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Clinical Course of Spinal Pain in Adolescents: A Feasibility Study in a Chiropractic Setting

By Frank M. Painter|February 21, 2025|Chiropractic Management, Pediatrics, Spinal Joint Pain|

Clinical Course of Spinal Pain in Adolescents: A Feasibility Study in a Chiropractic Setting

SOURCE: BMJ Open 2025 (Jan 30); 15 (1): e088834
Laura RC Montgomery • Steven J Kamper • Anika Young • Amber Beynon • Katherine A Pohlman • Lise Hestbæk • Mark J Hancock • Simon D French • Christopher G Maher • Michael S Swain

Faculty of Medicine and Health,
The University of Sydney,
Sydney, New South Wales, Australia

Design: Prospective feasibility study.

Objectives: To inform the design and conduct of a large-scale clinical cohort study investigating adolescents with moderate-to-severe spinal pain.

Setting: Chiropractic care in Sydney, Australia.

Participants: Adolescents aged 12-17 years with spinal pain (≥4/10 pain intensity score).

Methods: Adolescents and chiropractors completed baseline and week-12 follow-up questionnaires, with adolescents reporting pain intensity and recovery weekly via text messages during weeks 1-11. Questionnaire measures included spinal pain, pain coping, quality of life, physical activity, clinical assessment findings and care delivered. Chiropractors provided usual clinical care. We conducted a descriptive feasibility analysis.

Primary outcomes: (1) Recruitment rate, (2) response rate to each data collection instrument and (3) retention rate.

Results: From May 2021 to February 2023, 20 chiropractors from 10 clinics were enrolled (invited n=85). 10 chiropractors recruited 45 adolescents (15.4±1.4 years, 43% female) over 13.5 months, excluding an 8-month pause due to COVID-19 disruptions. The average recruitment rate was 0.6 adolescents/recruiting chiropractor/month. We achieved a 100% response to chiropractor baseline and follow-up questionnaires, 98% to adolescent baseline, 94% average response to combined weekly text messages and 93% retention of adolescents at study completion.

Conclusions: Our high response and retention rates demonstrate feasible data collection methods in this population. Addressing low recruitment by expanding the number and type of clinicians is necessary for a successful larger study.

Keywords: Adolescent; Back pain; Prognosis.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

This study used a prospective clinical cohort design to investigate the feasibility of studying adolescents with moderate to severe spinal pain in Australian chiropractic care.

Weekly data collection tracked pain intensity and recovery, providing valuable insight into the clinical course of spinal pain in adolescents.

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Addressing The Burden Of Spine-Related Disorders Through Integrated Value-Based Care

By Frank M. Painter|February 19, 2025|Cost-Effectiveness of Chiropractic, Integrative Care, Nonpharmacologic Therapies|

Addressing The Burden Of Spine-Related Disorders Through Integrated Value-Based Care

The Chiro.Org Blog

SOURCE: Health Affairs Forefront, February 12, 2025

Ryan Burdick • Christian Péan Sara • Holleran Inga Morken • Christine Goertz

Faculty of Health Sciences,
Ontario Tech University.

Editor’s Note:

This article is the latest in the Health Affairs Forefront series, Accountable Care for Population Health, featuring analysis and discussion of how to understand, design, support, and measure patient-centered, cost-efficient care under the umbrella of accountable care. Readers are encouraged to review the Call for Submissions for this series. We are grateful to Arnold Ventures for their support of this work.

The unsustainable rise of health care costs in the US, coupled with suboptimal health outcomes, is driving both conversation and real action toward value-based care (VBC) models in this country. There is no more low-hanging fruit for this effort than spine-related disorders. Low back and neck pain cost us more than $134 billion annually and continues to rise at a rate more than twice that of overall health spending despite the fact that it is already at or near the top of all direct health care expenditures.

Despite aggressive and often invasive treatment approaches, low back pain remains the leading cause of physical disability worldwide with neck pain not far behind. This divergence between cost and outcomes is driven largely by the sustained use of expensive and ineffective treatments that can lead to more harm than benefit. Overreliance on prescription opioids began in the early 2000s, based on weak evidence suggesting that these medications were safe and effective treatments. In addition, the US maintains a higher rate of surgical interventions, more frequent specialist consultations for initial diagnoses, and consistently higher use of medically unnecessary advanced imaging.

Recognizing the profound impact of spine-related disorders, organizations including the

American College of Physicians, the

Centers for Disease Control and Prevention, the

World Health Organization

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Temporal Trends and Geographic Variations in the Supply of Clinicians Who Provide Spinal Manipulation to Medicare Beneficiaries: A Serial Cross-Sectional Study

By Frank M. Painter|February 9, 2025|Chiropractic Care, Medicare|

Temporal Trends and Geographic Variations in the Supply of Clinicians Who Provide Spinal Manipulation to Medicare Beneficiaries: A Serial Cross-Sectional Study

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2021 (Mar)

James M Whedon • Scott Haldeman • Curtis L Petersen • William Schoellkopf • Todd A MacKenzie • Jon D Lurie

Health Services Research,
Southern California University of Health Sciences,
Whittier, California.

