Frank M. Painter

Are Nonpharmacologic Interventions for Chronic Low Back Pain More Cost Effective Than Usual Care? Proof of Concept Results From a Markov Model

By Frank M. Painter|December 27, 2021|Chiropractic Management, Nonpharmacologic Therapies|

Are Nonpharmacologic Interventions for Chronic Low Back Pain More Cost Effective Than Usual Care? Proof of Concept Results From a Markov Model

SOURCE: Spine (Phila Pa 1976) 2019 (Oct 15); 44 (20): 1456–1464

Patricia M. Herman, ND, PhD; Tara A. Lavelle, PhD; Melony E. Sorbero, PhD; Eric L. Hurwitz, DC, PhD; Ian D. Coulter, PhD

RAND Corporation,
Santa Monica, CA

Study design: Markov model.

Objective: Examine the 1-year effectiveness and cost-effectiveness (societal and payer perspectives) of adding nonpharmacologic interventions for chronic low back pain (CLBP) to usual care using a decision analytic model-based approach.

Summary of background data : Treatment guidelines now recommend many safe and effective nonpharmacologic interventions for CLBP. However, little is known regarding their effectiveness in subpopulations (e.g., high-impact chronic pain patients), nor about their cost-effectiveness.

Methods: The model included four health states: high-impact chronic pain (substantial activity limitations); no pain; and two others without activity limitations, but with higher (moderate-impact) or lower (low-impact) pain. We estimated intervention-specific transition probabilities for these health states using individual patient-level data from 10 large randomized trials covering 17 nonpharmacologic therapies. The model was run for nine 6-week cycles to approximate a 1-year time horizon. Quality-adjusted life-year weights were based on six-dimensional health state short form scores; healthcare costs were based on 2003 to 2015 Medical Expenditure Panel Survey data; and lost productivity costs used in the societal perspective were based on reported absenteeism. Results were generated for two target populations: (1) a typical baseline mix of patients with CLBP (25% low-impact, 35% moderate-impact, and 40% high-impact chronic pain) and (2) high-impact chronic pain patients.

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NON-PHARMACOLOGIC THERAPY Section

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Effectiveness of Chiropractic Manipulation Versus Sham Manipulation for Recurrent Headaches in Children Aged 7-14 Years – A Randomised Clinical Trial

By Frank M. Painter|December 25, 2021|Headache, Pediatrics|

Effectiveness of Chiropractic Manipulation Versus Sham Manipulation for Recurrent Headaches in Children Aged 7-14 Years – A Randomised Clinical Trial

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2021 (Jan 7); 29: 1

Susanne Lynge, Kristina Boe Dissing, Werner Vach, Henrik Wulff Christensen, and Lise Hestbaek

Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Campusvej 55, 5230, Odense M, Denmark.

Background: To investigate the effectiveness of chiropractic spinal manipulation versus sham manipulation in children aged 7–14 with recurrent headaches.

Methods: Design: A two-arm, single-blind, superiority randomised controlled trial.

Setting: One chiropractic clinic and one paediatric specialty practice in Denmark, November 2015 to August 2020.

Participants: 199 children aged 7 to 14 years, with at least one episode of headache per week for the previous 6 months and at least one musculoskeletal dysfunction identified.

Interventions: All participants received standard oral and written advice to reduce headaches. In addition, children in the active treatment group received chiropractic spinal manipulation and children in the control group received sham manipulation for a period of 4 months. Number and frequency of treatments were based on the chiropractor’s individual evaluation in the active treatment group; the children in the control group received approximately eight visits during the treatment period.

Primary outcome measures: ‘Number of days with headache’, ‘pain intensity’ and ‘medication’ were reported weekly by text messages, and global perceived effect by text message after 4 months. A planned fixed sequence strategy based on an initial outcome data analysis was used to prioritize outcomes. ‘Number of days with headache’ and ‘pain intensity’ were chosen as equally important outcomes of highest priority, followed by

Results: Chiropractic spinal manipulation resulted in significantly fewer days with headaches (reduction of 0.81 vs. 0.41, p = 0.019, NNT = 7 for 20% improvement) and better global perceived effect (dichotomized into improved/not improved, OR = 2.8 (95% CI: 1.5–5.3), NNT = 5) compared with a sham manipulation procedure. There was no difference between groups for pain intensity during headache episodes. Due to methodological shortcomings, no conclusions could be drawn about medication use.

