Frank M. Painter

Change in Young People’s Spine Pain

By Frank M. Painter|May 7, 2019|Pediatrics, Spinal Pain|

Change in Young People’s Spine Pain Following Chiropractic Care at a Publicly Funded Healthcare Facility in Canada

SOURCE: Complement Ther Clin Pract. 2019 (May); 35: 301–307

Christian Manansala, DC, MSc(c), Steven Passmore, DC, PhD, Katie Pohlman, DC, PhD(c), Audrey Toth, DC, Gerald Olin, BSc, DC, CDir

Faculty of Kinesiology and Recreation Management,
University of Manitoba, Canada.

BACKGROUND: The presence of spinal pain in young people has been established as a risk factor for spinal pain later in life. Recent clinical practice guidelines recommend spinal manipulation (SM), soft tissue therapy, acupuncture, and other modalities that are common treatments provided by chiropractors, as interventions for spine pain. Less is known specifically on the response to chiropractic management in young people with spinal pain. The purpose of this manuscript was to describe the impact, through pain measures, of a pragmatic course of chiropractic management in young people’s spinal pain at a publicly funded healthcare facility for a low-income population.

METHODS: The study utilized a retrospective analysis of prospectively collected quality assurance data attained from the Mount Carmel Clinic (MCC) chiropractic program database. Formal permission to conduct the analysis of the database was acquired from the officer of records at the MCC. The University of Manitoba’s Health Research Ethics Board approved all procedures.

RESULTS: Young people (defined as 10-24 years of age) demonstrated statistically and clinically significant improvement on the numeric rating scale (NRS) in all four spinal regions following chiropractic management.

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Use of Non-Pharmacological Pain Treatment Modalities

By Frank M. Painter|May 6, 2019|Spinal Pain, Veterans|

Use of Non-Pharmacological Pain Treatment Modalities Among Veterans with Chronic Pain:

The Chiro.Org Blog

SOURCE: J Gen Intern Med. 2018 (May); 33 (Sup 1): 54–60

Sara N. Edmond, Ph.D., William C. Becker, M.D., Mary A. Driscoll, Ph.D., Suzanne E. Decker, Ph.D., Diana M. Higgins, Ph.D., Kristin M. Mattocks, Ph.D., M.P.H., Robert D. Kerns, Ph.D., and Sally G. Haskell, M.D.

Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center/11ACSLG,
VA Connecticut Healthcare System,
950 Campbell Avenue, West Haven, CT, 06516, USA.

BACKGROUND: Despite strong evidence for the effectiveness of non-pharmacological pain treatment modalities (NPMs), little is known about the prevalence or correlates of NPM use.

OBJECTIVE: This study examined rates and correlates of NPM use in a sample of veterans who served during recent conflicts.

DESIGN: We examined rates and demographic and clinical correlates of self-reported NPM use (operationalized as psychological/behavioral therapies, exercise/movement therapies, and manual therapies). We calculated descriptive statistics and examined bivariate associations and multivariable associations using logistic regression.

PARTICIPANTS: Participants were 460 veterans endorsing pain lasting ≥ 3 months who completed the baseline survey of the Women Veterans Cohort Study (response rate 7.7%.

MAIN MEASURES: Outcome was self-reported use of NPMs in the past 12 months.

KEY RESULTS: Veterans were 33.76 years old (SD = 10.72), 56.3% female, and 80.2% White. Regarding NPM use,

22.6% reported using psychological/behavioral,
50.9% used exercise/movement and
51.7% used manual therapies.

Veterans with a college degree (vs. no degree; OR = 2.51, 95% CI = 1.46, 4.30, p = 0.001) or those with worse mental health symptoms (OR = 2.88, 95% CI = 2.11, 3.93, p < 0.001) were more likely to use psychological/behavioral therapies.

Veterans who were female (OR = 0.63, 95% CI = 0.43, 0.93, p = 0.02) or who used non-opioid pain medications (OR = 1.82, 95% CI = 1.146, 2.84, p = 0.009) were more likely to use exercise/movement therapies.

Veterans who were non-White (OR = 0.57, 95% CI = 0.5, 0.94, p = 0.03), with greater educational attainment (OR = 2.11, 95% CI = 1.42, 3.15, p < 0.001), or who used non-opioid pain medication (OR = 1.71, 95% CI = 1.09, 2.68, p = 0.02) were more likely to use manual therapies.

