Frank M. Painter

Association Between Use of Acid-Suppressive Medications

By Frank M. Painter|April 3, 2018|Pediatrics|

Association Between Use of Acid-Suppressive Medications and Antibiotics During Infancy and Allergic Diseases in Early Childhood

SOURCE: JAMA Pediatrics 2018 (Apr 2) [Epub]

Edward Mitre, MD; Apryl Susi, MS; Laura E. Kropp, MPH

Department of Microbiology and Immunology,
F. Edward Hébert School of Medicine,
Uniformed Services University of the Health Sciences,
Bethesda, Maryland

A new Study reports:
Infants who are given antacids like Zantac or Pepcid
are more likely to develop childhood allergies

FROM: TIME Magazine ~ April 2, 2018

Infants who are given antacids like Zantac or Pepcid are more likely to develop childhood allergies, perhaps because these drugs may alter their gut bacteria, a new large study suggests.

Early use of antibiotics also raised the chances of allergies in the study of nearly 800,000 children.

Researchers combed the health records of kids born between 2001 and 2013 and covered by Tricare, an insurance program for active duty and retired military personnel and their families. A surprising 9 percent of the babies received antacids, reflecting the popularity of treating reflux in infancy.

Over four years, more than half of all the children developed allergies to foods or medications, rashes, asthma, hay fever or other allergic diseases. The study couldn’t prove causes, but the connection with antacids and antibiotics was striking.

For children who received an antacid during their first six months, the chances of developing a food allergy doubled; the chances of developing a severe allergic reaction called anaphylaxis or hay fever were about 50 percent higher. For babies who received antibiotics, the chances doubled for asthma and were at least 50 percent higher for hay fever and anaphylaxis.

The results were published Monday in JAMA Pediatrics.

The Abstract:

Importance Allergic diseases are prevalent in childhood. Early exposure to medications that can alter the microbiome, including acid-suppressive medications and antibiotics, may influence the likelihood of allergy.

Objective To determine whether there is an association between the use of acid-suppressive medications or antibiotics in the first 6 months of infancy and development of allergic diseases in early childhood.

Design, Setting, and Participants A retrospective cohort study was conducted in 792,130 children who were Department of Defense TRICARE beneficiaries with a birth medical record in the Military Health System database between October 1, 2001, and September 30, 2013, with continued enrollment from within 35 days of birth until at least age 1 year. Children who had an initial birth stay of greater than 7 days or were diagnosed with any of the outcome allergic conditions within the first 6 months of life were excluded from the study. Data analysis was performed from April 15, 2015, to January 4, 2018.

Exposures Exposures were defined as having any dispensed prescription for a histamine-2 receptor antagonist (H₂RA), proton pump inhibitor (PPI), or antibiotic.

Main Outcomes and Measures The main outcome was allergic disease, defined as the presence of food allergy, anaphylaxis, asthma, atopic dermatitis, allergic rhinitis, allergic conjunctivitis, urticaria, contact dermatitis, medication allergy, or other allergy.

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VA Chiropractic Residents: Where Are They Now?

By Frank M. Painter|March 28, 2018|Uncategorized|

VA Chiropractic Residents: Where Are They Now?

The Chiro.Org Blog

SOURCE: ACA News ~ 3-26-2018

By Stephanie Halloran, DC

Part of a series on the chiropractic residency program in the VA health care system

The blog posts in the VA Chiropractic Residencies series thus far have been focused solely on the current residents’ experiences as they unfold throughout the year. For many, the question remains: What happens after the residency ends? In this post, I summarize what Brian Giuliani, DC, the 2016 graduate of the VA Connecticut Healthcare System, and Kelsey Corcoran, DC, the 2017 graduate of the VA of Western New York Healthcare System, learned from their respective programs, their favorite rotations, where they are now, and what advice they have for students interested in applying for the VA Chiropractic Residency.

Brian Giuliani, DC

Dr. Giuliani, an alumnus of New York Chiropractic College, is currently practicing with the Aurora Spine Institute, a subset of the larger Aurora Healthcare Hospital System, in Sheboygan, Wis. His clinic is comprised of an orthopedic spine surgeon, surgical PA, physiatrist, two spine-specific physical therapists, three chiropractors, and multiple anesthesiologists who perform interventional procedures. In the chiropractic department, Dr. Giuliani primarily treats patients with non-operative musculoskeletal conditions of the neck and low back (with and without radiculopathy) and headache.