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Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults

By Frank M. Painter|December 23, 2021|Cost-Effectiveness, Low Back Pain, Medicare|

Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2021 (Dec 5)

James M. Whedon, DC, MSm Anupama Kizhakkeveettil, PhD, Andrew Toler, MS, Todd A. MacKenzie, PhD, Jon D. Lurie, MD, MS, Serena Bezdjian, PhD, Scott Haldeman, DC, MD, PhD, Eric Hurwitz, DC, PhD, Ian Coulter, PhD

Health Services Research,
Southern California University of Health Sciences,
Whittier, California.

FROM: The Facts on Medicare Spending (2019)

Objectives: The purpose of this study was to compare Medicare healthcare expenditures for patients who received long-term treatment of chronic low back pain (cLBP) with either opioid analgesic therapy (OAT) or spinal manipulative therapy (SMT).

Methods: We conducted a retrospective observational study using a cohort design for analysis of Medicare claims data. The study population included Medicare beneficiaries enrolled under Medicare Parts A, B, and D from 2012 through 2016. We assembled cohorts of patients who received long-term management of cLBP with OAT or SMT (such as delivered by chiropractic or osteopathic practitioners) and evaluated the comparative effect of OAT vs SMT upon expenditures, using multivariable regression to control for beneficiary characteristics and measures of health status, and propensity score weighting and binning to account for selection bias.

Results: The study sample totaled 28,160 participants, of whom 77% initiated long-term care of cLBP with OAT, and 23% initiated care with SMT. For care of low back pain specifically, average long-term costs for patients who initiated care with OAT were 58% lower than those who initiated care with SMT. However, overall long-term healthcare expenditures under Medicare were 1.87 times higher for patients who initiated care via OAT compared with those initiated care with SMT (95% CI 1.65-2.11; P < .0001).

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Manipulative Therapy for Pregnancy and Related Conditions: A Systematic Review

By Frank M. Painter|December 22, 2021|Chiropractic Management, Pregnancy|

Manipulative Therapy for Pregnancy and Related Conditions: A Systematic Review

The Chiro.Org Blog

SOURCE: Obstet Gynecol Surv 2009 (Jun); 64 (6): 416–427

Raheleh Khorsan, MA, Cheryl Hawk, DC, PhD, Anthony J. Lisi, DC, and Anupama Kizhakkeveettil, BAMS, MAOM

Military Medical Research and Integrative Medicine,
Samueli Institute,
Corona del Mar,
California 92625, USA

Objective: The objective of this review is to evaluate the evidence on the effects of Spinal Manipulative Therapy (SMT) on back pain and other related symptoms during pregnancy.

Data sources: A literature search was conducted using Pubmed, Manual, Alternative and Natural Therapy Index System, Cumulated Index to Nursing and Allied Health, Index to Chiropractic Literature, the Cochrane Library, and Google Scholar. In addition hand searches and reference tracking were also performed, and the citation list was assessed for comprehensiveness by content experts.

Methods of study selection : This review was limited to peer-reviewed manuscripts published in English from 1966 until September 2008. The initial search strategy yielded 140 citations of which 12 studies were reviewed for quality.

Tabulation, integration, and results: The methodological quality of the included studies was assessed independently using quality checklists of the Scottish Intercollegiate Guidelines Network and Council on Chiropractic Guidelines and Practice Parameters. The review indicates that the use of SMT during pregnancy to reduce back pain and other related symptoms is supported by limited evidence.

Conclusion: Overall, this body of evidence is best described as emergent. However, since effective treatments for pregnancy-related back pain are limited, clinicians may want to consider SMT as a treatment option, if no contraindications are present.

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The Contemporary Model of Vertebral Column Joint Dysfunction and Impact of High-velocity, Low-amplitude Controlled Vertebral Thrusts on Neuromuscular Function

By Frank M. Painter|December 17, 2021|Neurology, Subluxation|

The Contemporary Model of Vertebral Column Joint Dysfunction and Impact of High-velocity, Low-amplitude Controlled Vertebral Thrusts on Neuromuscular Function

The Chiro.Org Blog

SOURCE: European J Applied Physiology 2021 (Oct); 121 (10): 2675–2720

Heidi Haavik, Nitika Kumari, Kelly Holt, Imran Khan Niazi, Imran Amjad, Amit N Pujari, Kemal Sitki Türker, Bernadette Murphy

Centre for Chiropractic Research,
New Zealand College of Chiropractic,
Auckland, New Zealand.

