BLOG – Page 104 – Chiropractic Resource Organization

Effects of Upper and Lower Cervical Spinal Manipulative Therapy on Blood Pressure

By Frank M. Painter|January 14, 2016|Blood Pressure|

Effects of Upper and Lower Cervical Spinal Manipulative Therapy on Blood Pressure and Heart Rate Variability in Volunteers and Patients With Neck Pain: A Randomized Controlled, Cross-Over, Preliminary Study

SOURCE: J Chiro Med 2015 (Mar); 14 (1): 1–9 ~ FULL TEXT

Ni Ni Win, MBBS, PhD, Anna Maria S. Jorgensen, PhD,
Yu Sui Chen, PhD, and Michael T. Haneline, DC, MPH

Senior Lecturer, International Medical University,
Chiropractic, School of Health Sciences,
Kuala Lumpur, Malaysia

OBJECTIVE: The aims of this study were to examine autonomic nervous system responses by using heart rate variability analysis (HRV), hemodynamic parameters and numeric pain scale (NPS) when either upper (C1 and C2) or lower (C6 and C7) cervical segments were manipulated in volunteers, and whether such response would be altered in acute mechanical neck pain patients after spinal manipulative therapy (SMT).

METHODS: A randomized controlled, cross-over, preliminary study was conducted on 10 asymptomatic normotensive volunteers and 10 normotensive patients complaining of acute neck pain. HRV, blood pressure (BP) and heart rate (HR), and NPS were recorded after upper cervical and lower cervical segments SMT in volunteer and patient groups.

RESULTS: The standard deviation of average normal to normal R-R intervals (SDNN) increased (83.54 ± 22 vs. 105.41 ± 20; P = .02) after upper cervical SMT. The normalized unit of high frequency (nuHF), which shows parasympathetic activity, was predominant (40.18 ± 9 vs. 46.08 ± 14) after upper cervical SMT (P = .03) with a significant decrease (109 ± 10 vs. 98 ± 5) in systolic BP (P = .002). Low frequency to high frequency (LF/HF) ratio, which shows predominance of sympathetic activity increased (1.05 ± 0.7 vs. 1.51 ± 0.5; P = .02) after lower cervical SMT in the healthy volunteers group. However, there was an increase in SDNN (70.48 ± 18 vs. 90.23 ± 20; P = .02 and 75.19 ± 16 vs 97.52 ± 22; P = .01), a decrease in LF/HF ratio (1.33 ± 0.3 vs. 0.81 ± 0.2; P = .001 and 1.22 ± 0.4 vs. 0.86 ± 0.3; P = .02), which was associated with decreased systolic BP (105 ± 10 vs. 95 ± 9; P = .01 and 102 ± 9 vs. 91 ± 10; P = .02) and NPS scores (3 ± 1 vs. 0; P = .01 and 3 ± 1 vs. 1 ± 1; P = .03) following both upper and lower cervical SMT in the patient’s group. The baseline HR was 67 ± 9 vs 64 ± 5 (upper cervical) and 65 ± 7 vs 69 ± 11 (lower cervical) in both the healthy volunteer’ and patient’ groups.

There are more articles like this @ our:

Blood Pressure and Chiropractic Page

(more…)

0

Morbidity and Mortality of Major Adult Spinal Surgery. A Prospective Cohort Analysis of 942 Consecutive Patients

By Frank M. Painter|January 12, 2016|Iatrogenic Injury|

Morbidity and Mortality of Major Adult Spinal Surgery. A Prospective Cohort Analysis of 942 Consecutive Patients

The Chiro.Org Blog

SOURCE: Spine J. 2012 (Jan); 12 (1): 22–34

John T. Street, Brian J. Lenehan, Christian P. DiPaola et. al

Combined Neurosurgical and Orthopedic Spine Program,
Vancouver General Hospital,
818 West 10th Ave.,
Vancouver, British Columbia, Canada

BACKGROUND CONTEXT: To date, most reports on the incidence of adverse events (AEs) in spine surgery have been retrospective and dependent on data abstraction from hospital-based administrative databases. To our knowledge, there have been no previous rigorously performed prospective analysis of all AEs occurring in the entire population of patients presenting to an academic quaternary referral center.

