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The Vast Majority of Patients With Fibromyalgia Have a Straight Neck Observed on a Lateral View Radiograph of the Cervical Spine: An Aid in the Diagnosis of Fibromyalgia and a Possible Clue to the Etiology

By Frank M. Painter|November 10, 2022|Chiropractic Management, Fibromyalgia, Hypolordosis|

The Vast Majority of Patients With Fibromyalgia Have a Straight Neck Observed on a Lateral View Radiograph of the Cervical Spine: An Aid in the Diagnosis of Fibromyalgia and a Possible Clue to the Etiology

SOURCE: J Clinical Rheumatology 2022 (Nov 3) [EPUB]

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Robert S Katz, MD, Frank Leavitt, PhD, Katya Cherny,MS , Alexandra Katz Small, MD, Ben J Small, MD

From the Rush Medical University.
Rheumatology Associates.
Northwestern University Medical Center,
Chicago, IL.

Objective: A straight cervical spine is an underappreciated and often overlooked finding in fibromyalgia. The aim of this medical records review study was to evaluate the cervical curvature on radiographs of patients with fibromyalgia.

Methods: A consecutive series of 270 cervical spine radiographs of patients with neck pain from 2015 to 2018 were retrospectively analyzed for cervical curvature using the Cobb angle measurement. One hundred fifty-five patients met full American College of Rheumatology criteria for fibromyalgia, whereas 115 subjects with other rheumatic diseases who were similar in age and education served as control subjects.

Results: Mean cervical curvature in fibromyalgia was 6.4 ± 5.2 degrees and 13.8 ± 7.4 degrees in control subjects. The more than 7-degree difference was significant (p < 0.001). Curvature in the magnitude of 21 degrees is at the low end of normal. At ≤10 degrees, where the cervical spine is essentially straight, there were 129 fibromyalgia patients (83.2%) and 37 control subjects (32.2%). The 51% difference was significant (p < 0.001).

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RADIOLOGY Section and the:

FIBROMYALGIA Section and the:

SPINAL ALLIGNMENT Section

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Initial Integration of Chiropractic Services into a Provincially Funded Inner City Community Health Centre: A Program Description

By Frank M. Painter|November 7, 2022|Integrative Care|

Initial Integration of Chiropractic Services into a Provincially Funded Inner City Community Health Centre: A Program Description

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc 2015 (Dec); 59 (4): 363–372

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Steven R. Passmore, DC, PhDm Audrey Toth, DC, Joel Kanovsky, DC. Gerald Olin, BSc, DC

University of Manitoba,
College of Rehabilitation Sciences;
University of Manitoba,
Faculty of Kinesiology & Recreation Management.

Background: The burden of fees for chiropractic services rendered often falls on the patient and must be provided out-of-pocket regardless of their socioeconomic status and clinical need. Universal healthcare coverage reduces the financial barrier to healthcare utilization, thereby increasing the opportunity for the financially disadvantaged to have access to care. In 2011 the Canadian Province of Manitoba initiated a pilot program providing access to chiropractic care within the Mount Carmel Clinic (MCC), a non-secular, non-profit, inner city community health centre.

Objective: To describe the initial integration of chiropractic services into a publically funded healthcare facility including patient demographics, referral patterns, treatment practices and clinical outcomes.

Method: A retrospective database review of chiropractic consultations in 2011 (N=177) was performed.

Results: The typical patient referred for chiropractic care was a non-working (86%), 47.3 (SD=16.8) year old, who self-identified as Caucasian (52.2%), or Aboriginal (35.8%) and female (68.3%) with a body mass index considered obese at 30.4(SD=7.0). New patient consultations were primarily referrals from other health providers internal to the MCC (71.2%), frequently primary care physicians (76%). Baseline to discharge comparisons of numeric rating scale scores for the cervical, thoracic, lumbar, sacroiliac and extremity regions all exceeded the minimally clinically important difference for reduction in musculoskeletal pain. Improvements occurred over an average of 12.7 (SD=14.3) treatments, and pain reductions were also statistically significant at p<0.05.