Purpose: There is growing evidence that vertebral column function and dysfunction play a vital role in neuromuscular control. This invited review summarises the evidence about how vertebral column dysfunction, known as a central segmental motor control (CSMC) problem, alters neuromuscular function and how spinal adjustments (high-velocity, low-amplitude or HVLA thrusts directed at a CSMC problem) and spinal manipulation (HVLA thrusts directed at segments of the vertebral column that may not have clinical indicators of a CSMC problem) alters neuromuscular function.

Methods: The current review elucidates the peripheral mechanisms by which CSMC problems, the spinal adjustment or spinal manipulation alter the afferent input from the paravertebral tissues. It summarises the contemporary model that provides a biologically plausible explanation for CSMC problems, the manipulable spinal lesion. This review also summarises the contemporary, biologically plausible understanding about how spinal adjustments enable more efficient production of muscular force. The evidence showing how spinal dysfunction, spinal manipulation and spinal adjustments alter central multimodal integration and motor control centres will be covered in a second invited review.

Results: Many studies have shown spinal adjustments increase voluntary force and prevent fatigue, which mainly occurs due to altered supraspinal excitability and multimodal integration. The literature suggests physical injury, pain, inflammation, and acute or chronic physiological or psychological stress can alter the vertebral column’s central neural motor control, leading to a CSMC problem. The many gaps in the literature have been identified, along with suggestions for future studies.

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Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process

By Frank M. Painter|December 16, 2021|Chiropractic Management, Pregnancy|

Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2021 (Nov 23)

Carol Ann Weis, MSc, DC, Katherine Pohlman, DC, PhD, Jon Barrett, MBBch, MD, Maeve O’Beirne, MD, PhD, Kent Stuber, DC, MSc, Cheryl Hawk, DC, PhD

Department of Research,
Canadian Memorial Chiropractic College,
Toronto, ON, Canada.

Objective: The purpose of this project was to develop a best-practices document on chiropractic care for pregnant and postpartum patients with low back pain (LBP), pelvic girdle pain (PGP), or a combination.

Methods: A modified Delphi consensus process was conducted. A multidisciplinary steering committee of 11 health care professionals developed 71 seed statements based on their clinical experience and relevant literature. A total of 78 panelists from 7 countries were asked to rate the recommendations (70 chiropractors and representatives from 4 other health professions). Consensus was reached when at least 80% of the panelists deemed the statement to be appropriate along with a median response of at least 7 on a 9-point scale.

Results: Consensus was reached on 71 statements after 3 rounds of distribution. Statements included informed consent and risks, multidisciplinary care, key components regarding LBP during pregnancy, PGP during pregnancy and combined pain during pregnancy, as well as key components regarding postpartum LBP, PGP, and combined pain. Examination, diagnostic imaging, interventions, and lifestyle factors statements are included.

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About Frank M. Painter

Are Nonpharmacologic Interventions for Chronic Low Back Pain More Cost Effective Than Usual Care? Proof of Concept Results From a Markov Model

Are Nonpharmacologic Interventions for Chronic Low Back Pain More Cost Effective Than Usual Care? Proof of Concept Results From a Markov Model

Effectiveness of Chiropractic Manipulation Versus Sham Manipulation for Recurrent Headaches in Children Aged 7-14 Years – A Randomised Clinical Trial

Effectiveness of Chiropractic Manipulation Versus Sham Manipulation for Recurrent Headaches in Children Aged 7-14 Years – A Randomised Clinical Trial

Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults

Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults

Manipulative Therapy for Pregnancy and Related Conditions: A Systematic Review

Manipulative Therapy for Pregnancy and Related Conditions: A Systematic Review

The Contemporary Model of Vertebral Column Joint Dysfunction and Impact of High-velocity, Low-amplitude Controlled Vertebral Thrusts on Neuromuscular Function

The Contemporary Model of Vertebral Column Joint Dysfunction and Impact of High-velocity, Low-amplitude Controlled Vertebral Thrusts on Neuromuscular Function

Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process

Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process