Frank M. Painter

Observational Retrospective Study of the Association

By Frank M. Painter|September 26, 2019|Low Back Pain, Opioid Epidemic|

Observational Retrospective Study of the Association of Initial Healthcare Provider for New-onset Low Back Pain with Early and Long-term Opioid Use

SOURCE: BMJ Open. 2019 (Sep 20); 9 (9): e028633

Lewis E Kazis, Omid Ameli, James Rothendler, Brigid Garrity, Howard Cabral, Christine McDonough, et. al.

Department of Health Law,
Policy and Management,
Boston University School of Public Health,
Boston, Massachusetts, USA

OBJECTIVE: This study examined the association of initial provider treatment with early and long-term opioid use in a national sample of patients with new-onset low back pain (LBP).

DESIGN: A retrospective cohort study of patients with new-onset LBP from 2008 to 2013.

SETTING: The study evaluated outpatient and inpatient claims from patient visits, pharmacy claims and inpatient and outpatient procedures with initial providers seen for new-onset LBP.

PARTICIPANTS: 216,504 individuals aged 18 years or older across the USA who were diagnosed with new-onset LBP and were opioid-naïve were included. Participants had commercial or Medicare Advantage insurance.

EXPOSURES: The primary independent variable is type of initial healthcare provider including physicians and conservative therapists (physical therapists, chiropractors, acupuncturists).

MAIN OUTCOME MEASURES: Short-term opioid use (within 30 days of the index visit) following new LBP visit and long-term opioid use (starting within 60 days of the index date and either 120 or more days’ supply of opioids over 12 months, or 90 days or more supply of opioids and 10 or more opioid prescriptions over 12 months).

RESULTS: Short-term use of opioids was 22%. Patients who received initial treatment from chiropractors or physical therapists had decreased odds of short-term and long-term opioid use compared with those who received initial treatment from primary care physicians (PCPs) (adjusted OR (AOR) (95% CI) 0.10 (0.09 to 0.10) and 0.15 (0.13 to 0.17), respectively). Compared with PCP visits, initial chiropractic and physical therapy also were associated with decreased odds of long-term opioid use in a propensity score matched sample (AOR (95% CI) 0.21 (0.16 to 0.27) and 0.29 (0.12 to 0.69), respectively).

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Low Back Pain and Chiropractic Page

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Chiropractic Care Works for Troops with Lower Back Pain

By Frank M. Painter|September 19, 2019|Veterans|

Chiropractic Care Works for Troops with Lower Back Pain, But Not Everyone Can Access It

The Chiro.Org Blog

SOURCE: Military.com ~ 16 Sep 2019

By Patricia Kime

Military.com

A decade after being asked to study how chiropractic care may increase fitness among troops with lower back pain, the Defense Department has submitted its report to Congress.

The answer? It works.

But service members still shouldn’t expect the treatment to be available at every military health facility.

And as for military family members, retirees and their families, the benefit, along with other alternative therapies, remains uncovered by Tricare.

Earlier this month, Acting Assistant Secretary of Defense for Manpower and Reserve Affairs James Stewart sent a final report to Congress (PDF) on three clinical trials conducted in the last 10 years at military health facilities by Rand Corp., Palmer College of Chiropractic and the Samueli Institute to determine whether chiropractic care can ease lower back pain in troops, help service members stop smoking and increase readiness.

The $7.5 million study was ordered under the fiscal 2010 National Defense Authorization Act, signed into law on Oct. 28, 2009. According to the report released Sept. 6, the trials showed some positive results.

The first clinical trial, to determine whether chiropractic care reduced pain and helped troops stop smoking, showed statistically significant improvement for service members with back pain who received chiropractic care alongside regular medical care.

The second trial, to test whether chiropractic care had any effect on the reaction and response times of special operations troops, showed that a single session had an immediate effect on motor response.

But the trials also found that chiropractic care had no real influence on smoking cessation, nor did the acceleration of response time among special operators last after the initial effect.