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INTEGRATED HEALTH CARE Section and the:

INITIAL PROVIDER/FIRST CONTACT Section

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Adverse Impacts of Chronic Pain on Health-related Quality of Life, Work Productivity, Depression and Anxiety in a Community-based Study

By Frank M. Painter|November 5, 2022|Initial Provider, Low Back Pain, Spinal Pain Management|

Adverse Impacts of Chronic Pain on Health-related Quality of Life, Work Productivity, Depression and Anxiety in a Community-based Study

The Chiro.Org Blog

SOURCE: Family Practice 2017 (Nov 16); 34 (6): 656–661

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Kosuke Kawai, Alison Tse Kawai, Peter Wollan, Barbara P Yawn

Clinical Research Center,
Boston Children’s Hospital,
Harvard Medical School,
Boston, MA, USA.

Background: Chronic pain has major clinical and social consequences. Few studies have examined any variation in the extent of impairment on quality of life and work productivity by site and type of chronic pain.

Objective: The objective of our study is to examine adverse impacts of chronic pain on physical and psychological health and work productivity.

Methods: Our community-population study was based on a phone-interview of adults with chronic pain, residing in Olmsted County, MN. Chronic pain groups were categorized into abdominal pain, back pain, joint pain, multisite pain, neuropathic pain or no chronic pain. We used standardized instruments, including the Brief Pain Inventory, the Patients Health Questionnair-9, and Work Productivity and Activity Impairment Questionnaire.

Results: We evaluated 591 patients suffering from chronic pain and 150 participants with no chronic pain. Almost one third of patients with multisite pain (33%) and neuropathic pain (32%) reported mild/major depressive symptoms. Patients suffering from chronic pain, particularly from multisite pain and neuropathic pain, reported significant pain interferences with daily activities and impairments in physical function. Chronic pain was significantly associated with reduced performance at work but not with missed work hours. The average reported reduction in work productivity ranged from 2.4 hours (±5.6) per week for adults with joint chronic pain to 9.8 hours (±11.1) per week for adults with multisite chronic pain.

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LOW BACK PAIN Section and the:

SPINAL PAIN MANAGEMENT Section

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A Retrospective Analysis of Pain Changes and Opioid Use Patterns Temporally Associated with a Course of Chiropractic Care at a Publicly Funded Inner-city Facility

By Frank M. Painter|November 4, 2022|Initial Provider, Opioid Epidemic|

A Retrospective Analysis of Pain Changes and Opioid Use Patterns Temporally Associated with a Course of Chiropractic Care at a Publicly Funded Inner-city Facility

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc 2022 (Aug); 66 (2): 107–117

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Steven Passmore, Hons BKin, MS, DC, PhD, Quinn Malone, BSc, MSc1, Christian Manansala, BSc, DC, MSc, Spencer Ferbers, BSc,
E. Audrey Toth, DC, Gerald M. Olin, BSc, DC, CDir

Faculty of Kinesiology and Recreation Management,
University of Manitoba,
102- Frank Kennedy Centre,
420 University Crescent,
Winnipeg, MB, R3T 2N2 Canada

FROM: Kazis et. al, BMJ Open 2019

Background: Non-pharmacologic treatment, including chiropractic care, is now recommended instead of opioid prescriptions as the initial management of chronic spine pain by clinical practice guidelines. Chiropractic care, commonly including spinal manipulation, has been temporally associated with reduced opioid prescription in veterans with spine pain.

Purpose: To determine if chiropractic management including spinal manipulation was associated with decreased pain or opioid usage in financially disadvantaged individuals utilizing opioid medications and diagnosed with musculoskeletal conditions.

Methods: A retrospective analysis of quality assurance data from a publicly funded healthcare facility was conducted. Measures included numeric pain scores of spine and extremity regions across three time points, opioid utilization, demographics, and care modalities.

Results: Pain and opioid use significantly decreased concomitant with a course of chiropractic care.