PURPOSE: To determine the mortality and true incidence and severity of morbidity (major and minor, medical and surgical) in adults undergoing complex spinal surgery, both trauma and elective, in a quaternary referral center. To examine the influence of the introduction of a dedicated weekly multidisciplinary rounds, and a formal abstraction tool, on the recording of this prospective perioperative morbidity data. To examine the validity and inter- and intraobserver reliability of a dedicated Spine AdVerse Events Severity system, version 2 (SAVES V2) AE abstraction tool.

STUDY DESIGN: Ours is an academic quaternary referral center serving a population of 4.5 million people. Beginning in April 2008, a spine-specific AE-recording instrument, entitled SAVES V2, was introduced at our center for reporting, categorization, and classification of AEs. The use of this system remains an ongoing prospective study.

PATIENT SAMPLE: All adult patients admitted to the spine service of a quaternary referral center for a 12-month period.

OUTCOME MEASURES: A validity and an inter- and intraobserver reliability examination of the SAVES V2 system, as used at our institution. Morbidity and inhospital deaths, unplanned second surgeries during index admission, wound infections requiring reoperation, and readmissions during the same calendar year. We also examined in detail all intraoperative and nonsurgical postoperative AEs, as well as hospital length of stay (LOS).

METHODS: Data on all patients undergoing surgery over a 12-month period were prospectively collected using a perioperative morbidity abstraction tool at weekly dedicated mortality and morbidity rounds. This tool allows identification of each specific AE and grades the severity. Before the introduction of this system, and using the hospital inpatient database, our documented perioperative morbidity rate (major and minor, medical and surgical) was 23%. Diagnosis, operative data, hospital data, major and minor complications both medical and surgical, and deaths were recorded.

RESULTS: One hundred percent of all patients discharged from the unit had complete data available for analysis. Nine hundred forty-two patients with an age range of 16 to 90 years (mean, 54 years; mode, 38 years) were identified. There were 552 males and 390 females. Around 58.5% of patients had undergone elective surgery. Thirty percent of patients were American Spinal Injury Association class D or worse on admission.

The average hospital length of stay was 13.5 days (range, 1-221 days).

Eight hundred twenty-two (87%) patients had at least one documented complication.
Thirty-nine percent of these adversely affected hospital length of stay.
There were 14 mortalities during the study period.
The rate of intraoperative surgical complication was 10.5% (4.5% incidental durotomy and 1.9% hardware malposition requiring revision and 2.2% blood loss >2 L).
The incidence of postoperative complication was 73.5%
(wound complications, 13.5%; delerium, 8%; pneumonia, 7%; neuropathic pain, 5%; dysphagia, 4.5%; and neurological deterioration, 3%).

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

(more…)

0

Chiropractic Spinal Manipulative Therapy for Cervicogenic Headache

By Frank M. Painter|January 9, 2016|Headache|

Chiropractic Spinal Manipulative Therapy for Cervicogenic Headache: A Study Protocol of a Single-blinded Placebo-controlled Randomized Clinical Trial

The Chiro.Org Blog

SOURCE: Springerplus. 2015 (Dec 16); 4: 779

Aleksander Chaibi, Jurate Šaltyte Benth, Peter J. Tuchin, and Michael Bjørn Russell

Head and Neck Research Group,
Research Centre, Akershus University Hospital,
1478 Lørenskog, Norway ;

Institute of Clinical Medicine,
Akershus University Hospital, University of Oslo,
1474 Nordbyhagen, Norway

Cervicogenic headache (CEH) is a secondary headache which affects 1.0-4.6% of the population. Although the costs are unknown, the health consequences are substantial for the individual; especially considering that they often suffers chronicity. Pharmacological management has no or only minor effect on CEH. Thus, we aim to assess the efficacy of chiropractic spinal manipulative therapy (CSMT) for CEH in a single-blinded placebo-controlled randomized clinical trial (RCT). According to the power calculations, we aim to recruit 120 participants to the RCT. Participants will be randomized into one of three groups; CSMT, placebo (sham manipulation) and control (usual non-manual management). The RCT consists of three stages: 1 month run-in, 3 months intervention and follow-up analyses at the end of intervention and 3, 6 and 12 months. Primary end-point is headache frequency, while headache duration, headache intensity, headache index (frequency × duration × intensity) and medicine consumption are secondary end-points. Primary analysis will assess a change in headache frequency from baseline to the end of intervention and to follow-up, where the groups CSMT and placebo and CSMT and control will be compared. Due to two group-comparisons, the results with p values below 0.025 will be considered statistically significant. For all secondary end-points and analyses, the significance level of 0.05 will be used. The results will be presented with the corresponding p values and 95 % confidence intervals. To our knowledge, this is the first prospective manual therapy three-armed single-blinded placebo-controlled RCT to be conducted for CEH. Current RCTs suggest efficacy in headache frequency, duration and intensity. However a firm conclusion requires clinical single-blinded placebo-controlled RCTs with few methodological shortcomings. The present study design adheres to the recommendations for pharmacological RCTs as far as possible and follows the recommended clinical trial guidelines by the International Headache Society.