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Chiropractic Care For Veterans Page

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U.S. Comptroller Appoints Chiropractor Christine Goertz

By Frank M. Painter|September 18, 2019|Announcement|

U.S. Comptroller Appoints Chiropractor Christine Goertz as Chair of PCORI Board

The Chiro.Org Blog

SOURCE: Patient-Centered Outcomes Research Institute

PCORI Welcomes Christine Goertz as Next Chairperson and Sharon Levine as Next Vice Chairperson of Board of Governors Statement from PCORI Executive Director Joe Selby, MD, MPH

September 17, 2019

WASHINGTON, DC — The U.S. Government Accountability Office (GAO) today announced the appointment of Christine Goertz, DC, PhD, as the next Chairperson of the Patient-Centered Outcomes Research Institute (PCORI) Board of Governors, and the appointment of Sharon Levine, MD, as the next Vice Chairperson.

Goertz, who has been a member of PCORI’s Board since 2010 and its Vice Chairperson since September 2018, succeeds Grayson Norquist, MD, MSPH, as Chairperson upon his completion of a full term in this position. Norquist will continue to serve out the remainder of his current term as a Board member.

Levine, who has been a PCORI Board member since September 2010, takes over the Vice Chairperson role being vacated by Goertz. Both her and Goertz’s appointments are three-year terms ending September 2022.

“We are delighted with the GAO’s appointments and I look forward to continuing to work closely with Dr. Goertz and Dr. Levine in their new leadership roles,” said PCORI Executive Director Joe Selby, MD, MPH. “Their complementary expertise and long histories with PCORI will serve us and our Board very well in continuing to pursue our mission of helping people make better-informed healthcare decisions through patient-centered research.”

Selby also thanked Norquist “for his tireless, thoughtful, and wise leadership of the Board over the past six years during a time of significant expansion of PCORI’s research funding and efforts to promote the implementation of the growing body of useful evidence it is producing. We are grateful and pleased that he will continue to share his valuable insights and expertise with PCORI through his ongoing service on the Board.”

Goertz is currently the Chief Executive Officer of the Spine Institute for Quality. As of October, she will begin new positions as Professor in the Department of Orthopaedic Surgery at Duke University Medical Center and Director of System Development and Coordination for Spine Health at Duke Health.

Levine, a board-certified pediatrician, is a physician with the Southern California Permanente Medical Group. She practiced and held leadership positions within The Permanente Medical Group, a large multi-specialty group practice in California, from 1977 to 2017.

Norquist is Vice-Chair of the Emory University Department of Psychiatry and Behavioral Sciences, and Chief of Psychiatry Service at Grady Health System.

The diverse membership of PCORI’s Board is appointed by the Comptroller General of the United States and represents a broad range of perspectives and collective expertise in clinical health sciences research.

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Chiropractic, One Big Unhappy Family?

By Frank M. Painter|September 10, 2019|Evidence-based Practice|

Chiropractic, One Big Unhappy Family: Better Together or Apart?

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2019 (Feb 21); 27: 4

Charlotte Leboeuf-Yde, Stanley I. Innes, Kenneth J. Young, Gregory Neil Kawchuk and Jan Hartvigsen

Institute for Regional Health Research,
University of Southern Denmark, DK-5000
Odense C, Denmark.

Editorial Comment:

It’s with heavy heart that I realize that it’s all come down to this: chiropractic depicted as a bad soap-opera marriage.

What is more upsetting is that this article is penned by some of the best, brightest and most-published of our chiropractic researchers. I love these folks!

That said, I’d like to challenge some of their assumptions. Chiropractic is not a marriage between chiropractors. At best, it’s a Family.

And families interact. I just might marry your sister, for example.

Now you may not like me, or you may not like our marriage. But that’s a personal problem.

The word Evidence has taken on a sacred-cow glow lately, and is only eclipsed by the adoption of the word skeptic by every Tom, Dick and Harry blog-opinionist/critic on the planet. So, let’s set the stage for the conversation.

This article dishes up several reasons why (as they call themselves) the ‘evidence-friendly’ faction are opposed to the ‘traditional’ group.

Here’s a short list of the infractions that are practiced by the ‘traditionalists’

They ‘believe’ in “subluxations”
Some of them ‘believe’ that you can find “subluxations” on x-rays
Some of them ‘believe’ that correcting “subluxations” leads to improved health

So let’s address these concerns, one at a time.