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Complementary and Integrated Health Approaches

By Frank M. Painter|May 3, 2019|Alternative Medicine, Veterans|

Complementary and Integrated Health Approaches: What Do Veterans Use and Want

The Chiro.Org Blog

SOURCE: J Gen Intern Med. 2019 (Apr 22) [Epub]

Stephanie L. Taylor, PhD, Katherine J. Hoggatt, MPH, and Benjamin Kligler, MD, MPH

Center for the Study of Healthcare Innovation,
Implementation and Policy,
Greater Los Angeles VA Healthcare System,
Los Angeles, CA, USA.

OBJECTIVES: Non-pharmacological treatment options for common conditions such as chronic pain, anxiety, and depression are being given increased consideration in healthcare, especially given the recent emphasis to address the opioid crisis. One set of non-pharmacological treatment options are evidence-based complementary and integrative health (CIH) approaches, such as yoga, acupuncture, and meditation. The Veterans Health Administration (VHA), the nation’s largest healthcare system, has been at the forefront of implementing CIH approaches, given their patients’ high prevalence of pain, anxiety, and depression. We aimed to conduct the first national survey of veterans’ interest in and use of CIH approaches.

METHODS: Using a large national convenience sample of veterans who regularly use the VHA, we conducted the first national survey of veterans’ interest in, frequency of and reasons for use of, and satisfaction with 26 CIH approaches (n = 3346, 37% response rate) in July 2017.

RESULTS: In the past year, 52% used any CIH approach, with 44% using massage therapy, 37% using chiropractic, 34% using mindfulness, 24% using other meditation, and 25% using yoga. For nine CIH approaches, pain and stress reduction/relaxation were the two most frequent reasons veterans gave for using them. Overall, 84% said they were interested in trying/learning more about at least one CIH approach, with about half being interested in six individual CIH approaches (e.g., massage therapy, chiropractic, acupuncture, acupressure, reflexology, and progressive relaxation). Veterans appeared to be much more likely to use each CIH approach outside the VHA vs. within the VHA.

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Exposure to a Motor Vehicle Collision and the Risk

By Frank M. Painter|May 1, 2019|Chronic Neck Pain, Whiplash|

Exposure to a Motor Vehicle Collision and the Risk of Future Neck Pain: A Systematic Review and Meta-analysis

The Chiro.Org Blog

SOURCE: PM R. 2019 (Apr 25) [Epub]

Paul S. Nolet, DC, MS, MPH, Peter C. Emary, DC, MSc, Vicki L. Kristman, PhD, Kent Murnaghan, MA MISt,
Maurice P. Zeegers, PhD, Michael D. Freeman, MedDr, PhD

Care and Public Health Research Institute,
Maastricht University,
Maastricht, Netherlands.

OBJECTIVE: To summarize the literature that has examined the association between a motor vehicle collision (MVC) related neck injury and future neck pain (NP) in comparison with the population that has not been exposed to neck injury from an MVC.

LITERATURE SURVEY: Neck injury resulting from a MVC is associated with a high rate of chronicity. Prognosis studies indicate 50% of injured continue to experience NP a year after the collision. This is difficult to interpret due to the high prevalence of NP in the general population.

METHODOLOGY: We performed a systematic review of the literature using five electronic databases, searching for risk studies on exposure to a MVC and future NP published from 1998 to 2018. The outcome of interest was future NP. Eligible risk studies were critically appraised using the modified Quality in Prognosis Studies (QUIPS) instrument. The results were summarized using best-evidence synthesis principles, a random effects meta-analysis, meta-regression and testing for publication bias was performed with the pooled data.

SYNTHESIS: Eight articles were identified of which seven were of lower risk of bias. Six studies reported a positive association between a neck injury in an MVC and future NP compared to those without a neck injury in a MVC. Pooled analysis of the six studies indicated an unadjusted relative risk of future NP in the MVC exposed population with neck injury of 2.3 (95% CI [1.8, 3.1]), which equates to a 57% attributable risk under the exposed. In two studies where exposed subjects were either not injured or injury status was unknown, there was no increased risk of future NP.

