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Limited Prognostic Value of Pain Duration in Non-specific Neck Pain Patients Seeking Chiropractic Care

By |May 21, 2022|Chronic Neck Pain|

Limited Prognostic Value of Pain Duration in Non-specific Neck Pain Patients Seeking Chiropractic Care

The Chiro.Org Blog


SOURCE:   European Journal of Pain 2022 (Apr 21) [EPUB]

David Guillén, Alexandros Guekos, Nadia Graf, Barry Kim Humphreys, Cynthia Peterson, Petra Schweinhardt

Faculty of Medicine,
University of Zurich,
Zurich, Switzerland.



Background:   Pain chronicity is considered an important prognostic factor for outcome. Here, it was investigated whether pain duration influences outcome when only chronic patients (pain >3 months) are considered. Secondary aims were to determine, in patients of any pain duration, how much variance in outcome is explained by pain duration and whether pain duration truly predicts outcomes, that is out-of-sample prediction in independent data.

Methods:   Secondary analysis of a cohort study of neck pain patients. Patients were assessed before start of treatment and at 1-week, 1-, 3-, 6- and 12-month follow-up. Outcomes were patient global impression of change (PGIC) and percent change in patients’ perceived pain intensity, rated on a numerical rating scale (NRS). Regression analyses (linear and logistic) and supervised machine learning were used to test the influence of pain duration on PGIC and percent NRS change at 1-week, 1-, 3-, 6- and 12-month follow-up within sample and out-of-sample. Separate analyses were performed for the full sample (n = 720) and for chronic patients (n = 238) only.

Results:   No relationship between pain duration and outcome was found for chronic patients only. For the full sample, statistical relationships between pain duration and outcomes were observed at all tested follow-up time points. However, the amount of variance in outcome explained by pain duration was low and no out-of-sample prediction was possible.

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Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain Among Older Medicare Beneficiaries

By |May 10, 2022|Chiropractic Management, Escalation of Care, Opioid Epidemic|

Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain Among Older Medicare Beneficiaries

The Chiro.Org Blog


SOURCE:   Spine (Phila Pa 1976) 2021 (May 11) [EPUB]

James M Whedon, Anupama Kizhakkeveettil, Andrew W Toler, Serena Bezdjian, Daniel Rossi, Sarah Uptmor, Todd A MacKenzie, Jon D Lurie, Eric L Hurwitz, Ian Coulter, Scott Haldeman

Southern California University of Health Sciences,
Whittier, CA, USA

Geisel School of Medicine at Dartmouth,
Hanover, NH, USA.



Study design:   We combined elements of cohort and crossover-cohort design.

Objective:   The objective of this study was to compare long-term outcomes for Spinal Manipulative Therapy (SMT) and Opioid Analgesic Therapy (OAT) regarding escalation of care for patients with chronic low back pain (cLBP).

Summary of background data   : Current evidence-based guidelines for clinical management of cLBP include both OAT and SMT. For long-term care of older adults, the efficiency and value of continuing either OAT or SMT are uncertain.

Methods:   We examined Medicare claims data spanning a five-year period. We included older Medicare beneficiaries with an episode of cLBP beginning in 2013. All patients were continuously enrolled under Medicare Parts A, B, and D. We analyzed the cumulative frequency of encounters indicative of an escalation of care for cLBP, including hospitalizations, emergency department visits, advanced diagnostic imaging, specialist visits, lumbosacral surgery, interventional pain medicine techniques, and encounters for potential complications of cLBP.

Results:   SMT was associated with lower rates of escalation of care as compared to OAT. The adjusted rate of escalated care encounters was approximately 2.5 times higher for initial choice of OAT vs. initial choice of SMT (with weighted propensity scoring: rate ratio 2.67, 95% CI 2.64-2.69, p < .0001).

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Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

By |May 8, 2022|Acute Neck Pain, Chiropractic Care, Chronic Neck Pain|

Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

The Chiro.Org Blog


SOURCE:   J Clinical Medicine 2021 (Oct 28); 10 (21): 5011

Aleksander Chaibi, Knut Stavem and Michael Bjørn Russell

Head and Neck Research Group,
Division for Research and Innovation,
Akershus University Hospital,
1478 Oslo, Norway



Background:   Acute neck pain is common and usually managed by medication and/or manual therapy. General practitioners (GPs) hesitate to refer to manual therapy due to uncertainty about the effectiveness and adverse events (AEs)

Method:   To review original randomized controlled trials (RCTs) assessing the effect of spinal manipulative therapy (SMT) for acute neck pain. Data extraction was done in duplicate and formulated in tables. Quality and evidence were assessed using the Cochrane Back and

Results:   Six studies were included. The overall pooled effect size for neck pain was very large –1.37 (95% CI, –2.41, –0.34), favouring treatments with SMT compared with controls. A single study that showed that SMT was statistically significantly better than medicine (30 mg ketorolac im.) one day post-treatment, ((–2.8 (46%) (95% CI, –2.1, –3.4) vs. –1.7 (30%) (95% CI, –1.1, –2.3), respectively; p = 0.02)). Minor transient AEs reported included increased pain and headache, while no serious AEs were reported.

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NON-PHARMACOLOGIC THERAPY Page

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The Passing of a Giant – Chester Wilk dies at 91

By |April 23, 2022|History|

Shared from the World Federation of Chiropractic Facebook page

Dr Chester A. Wilk, the chiropractor famed for taking on the American Medical Association – and winning – passed away on Thursday, April, 21 at Advocate Lutheran Hospital, Park Ridge, Illinois.

