interval [CI] – 5.78 to 0.66; functional status: standardized mean difference [SMD] – 0.18, 95% CI – 0.41 to 0.05). Second-stage and sensitivity analysis confirmed these findings.

There is more like this @ our:

MEDICARE Section and the:

LOW BACK PAIN Section

(more…)

Where to Start? A Two Stage Residual Inclusion Approach to Estimating Influence of the Initial Provider on Health Care Utilization and Costs for Low Back Pain in the US

By |May 28, 2022|Cost-Effectiveness of Chiropractic, Initial Provider|

Where to Start? A Two Stage Residual Inclusion Approach to Estimating Influence of the Initial Provider on Health Care Utilization and Costs for Low Back Pain in the US

The Chiro.Org Blog


SOURCE:   BMC Health Serv Res 2022 (May 23); 22 (1): 694

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Kenneth J. Harwood, Jesse M. Pines, C. Holly A. Andrilla & Bianca K. Frogner

College of Health and Education,
Marymount University,
Arlington, VA, USA.



Background:   Diagnostic testing and treatment recommendations can vary when medical care is sought by individuals for low back pain (LBP), leading to variation in quality and costs of care. We examine how the first provider seen by an individual at initial diagnosis of LBP influences downstream utilization and costs.

Methods:   Using national private health insurance claims data, individuals age 18 or older were retrospectively assigned to cohorts based on the first provider seen at the index date of LBP diagnosis. Exclusion criteria included individuals with a diagnosis of LBP or any serious medical conditions or an opioid prescription recorded in the 6 months prior to the index date. Outcome measures included use of imaging, back surgery rates, hospitalization rates, emergency department visits, early- and long-term opioid use, and costs (out-of-pocket and total costs of care) twelve months post-index date. We used a two-stage residual inclusion (2SRI) estimation approach comparing copay for the initial provider visit and differential distance as the instrumental variable to reduce selection bias in the choice of first provider, controlling for demographics.

Results:   Among 3,799,593 individuals, cost and utilization varied considerably based on the first provider seen by the patient. Copay and differential distance provided similar results, with copay preserving a greater sample size. The frequency of early opioid prescription was significantly lower when care began with an acupuncturist or chiropractor, and highest for those who began with an emergency medicine physician or advanced practice registered nurse (APRN). Long-term opioid prescriptions were low across most providers except physical medicine and rehabilitation physicians and APRNs. The frequency and time to serious illness varied little across providers. Total cost of care was lowest when starting with a chiropractor ($5,093) or primary care physician ($5,660), and highest when starting with an orthopedist ($9,434) or acupuncturist ($9,205).

There is more like this @ our:

COST-EFFECTIVENESS Section and the:

INITIAL PROVIDER/FIRST CONTACT Section

(more…)

Limited Prognostic Value of Pain Duration in Non-specific Neck Pain Patients Seeking Chiropractic Care

By |May 21, 2022|Chronic Neck Pain|

Limited Prognostic Value of Pain Duration in Non-specific Neck Pain Patients Seeking Chiropractic Care

The Chiro.Org Blog


SOURCE:   European Journal of Pain 2022 (Apr 21) [EPUB]

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David Guillén, Alexandros Guekos, Nadia Graf, Barry Kim Humphreys, Cynthia Peterson, Petra Schweinhardt

Faculty of Medicine,
University of Zurich,
Zurich, Switzerland.



Background:   Pain chronicity is considered an important prognostic factor for outcome. Here, it was investigated whether pain duration influences outcome when only chronic patients (pain >3 months) are considered. Secondary aims were to determine, in patients of any pain duration, how much variance in outcome is explained by pain duration and whether pain duration truly predicts outcomes, that is out-of-sample prediction in independent data.

Methods:   Secondary analysis of a cohort study of neck pain patients. Patients were assessed before start of treatment and at 1-week, 1-, 3-, 6- and 12-month follow-up. Outcomes were patient global impression of change (PGIC) and percent change in patients’ perceived pain intensity, rated on a numerical rating scale (NRS). Regression analyses (linear and logistic) and supervised machine learning were used to test the influence of pain duration on PGIC and percent NRS change at 1-week, 1-, 3-, 6- and 12-month follow-up within sample and out-of-sample. Separate analyses were performed for the full sample (n = 720) and for chronic patients (n = 238) only.

Results:   No relationship between pain duration and outcome was found for chronic patients only. For the full sample, statistical relationships between pain duration and outcomes were observed at all tested follow-up time points. However, the amount of variance in outcome explained by pain duration was low and no out-of-sample prediction was possible.

There are more articles like this @ our:

CHRONIC NECK PAIN Section

(more…)