Frank M. Painter

Patient Expectations as Predictors of Outcome

By Frank M. Painter|April 24, 2020|Patient Expectations|

Patient Expectations as Predictors of Outcome in Patients with Acute Low Back Pain

SOURCE: Journal of General Internal Medicine 2008 (Feb)

Samuel S. Myers MD, Russell S. Phillips MD, Roger B. Davis ScD, Daniel C. Cherkin PhD, Anna Legedza ScD, Ted J. Kaptchuk, Andrea Hrbek, Julie E. Buring ScD, Diana Post MD, Maureen T. Connelly MD, MPH & David M. Eisenberg MD

Department of Medicine,
Harvard Medical School,
Mount Auburn Hospital,
Cambridge, MA 02138, USA.

BACKGROUND: Few studies have evaluated the association between patient expectations for recovery and clinical outcomes, and no study has evaluated whether asking patients to choose their therapy modifies such an association.

OBJECTIVE: To evaluate the association between patients’ expectations and functional recovery in patients with acute low back pain (LBP), and to determine whether that association is affected by giving patients choice of therapy.

DESIGN AND PARTICIPANTS: A secondary analysis of a randomized controlled trial comparing usual care alone to usual care plus choice of chiropractic, acupuncture, or massage in 444 adults with acute LBP, lasting less than 21 days.

MEASUREMENTS AND MAIN RESULTS: Primary outcome was functional disability (Roland score) at 5 and 12 weeks.

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Maintenance Care Reduces the Number of Days

By Frank M. Painter|April 23, 2020|Maintenance Care|

The Nordic Maintenance Care Program: Maintenance Care Reduces the Number of Days With Pain in Acute Episodes and Increases the Length of Pain Free Periods for Dysfunctional Patients With Recurrent and Persistent Low Back Pain – A Secondary Analysis of a Pragmatic Randomized Controlled Trial

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2020 (Apr 21); 28: 19

Andreas Eklund, Jan Hagberg, Irene Jensen, Charlotte Leboeuf-Yde, Alice Kongsted, Peter Lövgren, Mattias Jonsson, Jakob Petersen-Klingberg, Christian Calvert & Iben Axén

Karolinska Institutet,
Institute of Environmental Medicine,
Unit of Intervention and Implementation Research for Worker Health,
Stockholm, Sweden.

BACKGROUND: A recent study showed that chiropractic patients had fewer days with bothersome (activity-limiting) low back pain (LBP) when receiving care at regular pre-planned intervals regardless of symptoms (‘maintenance care’, MC) compared to receiving treatment only with a new episode of LBP. Benefit varied across psychological subgroups. The aims of this study were to investigate 1) pain trajectories around treatments, 2) recurrence of new episodes of LBP, and 3) length of consecutive pain-free periods

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An Overview of Systematic Reviews of Infantile Colic

By Frank M. Painter|April 19, 2020|Colic, Complementary and Alternative Medicine|

An Overview of Systematic Reviews of Complementary and Alternative Therapies for Infantile Colic

The Chiro.Org Blog

SOURCE: Systematic Reviews 2019 (Nov 11)

Rachel Perry, Verity Leach, Chris Penfold & Philippa Davies

National Institute for Health Research Bristol Biomedical Research Centre,
University Hospitals Bristol NHS Foundation Trust and University of Bristol,
Nutrition Theme, 3rd Floor, Education & Research Centre,
Upper Maudlin Street,
Bristol, BS2 8AE, UK.

BACKGROUND: Infantile colic is a distressing condition characterised by excessive crying in the first few months of life. The aim of this research was to update the synthesis of evidence of complementary and alternative medicine (CAM) research literature on infantile colic and establish what evidence is currently available.

METHODS: Medline, Embase and AMED (via Ovid), Web of Science and Central via Cochrane library were searched from their inception to September 2018. Google Scholar and OpenGrey were searched for grey literature and PROSPERO for ongoing reviews. Published systematic reviews that included randomised controlled trials (RCTs) of infants aged up to 1 year, diagnosed with infantile colic using standard diagnostic criteria, were eligible. Reviews of RCTs that assessed the effectiveness of any individual CAM therapy were included. Three reviewers were involved in data extraction and quality assessment using the AMSTAR-2 scale and risk of bias using the ROBIS tool.

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Care for Low Back Pain: Can Health Systems Deliver?

By Frank M. Painter|March 30, 2020|Alternative Medicine, Low Back Pain, Medicare|

Care for Low Back Pain: Can Health Systems Deliver?

The Chiro.Org Blog

SOURCE: Bulletin of the World Health Organization 2019 (Jun 1)

Adrian C Traeger, Rachelle Buchbinder, Adam G Elshaug, Peter R Croft, and Chris G Mahera

Institute for Musculoskeletal Health,
University of Sydney,
PO Box M179, Missenden Road,
Camperdown NSW 2050, Australia.