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Manipulation and Mobilization for Treating Chronic Nonspecific Neck

By Frank M. Painter|April 24, 2019|Chronic Neck Pain|

Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel

The Chiro.Org Blog

SOURCE: Pain Physician. 2019 (Mar); 22 (2): E55–E70

Ian D. Coulter, PhD, Cindy Crawford, BA, Howard Vernon, DC, PhD, Eric L. Hurwitz, DC, PhD,
Raheleh Khorsan, PhD, Marika Suttorp Booth, MS,
and Patricia M. Herman, ND, PhD

RAND Corporation,
Santa Monica, CA

BACKGROUND: Mobilization and manipulation therapies are widely used by patients with chronic nonspecific neck pain; however, questions remain around efficacy, dosing, and safety, as well as how these approaches compare to other therapies.

OBJECTIVES: Based on published trials, to determine the efficacy, effectiveness, and safety of various mobilization and manipulation therapies for treatment of chronic nonspecific neck pain.

STUDY DESIGN: A systematic literature review and meta-analysis.

METHODS: We identified studies published between January 2000 and September 2017, by searching multiple electronic databases, examining reference lists, and communicating with experts. We selected randomized controlled trials comparing manipulation and/or mobilization therapies to sham, no treatment, each other, and other active therapies, or when combined as multimodal therapeutic approaches. We assessed risk of bias by using the Scottish Intercollegiate Guidelines Network criteria. When possible, we pooled data using random-effects meta-analysis. Grading of Recommendations, Assessment, Development, and Evaluation was applied to determine the confidence in effect estimates. This project was funded by the National Center for Complementary and Integrative Health under award number U19AT007912 and ultimately used to inform an appropriateness panel.

RESULTS: A total of 47 randomized trials (47 unique trials in 53 publications) were included in the systematic review. These studies were rated as having low risk of bias and included a total of 4,460 patients with nonspecific chronic neck pain who were being treated by a practitioner using various types of manipulation and/or mobilization interventions. A total of 37 trials were categorized as unimodal approaches and involved thrust or nonthrust compared with sham, no treatment, or other active comparators. Of these, only 6 trials with similar intervention styles, comparators, and outcome measures/timepoints were pooled for meta-analysis at 1, 3, and 6 months, showing a small effect in favor of thrust plus exercise compared to an exercise regimen alone for a reduction in pain and disability. Multimodal approaches appeared to be effective at reducing pain and improving function from the 10 studies evaluated. Health-related quality of life was seldom reported. Some 22/47 studies did not report or mention adverse events. Of the 25 that did, either no or minor events occurred.

LIMITATIONS: The current evidence is heterogeneous, and sample sizes are generally small.

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The Chiropractic Vertebral Subluxation Part 1

By Frank M. Painter|April 19, 2019|Subluxation|

The Chiropractic Vertebral Subluxation Part 1: Introduction

The Chiro.Org Blog

SOURCE: J Chiropractic Humanities 2018 (Dec); 25: 146–168

Simon A.Senzon, MA, DC

School of Health and Human Sciences,
Southern Cross University,
Lismore, New South Wales, Australia.

Objective The objective of this article is to present a rationale for the need of a history of chiropractic vertebral subluxation (CVS) theory based on primary sources.

Discussion There is a dichotomy in the chiropractic profession around subluxation terminology, which has many facets. The literature around this topic spans social, economic, cultural, and scientific questions. By developing a rationale for a historical perspective of CVS theory, including the tracking of the historical development of ideas throughout the profession, a foundation for future discourse may emerge.

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About Frank M. Painter

Change in Young People’s Spine Pain

Change in Young People’s Spine Pain Following Chiropractic Care at a Publicly Funded Healthcare Facility in Canada

Use of Non-Pharmacological Pain Treatment Modalities

Use of Non-Pharmacological Pain Treatment Modalities Among Veterans with Chronic Pain:

Complementary and Integrated Health Approaches

Complementary and Integrated Health Approaches: What Do Veterans Use and Want

Exposure to a Motor Vehicle Collision and the Risk

Exposure to a Motor Vehicle Collision and the Risk of Future Neck Pain: A Systematic Review and Meta-analysis

Manipulation and Mobilization for Treating Chronic Nonspecific Neck

Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel

The Chiropractic Vertebral Subluxation Part 1

The Chiropractic Vertebral Subluxation Part 1: Introduction