The Medicare and Medicaid definition of “subluxations” is:

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What is the Chiropractic Subluxation? Page

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Access to Chiropractic Care and the Cost of Spine Conditions Among Older Adults

By Frank M. Painter|August 18, 2019|Uncategorized|

Access to Chiropractic Care and the Cost of Spine Conditions Among Older Adults

The Chiro.Org Blog

SOURCE: American J Managed Care 2019 (Aug); 25 (8): e230–e236

Matthew A. Davis, PhD, DC, MPH et. al.

Matthew A. Davis, PhD, DC, MPH
University of Michigan,
400 N Ingalls St, Room 4347,
Ann Arbor, MI 48109.

Objectives: Chiropractic care is a service that operates outside of the conventional medical system and is reimbursed by Medicare. Our objective was to examine the extent to which accessibility of chiropractic care affects spending on medical spine care among Medicare beneficiaries.

Study Design: Retrospective cohort study that used beneficiary relocation as a quasi-experiment.

Methods: We used a combination of national data on provider location and Medicare claims to perform a quasi-experimental study to examine the effect of chiropractic care accessibility on healthcare spending. We identified 84,679 older adults enrolled in Medicare with a spine condition who relocated once between 2010 and 2014. For each year, we measured accessibility using the variable-distance enhanced 2-step floating catchment area method. Using data for the years before and after relocation, we estimated the effect of moving to an area of lower or higher chiropractic accessibility on spine-related spending adjusted for access to medical physicians.

Results: There are approximately 45,000 active chiropractors in the United States, and local accessibility varies considerably. A negative dose–response relationship was observed for spine-related spending on medical evaluation and management as well as diagnostic imaging and testing (mean differences, $20 and $40, respectively, among those exposed to increasingly higher chiropractic accessibility; P <.05 for both). Associations with other types of spine-related spending were not significant.

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Cost-Effectiveness of Chiropractic Page

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The Global Spine Care Initiative

By Frank M. Painter|August 10, 2019|Chronic Neck Pain, Low Back Pain|

The Global Spine Care Initiative: Applying Evidence-based Guidelines on the Non-invasive Management of Back and Neck Pain to Low- and Middle-income Communities

The Chiro.Org Blog

SOURCE: European Spine Journal 2018 (Sep); 27 (Suppl 6): 851–860

Roger Chou, Pierre Côté, Kristi Randhawa, Paola Torres, Hainan Yu, Margareta Nordin, Eric L. Hurwitz, Scott Haldeman, Christine Cedraschi

Department of Medical Informatics and Clinical Epidemiology,
Oregon Health and Science University,
Portland, OR, USA.

PURPOSE: The purpose of this review was to develop recommendations for the management of spinal disorders in low-income communities, with a focus on non-invasive pharmacological and non-pharmacological therapies for non-specific low back and neck pain.

METHODS: We synthesized two evidence-based clinical practice guidelines for the management of low back and neck pain. Our recommendations considered benefits, harms, quality of evidence, and costs, with attention to feasibility in medically underserved areas and low- and middle-income countries.

RESULTS: Clinicians should provide education and reassurance, advise patients to remain active, and provide information about self-care options. For acute low back and neck pain without serious pathology, primary conservative treatment options are exercise, manual therapy, superficial heat, and nonsteroidal anti-inflammatory drugs (NSAIDs).

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LOW BACK PAIN Page and the:

CHRONIC NECK PAIN Page

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About Frank M. Painter

Observational Retrospective Study of the Association

Observational Retrospective Study of the Association of Initial Healthcare Provider for New-onset Low Back Pain with Early and Long-term Opioid Use

Chiropractic Care Works for Troops with Lower Back Pain

Chiropractic Care Works for Troops with Lower Back Pain, But Not Everyone Can Access It

U.S. Comptroller Appoints Chiropractor Christine Goertz

U.S. Comptroller Appoints Chiropractor Christine Goertz as Chair of PCORI Board

Chiropractic, One Big Unhappy Family?

Chiropractic, One Big Unhappy Family: Better Together or Apart?

Access to Chiropractic Care and the Cost of Spine Conditions Among Older Adults

Access to Chiropractic Care and the Cost of Spine Conditions Among Older Adults

The Global Spine Care Initiative

The Global Spine Care Initiative: Applying Evidence-based Guidelines on the Non-invasive Management of Back and Neck Pain to Low- and Middle-income Communities