FROM: Davis ~ J Am Board Fam Med. 2015 (Jul)

Objective: Spinal manipulation (SM) is recommended for first-line treatment of patients with low back pain. Inadequate access to SM may result in inequitable spine care for older US adults, but the supply of clinicians who provide SM under Medicare is uncertain. The purpose of this study was to measure temporal trends and geographic variations in the supply of clinicians who provide SM to Medicare beneficiaries.

Methods: Medicare is a US government-administered health insurance program that provides coverage primarily for older adults and people with disabilities. We used a serial cross-sectional design to examine Medicare administrative data from 2007 to 2015 for SM services identified by procedure code. We identified unique providers by National Provider Identifier and distinguished between chiropractors and other specialties by Physician Specialty Code. We calculated supply as the number of providers per 100,000 beneficiaries, stratified by geographic location and year.

Results: Of all clinicians who provide SM to Medicare beneficiaries, 97% to 98% are doctors of chiropractic. The geographic supply of doctors of chiropractic providing SM services in 2015 ranged from 20/100,000 in the District of Columbia to 260/100,000 in North Dakota. The supply of other specialists performing the same services ranged from fewer than 1/100,000 in 11 states to 8/100,000 in Colorado. Nationally, the number of Medicare-active chiropractors declined from 47 102 in 2007 to 45 543 in 2015. The count of other clinicians providing SM rose from 700 in 2007 to 1441 in 2015.

Conclusion: Chiropractors constitute the vast majority of clinicians who bill for SM services to Medicare beneficiaries. The supply of Medicare-active SM providers varies widely by state. The overall supply of SM providers under Medicare is declining, while the supply of nonchiropractors who provide SM is growing.

Keywords: Chiropractic; Manipulation, Spinal; Medicare; Musculoskeletal Manipulations.

From the FULL TEXT Article:

Introduction

Low back pain is highly prevalent in the United States, and management of it can be particularly challenging in the Medicare beneficiary population, which is older and has disabilities and frequently comorbidities. [1, 2]

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Association Between Chiropractic Spinal Manipulation for Sciatica and Opioid-related Adverse Events: A Retrospective Cohort Study

By Frank M. Painter|January 31, 2025|Adverse Drug Reactions, Adverse Events, Chiropractic Management, Low Back Pain, Opioid Epidemic, Sciatica|

Association Between Chiropractic Spinal Manipulation for Sciatica and Opioid-related Adverse Events: A Retrospective Cohort Study

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SOURCE: PLoS One 2025 (Jan 28); 20 (1): e0317663

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Robert J. Trager • Zachary A. Cupler • Roshini Srinivasan • Elleson G. Harper • Jaime A. Perez

Connor Whole Health,
University Hospitals Cleveland Medical Center,
Cleveland, Ohio, United States of America.

Background: Patients receiving chiropractic spinal manipulation (CSM) for spinal pain are less likely to be prescribed opioids, and some evidence suggests that these patients have a lower risk of any type of adverse drug event. We hypothesize that adults receiving CSM for sciatica will have a reduced risk of opioid-related adverse drug events (ORADEs) over a one-year follow-up compared to matched controls not receiving CSM.

Methods: We searched a United States (US) claims-based data resource (Diamond Network, TriNetX, Inc.) of more than 216 million patients, yielding data ranging from 2009 to 2024. We included patients aged ?18 years with sciatica, excluding those post-spine surgery, prior anesthesia, serious pathology, high risk of ORADEs, and an ORADE ? 1-year prior. Patients were divided into two cohorts: (1) CSM and (2) usual medical care. We used propensity score matching to control for confounding variables associated with ORADEs. Comparative outcomes were analyzed by calculating risk ratios (RRs) and 95% confidence intervals (CIs) for the incidence of ORADEs and oral opioid prescription between cohorts.

Results: 372,471 patients per cohort remained after matching. The incidence of ORADEs over 1-year follow-up was less in the CSM cohort compared to the usual medical care cohort (CSM: 0.09%; usual medical care: 0.30%), yielding an RR of 0.29 (95% CI: 0.25-0.32; P < .00001). CSM patients had a lower risk of receiving an oral opioid prescription (RR of 0.68 [95% CI: 0.68-0.69; P < .00001]).

Conclusions: This study found that adults with sciatica who initially received CSM had a lower risk of an ORADE compared to matched controls not initially receiving CSM, likely explained by a lower probability of opioid prescription. These findings corroborate existing practice guidelines which recommend adding CSM to the management of sciatica when appropriately indicated.

From the FULL TEXT Article:

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Comparative Effectiveness of Cervical vs Thoracic Spinal-thrust Manipulation for Care of Cervicogenic Headache: A Randomized Controlled Trial

By Frank M. Painter|December 26, 2024|Cervicogenic Headache, Chiropractic Care|

Comparative Effectiveness of Cervical vs Thoracic Spinal-thrust Manipulation for Care of Cervicogenic Headache: A Randomized Controlled Trial

The Chiro.Org Blog

SOURCE: PLoS One 2024 (Mar 29); 19 (3): e0300737 ~ FULL TEXT

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Gopal Nambi • Mshari Alghadier • Mudathir Mohamedahmed Eltayeb • Osama R Aldhafian. et al.