The case of Wilk v AMA, an antitrust law suit, was a seminal moment in the profession’s history, at a time when chiropractors in the United States found themselves subjected to extreme prejudice and discrimination. The story of Chester Wilk’s epic battle is told in ‘Contain and Eliminate: the American Medical Association’s Conspiracy to Destroy Chiropractic’, written by Howard Wolinsky and published in 2021.

The persistence and fortitude of Wilk and his four co-plaintiffs, in the face of serious roadblocks to practicing as chiropractors, drove him to step up and take on the giant of healthcare. The David and Goliath story saw him consumed by his mission to expose the injustice and the covert Committee on Quackery that had been set up by the AMA to undermine and destroy chiropractic.

Starting in the 1970s, the legal battle continued for years, before a 1987 judgment by Judge Susan Getzendanner ruled that the AMA had illegally engaged in an unlawful conspiracy, a judgment subsequently upheld in 1990 in the Court of Appeals.

The impact of Wilk v AMA was huge. Doors that had previously been firmly shut opened up to allow interprofessional care and changes in the AMA’s ethical rules permitted referral by medical doctors to doctors of chiropractic.

We mourn the passing of Dr Wilk and recognize with gratitude the life of one of the legendary figures of the chiropractic profession.

Chiro.org has compiled a comprehensive page on the Wilk Anti-tust suit.

Spinal Manipulation vs Prescription Drug Therapy for Chronic Low Back Pain: Beliefs, Satisfaction With Care, and Qualify of Life Among Older Medicare Beneficiaries

By |April 10, 2022|Medicare|

Spinal Manipulation vs Prescription Drug Therapy for Chronic Low Back Pain: Beliefs, Satisfaction With Care, and Qualify of Life Among Older Medicare Beneficiaries

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther 2022 (Mar 26) [EPUB]

Anupama Kizhakkeveettil, PhD, Serena Bezdjian, PhD, Eric L. Hurwitz, PhD, Ian Coulter, PhD, Scott Haldeman, PhD, James M. Whedon, DC, MS et. al

Ayurveda Medicine Department,
Southern California University of Health Sciences,
Whittier, California.



  Davis (J Am Board Fam Med 2015)


Objective:   The objective of this study was to compare patients’ perspectives on the use of spinal manipulative therapy (SMT) compared to prescription drug therapy (PDT) with regard to health-related quality of life (HRQoL), patient beliefs, and satisfaction with treatment.

Methods:   Four cohorts of Medicare beneficiaries were assembled according to previous treatment received as evidenced in claims data: SMT, PDT, and 2 crossover cohorts (where participants experienced both types of treatments). A total of 195 Medicare beneficiaries responded to the survey. Outcome measures used were a 0–to–10 numeric rating scale to measure satisfaction, the Low Back Pain Treatment Beliefs Questionnaire to measure patient beliefs, and the 12–item Short Form Health Survey to measure HRQoL.

Results:   Recipients of SMT were more likely to be very satisfied with their care (84%) than recipients of PDT (50%; P = .002). The SMT cohort self-reported significantly higher HRQoL compared to the PDT cohort; mean differences in physical and mental health scores on the 12–item Short Form Health Survey were 12.85 and 9.92, respectively. The SMT cohort had a lower degree of concern regarding chiropractic care for their back pain compared to the PDT cohort’s reported concern about PDT (P = .03).

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Development and Evaluation of the MAINTAIN Instrument, Selecting Patients Suitable for Secondary or Tertiary Preventive Manual Care: The Nordic Maintenance Care Program

By |March 24, 2022|Chiropractic Management, Maintenance Care|

Development and Evaluation of the MAINTAIN Instrument, Selecting Patients Suitable for Secondary or Tertiary Preventive Manual Care: The Nordic Maintenance Care Program

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2022 (Mar 17)

Andreas Eklund, Per J Palmgren, Ulf Jakobsson, Iben Axén

Unit of Intervention and Implementation Research for Worker Health,
The Institute of Environmental Medicine (IMM),
Karolinska Institutet,
Stockholm, Sweden



Background:   Chiropractic maintenance care (MC) has been found to be effective for patients classified as dysfunctional by the West Haven-Yale Multidimensional Pain Inventory (MPI). Although displaying good psychometric properties, the instrument was not designed to be used in clinical practice to screen patients for stratified care pathways. The aim was to develop a brief clinical instrument with the intent of identifying dysfunctional patients with acceptable diagnostic accuracy.

Methods:   Data from 249 patients with a complete MPI dataset from a randomized clinical trial that investigated the effect and cost-effectiveness of MC with a 12-month follow-up was used in this cross-sectional analysis. A brief screening instrument was developed to identify dysfunctional patients, with a summary measure. Different cut-offs were considered with regards to diagnostic accuracy using the original instrument’s classification of dysfunctional patients as a reference. Very good diagnostic accuracy was defined as an area under the curve (AUC) metric between 0.8 and 0.9. The instrument was then externally validated in 3 other existing datasets to assess model transportability across populations and medical settings.

Results:   Using an explorative approach, the MAINTAIN instrument with 10 questions (0-6 Likert responses) capturing 5 dimensions (pain severity, interference, life control, affective distress, and support) was developed, generating an algorithm-based score ranging from – 12 to 48. Reporting a MAINTAIN score of 18 or higher, 146 out of the 249 patients were classified as dysfunctional with 95.8% sensitivity and 64.3% specificity. At a score of 22 or higher, 109/249 were classified as dysfunctional with 81.1% sensitivity and 79.2% specificity. AUC was estimated to 0.87 (95% CI 0.83, 0.92) and Youden’s index was highest (0.70) at a score of 20. The diagnostic accuracy was similar and high across populations with minor differences in optimal thresholds for identifying dysfunctional individuals.

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