Frank M. Painter

Different Placebos, Different Mechanisms, Different Outcomes

By Frank M. Painter|May 14, 2019|Placebo|

Different Placebos, Different Mechanisms, Different Outcomes: Lessons for Clinical Trials

SOURCE: PLoS One. 2015 (Nov 4); 10 (11): e0140967

Fabrizio Benedetti, and Sara Dogue

University of Turin Medical School,
Neuroscience Department,
Turin, Italy.

I have been fascinated with placebo-controlled trials since the 90s. In those days, virtually all the placebo-controlled manipulative trials claimed that SMT was *no better than placebo*. And in those days, medicine looked down their long noses, considering placebo as worthless, a mild side-effect of trickery and quackery.

“A patient finally went to a chiropractor for her back pain after finding no relief with the orthopedist. After three adjustments and a week of no symptoms, she had a follow-up visit with her M.D.

Upon learning about the success of the D.C., the orthopedist stated, “That was just the placebo effect.”

The patient responded, “If it works so well, why didn’t you use it?”

–– Attributed to Robert Mootz, D.C.

Finally, I got around to copying several of those early SMT/placebo studies, and was pleasantly shocked to discover that, compared to pre-study findings, BOTH groups improved significantly. This did NOT mean SMT didn’t help patients, it just means that it didn’t help them MORE than the placebo did. It also strongly suggested that the plazcebo(s) were probably NOT inert.

At any rate, now you know why I started collecrting articles on placebo, and they eventually coalesced (2002) into our topical Problem with Placebos/Shams Page. This is how many of our other Topical pages evolved from their humble beginnings.

Clinical trials use placebos with the assumption that they are inert, thus all placebos are considered to be equal. Here we show that this assumption is wrong and that different placebo procedures are associated to different therapeutic rituals which, in turn, trigger different mechanisms and produce different therapeutic outcomes. We studied high altitude, or hypobaric hypoxia, headache, in which two different placebos were administered. The first was placebo oxygen inhaled through a mask, whereas the second was placebo aspirin swallowed with a pill.

There are more articles like this @ our:

PROBLEMS WITH PLACEBOS Page

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The Course of Serum Inflammatory Biomarkers

By Frank M. Painter|May 10, 2019|Chronic Neck Pain, Whiplash|

The Course of Serum Inflammatory Biomarkers Following Whiplash Injury and their Relationship to Sensory and Muscle Measures: A Longitudinal Cohort Study

The Chiro.Org Blog

SOURCE: PLoS One. 2013 (Oct 17); 8 (10): e77903

Michele Sterling, James M. Elliott, and Peter J. Cabot

Centre of National Research on Disability and Rehabilitation Medicine (CONROD),
The University of Queensland, Brisbane,
Queensland, Australia.

Tissue damage or pathological alterations are not detectable in the majority of people with whiplash associated disorders (WAD). Widespread hyperalgisa, morphological muscle changes and psychological distress are common features of WAD. However little is known about the presence of inflammation and its association with symptom persistence or the clinical presentation of WAD. This study aimed to prospectively investigate changes in serum inflammatory biomarker levels from the acute (<3 weeks) to chronic (>3 months) stages of whiplash injury.

It also aimed to determine relationships between biomarker levels and hyperalgesia, fatty muscle infiltrates of the cervical extensors identified on MRI and psychological factors. 40 volunteers with acute WAD and 18 healthy controls participated. Participants with WAD were classified at 3 months as recovered/mild disability or having moderate/severe disability using the Neck Disability Index. At baseline both WAD groups showed elevated serum levels of C-reactive protein (CRP) but by 3 months levels remained elevated only in the moderate/severe group.

The recovered/mild disability WAD group had higher levels of TNF-α at both time points than both the moderate/severe WAD group and healthy controls. There were no differences found in serum IL-1β. Moderate relationships were found between hyperalgesia and CRP at both time points and between hyperalgesia and IL-1β 3 months post injury. There was a moderate negative correlation between TNF-α and amount of fatty muscle infiltrate and pain intensity at 3 months.

Only a weak relationship was found between CRP and pain catastrophising and no relationship between biomarker levels and posttraumatic stress symptoms. The results of the study indicate that inflammatory biomarkers may play a role in outcomes following whiplash injury as well as being associated with hyperalgesia and fatty muscle infiltrate in the cervical extensors.

From the FULL TEXT Article:

Introduction

Whiplash associated disorders (WAD) are a common and costly health problem for western society. Many (up to 50%) of those injured transition to chronicity [1] and current management approaches for both acute and chronic WAD are only modestly effective. [2, 3] Further understanding of processes underlying ongoing pain and disability following whiplash injury may facilitate new directions for management of this condition and improve health outcomes.

There are more articles like this @ our:

WHIPLASH Page and the:

CHRONIC NECK PAIN Page

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Progressive Degeneration of the Cervical Multifidus

By Frank M. Painter|May 8, 2019|Whiplash|

The Rapid and Progressive Degeneration of the Cervical Multifidus in Whiplash: An MRI Study of Fatty Infiltration

The Chiro.Org Blog

SOURCE: Spine (Phila Pa 1976). 2015 (Jun 15); 40 (12): E694–700

James M. Elliott, PhD, PT, D. Mark Courtney, MD, Alfred Rademaker, PhD, Daniel Pinto, PhD, PT, Michele M. Sterling, PhD, PT, and Todd B. Parrish, PhD

Department of Physical Therapy and Human Movement Sciences,
Feinberg School of Medicine,
Northwestern University,
Chicago, IL

STUDY DESIGN: Single-center prospective longitudinal study.

OBJECTIVE: To study the (1) temporal development of muscle fatty infiltrates (MFI) in the cervical multifidi after whiplash, (2) differences in multifidi MFI between those who recover or report milder pain-related disability and those who report moderate/severe symptoms at 3 months, and (3) predictive value of multifidi MFI outcomes.

SUMMARY OF BACKGROUND DATA: The temporal development of MFI on conventional magnetic resonance image has been shown to be associated with specific aspects of pain and psychological factors. The replication of such findings has yet to be explored longitudinally.

METHODS: Thirty-six subjects with whiplash injury were enrolled at less than 1 week postinjury and classified at 3 months using percentage scores on the Neck Disability Index as recovered/mild (0%–28%) or severe (≥30%). A fat/water magnetic resonance imaging measure, patient self-report of pain-related disability, and post-traumatic stress disorder were collected at less than 1 week, 2 weeks, and 3 months postinjury.

There are more articles like this @ our:

WHIPLASH Page

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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

The Chiro.Org Blog

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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CHIROPRACTIC PEDIATRICS Page

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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.

There are more articles like this @ our:

CHIROPRACTIC CARE FOR VETERANS Page

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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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CHIROPRACTIC CARE FOR VETERANS Page

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About Frank M. Painter

Different Placebos, Different Mechanisms, Different Outcomes

Different Placebos, Different Mechanisms, Different Outcomes: Lessons for Clinical Trials

The Course of Serum Inflammatory Biomarkers

The Course of Serum Inflammatory Biomarkers Following Whiplash Injury and their Relationship to Sensory and Muscle Measures: A Longitudinal Cohort Study

Progressive Degeneration of the Cervical Multifidus

The Rapid and Progressive Degeneration of the Cervical Multifidus in Whiplash: An MRI Study of Fatty Infiltration

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