Department of Health and Rehabilitation Sciences,
College of Applied Medical Sciences,
Prince Sattam Bin Abdulaziz University,
Al-Kharj, Saudi Arabia.

Background: There is ample evidence supporting the use of different manipulative therapy techniques for cervicogenic headache (CgH). However, no technique can be singled as the best available treatment for patients with CgH. Therefore, the objective of the study is to find and compare the clinical effects of cervical spine over thoracic spine manipulation and conventional physiotherapy in patients with CgH.

Design, setting, and participants: It is a prospective, randomized controlled study conducted between July 2020 and January 2023 at the University hospital. N = 96 eligible patients with CgH were selected based on selection criteria and they were divided into cervical spine manipulation (CSM; n = 32), thoracic spine manipulation (TSM; n = 32) and conventional physiotherapy (CPT; n = 32) groups, and received the respective treatment for four weeks. Primary (CgH frequency) and secondary CgH pain intensity, CgH disability, neck pain frequency, neck pain intensity, neck pain threshold, cervical flexion rotation test (CFRT), neck disability index (NDI) and quality of life (QoL) scores were measured. The effects of treatment at various intervals were analyzed using a 3 × 4 linear mixed model analysis (LMM), with treatment group (cervical spine manipulation, thoracic spine manipulation, and conventional physiotherapy) and time intervals (baseline, 4 weeks, 8 weeks, and 6 months), and the statistical significance level was set at P < 0.05.

Results: The reports of the CSM, TSM and CPT groups were compared between the groups. Four weeks following treatment CSM group showed more significant changes in primary (CgH frequency) and secondary (CgH pain intensity, CgH disability, neck pain frequency, pain intensity, pain threshold, CFRT, NDI and QoL) than the TSM and CPT groups (p = 0.001). The same gradual improvement was seen in the CSM group when compared to TSM and CPT.

Conclusion: The reports of the current randomized clinical study found that CSM resulted in significantly better improvements in pain parameters (intensity, frequency and threshold) functional disability and quality of life in patients with CgH than thoracic spine manipulation and conventional physiotherapy.

Trial registration: Clinical trial registration: CTRI/2020/06/026092 trial was registered prospectively on 24/06/2020.

From the FULL TEXT Article:

Introduction

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Clinician Experiences in Providing Reassurance for Patients with Low Back Pain in Primary Care: a Qualitative Study

By Frank M. Painter|December 24, 2024|Low Back Pain|

Clinician Experiences in Providing Reassurance for Patients with Low Back Pain in Primary Care: a Qualitative Study

The Chiro.Org Blog

SOURCE: J Physiotherapy 2024 (Dec 12): [EPUB]

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Anika Young • Simon D French • Adrian C Traeger< Julie Ayre • Mark Hancock • Hazel J Jenkins
Department of Chiropractic,
Faculty of Medicine, Health and Health Science,
Macquarie University,
Sydney, Australia.

Questions: What reassurance is being delivered by physiotherapists and chiropractors to people with non-specific low back pain? How is it being delivered? What are the barriers and enablers to delivering reassurance to people with non-specific low back pain?

Design: A qualitative study.

Participants: Thirty-two musculoskeletal clinicians (16 physiotherapists and 16 chiropractors) who manage low back pain in primary care.

Method: Semi-structured interviews were conducted about their experiences delivering reassurance. The interview schedule was developed using the Theoretical Domains Framework and analysed using framework thematic analysis.

Results: Four themes were identified: giving reassurance is a core clinical skill for delivering high-quality care; it takes practice and experience to confidently deliver reassurance; despite feeling capable and motivated, clinicians identified situations that challenge the delivery of reassurance; and reassurance needs to be contextualised to the individual.

Conclusion: Clinicians possess a strong understanding of reassurance but require clinical experience to confidently deliver it. This study provides insights into how reassurance is individualised in clinical practice, including suggestions for clinicians about how to implement reassurance effectively for people with low back pain.

Keywords: Low back pain; Primary healthcare; Qualitative research; Reassurance.

From the FULL TEXT Article:

Introduction

Low back pain (LBP) is common and is associated with substantial disability. Worldwide, 619 million people experienced back pain in 2020, [1] and there are significant personal and societal costs related to LBP. [2, 3] In Australia, back pain continues to be the second leading cause of disability [4] and back pain management cost AU$3.36 billion in 2020. [4] The prevalence of LBP has been projected to increase over the next 25 years, with associated increases in disability with healthcare costs. [1] Most LBP is non-specific low back pain (NSLBP), referring to LBP that does not have a known pathoanatomical cause. [5] LBP is a complex condition that is multifactorial in nature, where a person’s pain experience is influenced by biological, psychological and social factors. [6] Recovery from an episode of LBP is also complex; approximately 25% of people with LBP experience recurrence within 12 months [7] and 44% of people can still experience pain at 12 months. [8]

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