The opportunity to train under experienced clinicians during the residency helped bridge the gap between classroom medicine and clinical medicine, according to Dr. Giuliani, resulting in proper application of the knowledge he acquired throughout his schooling. Additionally, he found the program rapidly exposed his clinical deficiencies and afforded him time and guidance to positively augment these areas. The clinical training, in his opinion, is the greatest strength of the residency, with development of interpersonal communication skills coming in a close second. These communication skills are developed by observing the attending chiropractic physician’s interactions with patients, as well as on rotation while working under other medical specialties.

Neurosurgery topped Dr. Giuliani’s list when it came to rotations. Taking place near the end of the year-long program, it was viewed somewhat as a capstone course. Application of the vast knowledge he gained over the year gave rise to competently performing consultations, planning both operative and non-operative strategies, and first-hand learning of some surgical aspects in the operating room. Additionally, he found physiatry and pain management to be valuable as they exposed him to a broad spectrum of musculoskeletal cases not generally seen in VA chiropractic clinics as well as increased his ability to synthesize large amounts of information into a novel management plan.

Dr. Giuliani advises interested students to look at the residency program from an educational perspective, rather than one focused on job security. “You should have an idea of where you want your career to take you, whether that is education, research, administration, etc. You will be presented with an opportunity that few in our profession have…if you approach it as an education opportunity, you will do very well.”

Kelsey Corcoran, DC

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Outcomes Indicators and a Risk Classification System

By Frank M. Painter|March 24, 2018|Spinal Pain Management|

Outcomes Indicators and a Risk Classification System for Spinal Manipulation Under Anesthesia: A Narrative Review and Proposal

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2018 (Mar 8); 26: 9

Dennis DiGiorgi, John L. Cerf, and Daniel S. Bowerman

Consultant Practice
Whitestone, NY, USA.

Over a period of decades chiropractors have utilized spinal manipulation under anesthesia (SMUA) to treat chronic back and neck pain. As an advanced form of manual therapy, SMUA is reserved for the patient whose condition has proven refractory to office-based manipulation and other modes of conservative care. Historically, the protocols and guidelines put forth by chiropractic MUA proponents have served as the clinical compass for directing MUA practice.

With many authors and MUA advocates having focused primarily on anticipated benefit, the published literature contains no resource dedicated to treatment precautions and contraindications. Also absent from current relevant literature is acknowledgement or guidance on the preliminary evidence that may predict poor clinical outcomes with SMUA. This review considers risk and unfavorable outcomes indicators in therapeutic decision making for spinal manipulation under anesthesia.

A new risk classification system is proposed that identifies patient safety and quality of care interests for a procedure that remains without higher-level research evidence. A scale which categorizes risk and outcome potential for SMUA is offered for the chiropractic clinician, which aims to elevate the standard of care and improve patient selection through the incorporation of specific indices from existing medical literature.

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Congress Passes Legislation Expanding Veteran Access

By Frank M. Painter|March 23, 2018|Announcement|

Congress Passes Legislation Expanding Veteran Access to Nondrug Chiropractic Services

The Chiro.Org Blog

SOURCE: American Chiropractic Association

Arlington, Va. — The American Chiropractic Association (ACA) announced today that Congress, with the passage of the Consolidated Appropriations Act of 2018, has approved a plan to expand access to chiropractic’s nondrug approach to pain relief to veterans, many of whom suffer from back pain and other musculoskeletal conditions resulting from their service.

The Senate voted 65-32 to approve the $1.3 trillion omnibus spending package early Friday, less than 24 hours ahead of what would have been a government shutdown. The vote follows House passage, and the bill now heads to the president’s desk for his signature.

Supported by several veterans groups and championed in Congress by Sens. Jerry Moran (R-Kansas), Jon Tester (D-Mont.), Johnny Isakson (R-Ga.) and Richard Blumenthal (D-Conn.), the approved language calls for the U.S. Department of Veterans Affairs (VA) to expand the availability of chiropractic services at no fewer than two medical centers or clinics in each Veterans Integrated Service Network (VISN) by no later than Dec. 31, 2019, and at no fewer than 50 percent of all medical centers in each VISN by no later than Dec. 31, 2021.

The measure also, for the first time, codifies and broadens chiropractic services in the VA to include services provided by doctors of chiropractic under the Preventive Health Services and Medical categories — in addition to existing coverage under Rehabilitative Services — placing chiropractors in service categories previously closed to them.

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Chiropractic Management of Postoperative Spine Pain

By Frank M. Painter|March 21, 2018|Spinal Pain Management|

Chiropractic Management of Postoperative Spine Pain: A Report of 3 Cases

The Chiro.Org Blog

SOURCE: J Chiropractic Medicine 2013 (Sep); 12 (3): 168–175

Christopher M. Coulisa, and Anthony J. Lisi

VA Connecticut Healthcare System,
West Haven, CT;
University of Bridgeport College of Chiropractic,
Bridgeport, CT.