Low back pain is the leading cause of years lived with disability globally. In 2018, an international working group called on the World Health Organization to increase attention on the burden of low back pain and the need to avoid excessively medical solutions. Indeed, major international clinical guidelines now recognize that many people with low back pain require little or no formal treatment. Where treatment is required the recommended approach is to discourage use of pain medication, steroid injections and spinal surgery, and instead promote physical and psychological therapies. Many health systems are not designed to support this approach.

In this paper we discuss why care for low back pain that is concordant with guidelines requires system-wide changes. We detail the key challenges of low back pain care within health systems. These include the financial interests of pharmaceutical and other companies; outdated payment systems that favour medical care over patients’ self-management; and deep-rooted medical traditions and beliefs about care for back pain among physicians and the public. We give international examples of promising solutions and policies and practices for health systems facing an increasing burden of ineffective care for low back pain.

We suggest policies that, by shifting resources from unnecessary care to guideline-concordant care for low back pain, could be cost-neutral and have widespread impact. Small adjustments to health policy will not work in isolation, however. Workplace systems, legal frameworks, personal beliefs, politics and the overall societal context in which we experience health, will also need to change.

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Primary Care for Low Back Pain

By Frank M. Painter|March 29, 2020|Alternative Medicine, Low Back Pain, Usual Medical Care|

Primary Care for Low Back Pain: We Don’t Know the Half of It

The Chiro.Org Blog

SOURCE: Pain. 2020 (Apr); 161 (4): 663–665

Peter Croft; Saurabb Sharma; Nadine E. Foster

Primary Care Centre Versus Arthritis,
School of Primary, Community and Social Care,
Keele University, Keele, United Kingdom.

Evidence-based medicine helps health care professionals and patients decide best care, drawing on research about effectiveness and safety of interventions. Systematic reviews summarise the evidence; guidelines report consensus between experts (including patients) on interpreting it for everyday practice. Although guideline recommendations are only one component of shared decisions that will vary patient-to-patient, the hoped-for outcome is health benefit for each individual. Guidelines also inform starker decisions by policymakers and health care leaders — for example, when to withdraw approval or funding for a poorly evidenced or harmful intervention. To assess whether all this research-driven activity is useful, 2 questions need answering: how well are guidelines followed in real-life practice and do patients benefit in the long-term?

In a new systematic review, Kamper et al. [9] tackle the first question in relation to first-contact care for patients with low back pain provided by family practice and emergency department physicians. (aka “usual medical care”) As the authors state, low back pain has major significance for the international pain community. It is the leading single cause of years lost to disability globally, [17] and there is good evidence for what constitutes best first-contact treatment. [6] The review selected best-quality studies of routine health care data to investigate whether first-contact physicians are putting back pain guidelines into practice (“usual care”).

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The Use of Complementary and Integrative Health

By Frank M. Painter|March 25, 2020|Alternative Medicine, Cost-Effectiveness of Chiropractic|

The Use of Complementary and Integrative Health Approaches for Chronic Musculoskeletal Pain in Younger US Veterans: An Economic Evaluation

The Chiro.Org Blog

SOURCE: PLoS One. 2019 (Jun 5); 14 (6): e0217831

Valerie F. Williams, MA, MS; Leslie L. Clark, PhD, MS; Mark G. McNellis, PhD

RAND Corporation,
Santa Monica, California,
United States of America.

OBJECTIVES: To estimate the cost-effectiveness to the US Veterans Health Administration (VA) of the use of complementary and integrative health (CIH) approaches by younger Veterans with chronic musculoskeletal disorder (MSD) pain.

PERSPECTIVE: VA healthcare system.

METHODS: We used a propensity score-adjusted hierarchical linear modeling (HLM), and 2010-2013 VA administrative data to estimate differences in VA healthcare costs, pain intensity (0-10 numerical rating scale), and opioid use between CIH users and nonusers. We identified CIH use in Veterans’ medical records through Current Procedural Terminology, VA workload tracking, and provider-type codes.

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About Frank M. Painter

Patient Expectations as Predictors of Outcome

Patient Expectations as Predictors of Outcome in Patients with Acute Low Back Pain

Maintenance Care Reduces the Number of Days

The Nordic Maintenance Care Program: Maintenance Care Reduces the Number of Days With Pain in Acute Episodes and Increases the Length of Pain Free Periods for Dysfunctional Patients With Recurrent and Persistent Low Back Pain – A Secondary Analysis of a Pragmatic Randomized Controlled Trial

An Overview of Systematic Reviews of Infantile Colic

An Overview of Systematic Reviews of Complementary and Alternative Therapies for Infantile Colic

Care for Low Back Pain: Can Health Systems Deliver?

Care for Low Back Pain: Can Health Systems Deliver?

Primary Care for Low Back Pain

Primary Care for Low Back Pain: We Don’t Know the Half of It

The Use of Complementary and Integrative Health

The Use of Complementary and Integrative Health Approaches for Chronic Musculoskeletal Pain in Younger US Veterans: An Economic Evaluation