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OPIOID EPIDEMIC Section and the:

INITIAL PROVIDER/FIRST CONTACT Section

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Providing Information at the Initial Consultation to Patients with Low Back Pain Across General Practice, Chiropractic and Physiotherapy – A Cross-sectorial Study of Danish Primary Care

By Frank M. Painter|November 2, 2022|Chiropractic Management, Low Back Pain|

Providing Information at the Initial Consultation to Patients with Low Back Pain Across General Practice, Chiropractic and Physiotherapy – A Cross-sectorial Study of Danish Primary Care

The Chiro.Org Blog

SOURCE: Scand J Prim Health Care 2022 (Oct 31); 1–9

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Lars Morsø, Jesper Lykkegaard, Merethe Kirstine Andersen, Anders Hansen, Mette Jensen Stochkendahl, Simon Dyrløv Madsen, Berit Schiøttz Christensen

Department of Clinical Research,
Research Unit OPEN,
University of Southern Denmark,
Odense, Denmark

Objective: Clinical guidelines for managing low back pain (LBP) emphasise patient information, patient education and physical activity as key components. Little is known about who actually receives information. This study investigates to what extent information at the first consultation with general practitioner (GP), chiropractor (DC) and physiotherapist (PT) in Danish primary care is provided to

Design and setting: This cross-sectorial study was conducted as a prospective survey registration of LBP consultations at the three primary health care professions in Denmark.

Intervention: Clinicians ticked off a paper survey chart during or after consultations with patients who visited the clinic for LBP (Approval number: ID # 11.220).

Subjects: 33 GPs, 43 DCs and 61 PTs registered first-time consultations.

Main outcome measures: The primary outcome was provision of information, overall and across care settings.

Results: The overall proportion of patients provided with information was 72%, but this varied among professions (GP, 44%; DC, 76%; and PT, 74%). Provision of information increased to 78% if patients had increased emotional distress or back-related leg pain below the knee. The strongest association with provision of information was having two or three signs of elevated distress (OR 2.58 and 5.05, respectively, p= 0.00) or physical disability (OR 2.55, p= 0.00).

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LOW BACK PAIN Section

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The Importance, Measurement and Practical Implications of Worker’s Expectations for Return to Work

By Frank M. Painter|October 10, 2022|Chiropractic Management, Low Back Pain, Return To Work, Whiplash|

The Importance, Measurement and Practical Implications of Worker’s Expectations for Return to Work

The Chiro.Org Blog

SOURCE: Disabil Rehabil 2015; 37 (20): 1808–1816

Amanda E Young, Elyssa Besen, YoonSun Choi

Liberty Mutual Research Institute for Safety,
Center for Disability Research,
Hopkinton, MA, USA.

Purpose: &nbsp Workers’ own expectations for return to work consistently predict work status. To advance the understanding of the relationship between RTW expectations and outcomes, we reviewed existing measures to determine those which we felt were the most likely to capture the construct.

Method: &nbsp A comprehensive search of the work-disability rehabilitation literature was undertaken. The review of the measures was conducted in three steps: first, a review of terminology; second, an examination of whether a time reference was included; third, an evaluation of ease of comprehension, and applicability across contexts.

Results: &nbsp A total of 42 different measures were identified. One of the most striking findings was the inconsistency in terminology. Measures were also limited by not including a time reference. Problems were also identified with regards to ease of understanding, utility of response options, and applicability in a wide variety of research and applied settings.

Conclusions: &nbsp Most previously used measures contain elements that potentially limit utility. However, it would seem that further development can overcome these, resulting in a tool that provides risk prediction information, and an opportunity to start a conversation to help identify problems that might negatively impact a worker’s movement through the RTW process and the outcomes achieved. Implications for Rehabilitation Return to work is an integral part of workplace injury management. The capture of RTW expectations affords a way to identify the potential for less than optimal RTW processes and outcomes. A mismatch between an injured worker’s expectations and what other stakeholders might expect suggests that efforts could be made to determine what is causing the injured worker’s concerns. Once underling issues are identified, work can be put into resolving these so that the worker’s return to the workplace is not impeded.

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WHIPLASH Section and the:

LOW BACK PAIN Section

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