OBJECTIVE: The purpose of this case series is to describe chiropractic care including spinal manipulation for 3 patients with postsurgical spine pain.

CLINICAL FEATURES: Three patients with postsurgical spine pain (1 cervical fusion, 1 lumbar discectomy, and 1 lumbar laminectomy) presented for chiropractic treatment at a major US medical center. Treatment included spinal manipulation and/or flexion-distraction mobilization based on patient response to joint loading strategies.

INTERVENTION AND OUTCOMES: Two patients were treated with high-velocity, low-amplitude spinal manipulation; and 1 patient was treated with flexion-distraction mobilization. Treatment frequency and duration were 4 treatments over 4 weeks for case 1, 17 treatments over 7 years for case 2, and 5 treatments over 5 weeks for case 3. Subjective improvement was noted using numeric pain scores and functional changes; and upon completion, the patients reported being “satisfied” with their overall outcome. One episode of transient benign soreness was noted by 1 patient. No additional adverse events or effects were noted.

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A Systematic Review on the Effectiveness of Physical and Rehabilitation

By Frank M. Painter|March 18, 2018|Low Back Pain|

A Systematic Review on the Effectiveness of Physical and Rehabilitation Interventions for Chronic Non-specific Low Back Pain

The Chiro.Org Blog

SOURCE: European Spine Journal 2011 (Jan); 20 (1): 19–39

Marienke van Middelkoop • Sidney M. Rubinstein • Ton Kuijpers • Arianne P. Verhagen • Raymond Ostelo •
Bart W. Koes • Maurits W. van Tulder

Department of General Practice,
Erasmus MC, University Medical Center,
Rotterdam, The Netherlands.

This study has been included for completeness sake. It provides a broad assessment of many of the treatments available in the Supermarket Approach to the Management of Chronic Low Back Pain

Strangely, it only mentions spinal manipulation in the Exercise therapy versus manual therapy/ manipulation section, and none of those studies included chiropractic (CMT) trials.

Perhaps they missed the numerous studies conducted by researchers at the Wolfe-Harris Center @ Northwestern Health Sciences University. They are certainly worth reviewing.

Low back pain (LBP) is a common and disabling disorder in western society. The management of LBP comprises a range of different intervention strategies including surgery, drug therapy, and non-medical interventions. The objective of the present study is to determine the effectiveness of physical and rehabilitation interventions (i.e. exercise therapy, back school, transcutaneous electrical nerve stimulation (TENS), low level laser therapy, education, massage, behavioural treatment, traction, multidisciplinary treatment, lumbar supports, and heat/cold therapy) for chronic LBP. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to 22 December 2008.

Existing Cochrane reviews for the individual interventions were screened for studies fulfilling the inclusion criteria. The search strategy outlined by the Cochrane Back Review Groups (CBRG) was followed. The following were included for selection criteria: (1) randomized controlled trials, (2) adult (≥ 18 years) population with chronic (≥ 12 weeks) non-specific LBP, and (3) evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery, or return to work). Two reviewers independently selected studies and extracted data on study characteristics, risk of bias, and outcomes at short, intermediate, and long-term follow-up. The GRADE approach was used to determine the quality of evidence.

In total 83 randomized controlled trials met the inclusion criteria: exercise therapy (n = 37), back school (n = 5), TENS (n = 6), low level laser therapy (n = 3), behavioural treatment (n = 21), patient education (n = 1), traction (n = 1), and multidisciplinary treatment (n = 6).

Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function.

Behavioural treatment was found to be effective in reducing pain intensity at short-term follow-up compared to no treatment/waiting list controls.

Finally, multidisciplinary treatment was found to reduce pain intensity and disability at short-term follow-up compared to no treatment/waiting list controls.

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About Frank M. Painter

Association Between Use of Acid-Suppressive Medications

Association Between Use of Acid-Suppressive Medications and Antibiotics During Infancy and Allergic Diseases in Early Childhood

VA Chiropractic Residents: Where Are They Now?

VA Chiropractic Residents: Where Are They Now?

Outcomes Indicators and a Risk Classification System

Outcomes Indicators and a Risk Classification System for Spinal Manipulation Under Anesthesia: A Narrative Review and Proposal

Congress Passes Legislation Expanding Veteran Access

Congress Passes Legislation Expanding Veteran Access to Nondrug Chiropractic Services

Chiropractic Management of Postoperative Spine Pain

Chiropractic Management of Postoperative Spine Pain: A Report of 3 Cases

A Systematic Review on the Effectiveness of Physical and Rehabilitation

A Systematic Review on the Effectiveness of Physical and Rehabilitation Interventions for Chronic Non-specific Low Back Pain