Trial registration ClinicalTrials.gov identifier: NCT01687881, 2 December 2012.

KEYWORDS: Cervicogenic headache; Chiropractic; Headache; Manual therapy; Protocol; Randomized controlled trial; Spinal manipulation

From the FULL TEXT Article:

Background

The prevalence of cervicogenic headache (CEH) is low and varies from 1.0 to 4.6 % in the general population, depending on the applied diagnostic criteria, i.e. 1.0 % if 6 and 4.6 % if 5 diagnostic criteria of the Cervicogenic Headache International Study Group are fulfilled, and 2.5 % if the criteria of the International Headache Society (IHS) are applied (Table 1) (Nilsson 1995a; Pareira Monteriro 1995; Sjaastad et al. 1998; Sjaastad and Bakketeig 2008; Headache Classification Subcommittee of the International Headache Society 2013). Headache disorders have substantial health and socio-economic costs (Vos et al. 2012). However, no studies have exclusively investigated the costs for CEH.

Table 1. Diagnostic criteria for cervicogenic headache by the Cervicogenic Headache International Study Group

There are more articles like this @ our:

Headache and Chiropractic Page

(more…)

0

Life-Threatening Lower Back Pain

By Frank M. Painter|January 8, 2016|Diagnosis, Low Back Pain|

Life-Threatening Lower Back Pain – Decoding the Mystery Step-By-Step

The Chiro.Org Blog

SOURCE: A Chiro.Org Contribution

David J Schimp DC, DACNB, DAAPM, FICCN and
Stefanie Krupp DC, MS

David J Schimp DC
Schimp Office of Chiropractic Professionals LTD
937 E. Sumner St.
Hartford, WI 53027 USA

This article will help clinicians identify life-threatening conditions that present with lower back pain.

Intra-abdominal bleed (e.g. aortic aneurysm), infection and tumor are the most dangerous causes of lower back pain and carry the potential for devastating consequences.

Table 1 identifies red flags that should raise suspicion of a serious disorder. [1]

Other red flags that are less likely to be associated with a life-threatening condition but that still warrant prompt diagnosis and appropriate management include:

pain that is worse with coughing

incontinence of bowel or bladder

urinary retention (inability to void or empty the bladder completely)

impotence

saddle anesthesia

intractable radicular pain into the lower extremity

rapidly progressive neurological deficit

The latter findings are common among patients with lumbar nerve root compression or cauda equina syndrome. Although serious, these disorders are seldom life threatening.

Step 1 – Evaluate for Red Flags*

Table 1: Red Flags of Low Back Pain [1]

RED FLAGS	BLEED	INFECTION	TUMOR
1. Duration greater than 6 weeks		X	X
2. Age less than 18y		X	X
3. Age greater than 50y	X	X	X
4. Prior history of cancer			X
5. Fever, chills or night sweats		X	X
6. Weight loss (unexplained)		X	X
7. IV drug use		X
8. Recent surgical procedure		X
9. Night pain		X	X
10. Unremitting, constant, no relief	X	X	X
11. Concomitant abdominal pain	X	X	X
12. Lightheaded, weak, diaphoretic, disorientated	X

* This is a list of red flags that may be associated with a life-threatening disease.

It is not meant to include all the other red flags of lower back pain.

Step 1: Evaluate for Red Flags (Discussion)

Duration greater than 6 weeks. Intractable or progressive lower back pain lasting longer than 6 weeks should raise suspicion of a serious underlying condition. Radiographs (lumbar plain film series including coronal, sagittal and spot views) and routine laboratory studies will add a greater level of diagnostic accuracy to the evaluation. Basic laboratory studies to consider include comprehensive metabolic panel, complete blood count (CBC), C-reactive protein(CRP) or high sensitivity CRP (preferred), erythrocyte sedimentation rate (ESR) and urinalysis (UA). [2]If imaging and lab studies are normal and the patient has normal vitals, then serious disease is unlikely. Advanced imaging (MRI or CT) can be utilized if plain film radiography if felt to lack sensitivity. In the absence of serious disease, a mechanical lesion, central sensitization or psychosocial co-morbidities may explain on-going pain over 6 weeks in duration.
Age less than 18 years. Persistent pain in a pediatric patient is a red flag for tumor or infection if symptoms cannot be ascribed to a congenital abnormality or acute injury. Advanced imaging (MRI) and routine laboratory studies as noted above should be considered.
Age greater than 50 years. Although low back pain is common in this population, clinicians should be particularly alert to the patient that presents with a new onset of low back pain, whether or not a mechanical basis is identified. Intra-abdominal disorders (e.g. abdominal aortic aneurysm) and cancer are more common in this population. Although a mechanical lesion is more likely, older patients require a greater level of diligence to rule out serious disease.(see Table 1)
Patient history of cancer. Neoplasm involving the spine may present as unrelenting pain (i.e. does not improve with rest or analgesia) or pain that is worse at night. Cancer recurrence or metastasis to the spine should be considered when a patient with a prior history of cancer complains of unrelenting back pain. Advanced imaging (MRI) is valuable and early use may be appropriate if the index of suspicion is high. Basic laboratory testing can be helpful (e.g., elevation of alkaline phosphatase on a comprehensive metabolic panel and leukocytosis on a complete blood count). [2] A history of prior malignancy is the most informative of the all the red flags listed in Table 1 and may suggest active neoplasm as the cause of the individual’s back pain. (more…)

0

Vitamins and Nutrients as Primary Treatments in Experimental Brain Injury

By Frank M. Painter|January 4, 2016|Nutrition, Traumatic Brain Injury|

Vitamins and Nutrients as Primary Treatments in Experimental Brain Injury: Clinical Implications for Nutraceutical Therapies

The Chiro.Org Blog

SOURCE: Brain Res. 2015 (Dec 23) [Epub ahead of print]

Cole Vonder Haara, Todd C. Petersonb, Kris M. Martensa, Michael R. Hoanec

Restorative Neuroscience Laboratory
Department of Psychology,
Life Science II, MC 6502
Southern Illinois University,
Carbondale, IL 62901, USA

With the numerous failures of pharmaceuticals to treat traumatic brain injury in humans, more researchers have become interested in combination therapies. This is largely due to the multimodal nature of damage from injury, which causes excitotoxicity, oxidative stress, edema, neuroinflammation and cell death. Polydrug treatments have the potential to target multiple aspects of the secondary injury cascade, while many previous therapies focused on one particular aspect. Of specific note are vitamins, minerals and nutrients that can be utilized to supplement other therapies. Many of these have low toxicity, are already FDA approved and have minimal interactions with other drugs, making them attractive targets for therapeutics.

There are more articles like this @ our:

Nutrition Section

(more…)

0

Year End Review

By Frank M. Painter|December 31, 2015|News|

“Americans’ Perceptions of Chiropractic”

The Chiro.Org Blog

SOURCE: A Chiro.Org Editorial

As 2015 draws to a close, let’s review one of the most interesting events of the year.

As tweeted by researcher Dr. Dana Lawrence on September 8th:

Gallup and Palmer College release first-ever national survey on Americans’ perception of chiropractic.

I am highlighting this Gallup survey for several reasons. The main reason is because we have so many different sources to draw from. I was particularly excited by the Palmer Homecoming presentation from Gallup researcher Cynthia English and the Dynamic Chiropractic webinar discussion by Dennis Marchiori, D.C., Ph.D. and William Meeker, D.C., M.P.H.

I hope you will find the following interviews as exciting as I did.

September 8th was when JMPT pre-published the article:

Public Perceptions of Doctors of Chiropractic

Gallup also released their own press release on the study on September 8th:

Majority in U.S. Say Chiropractic Works for Neck, Back Pain

You will also enjoy this fascinating Palmer Homecoming presentation from Gallup researcher Cynthia English about the gathering and meaning of the data they collected.

Gallup-Palmer Presentation from Palmer College of Chiropractic on Vimeo.

According to NewsUSA – Far more adults than anyone thought are seeking help from chiropractors, according to a new nationwide Gallup report.

The complete report “Americans’ Perceptions of Chiropractic”
is available for your review.

(more…)

0