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Magnetic Resonance Spectroscopy Displays the Structural and Biochemical Effects of Spinal Manipulative Therapy in Lumbar Discogenic Pain: A Case Report

By Frank M. Painter|April 12, 2023|Chiropractic Management, Disc Derangement|

Magnetic Resonance Spectroscopy Displays the Structural and Biochemical Effects of Spinal Manipulative Therapy in Lumbar Discogenic Pain: A Case Report

SOURCE: Research Square (Apr 4, 2023)

Jessica F Billham, Erika Evans Roland, Matthew F. Gornet, Kelly Brinkman, Francine Schranck, Jim Cox, Norman W. Kettner

Logan University
Chesterfield, MO, US

The Vertebral Disc
FROM: Bioengineering 2022

INTRODUCTION: We report utility of magnetic resonance spectroscopy (MRS) in identifying the intervertebral disc (IVD) as a pain generator, describe the contemporary pathophysiology underlying biochemical and structural components of discogenic low back pain (DLBP), and exhibit therapeutic responses to spinal manipulation.

CLINICAL FEATURES: A 29-year old man presented with uncomplicated low back pain (LBP). The nonspecific presentation and clinical exam findings were consistent with non-specific LBP with the IVD as likely pain generator.

INTERVENTION AND OUTCOMES: Conventional magnetic resonance imaging showed findings of IVD degeneration including Modic Type 1 changes consistent with a diagnosis of DLBP. MRS was utilized for structural and biochemical analysis of the IVDs. Altered spectral features confirmed a DLBP diagnosis. The patient underwent 12 Cox Flexion Distraction treatments at a chiropractic teaching clinic. Follow-up MRS revealed improved IVD spectral features including decreased biochemical pain markers and increased glycoprotein biosynthesis suggesting improved IVD structural integrity.

CONCLUSION: We report the first utilization of MRS to quantify structural integrity and biochemical pain profile of the IVD in a conservatively managed DLBP patient. Findings of this case suggest spinal manipulative therapy in DLBP management may improve the structural integrity of IVDs and alter pain biochemistry.

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LOW BACK PAIN Section and the:

DISC HERNIATION & CHIROPRACTIC Section

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The Swiss Chiropractic Practice-based Research Network: A Population-based Cross-sectional Study to Inform Future Musculoskeletal Research

By Frank M. Painter|April 7, 2023|Chiropractic Management, Musculoskeletal Dysfunction, Musculoskeletal Pain|

The Swiss Chiropractic Practice-based Research Network: A Population-based Cross-sectional Study to Inform Future Musculoskeletal Research

The Chiro.Org Blog

SOURCE: Scientific Reports 2023 (Apr 6); 13 (1): 5655

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Rahim Lalji, Léonie Hofstetter, Alice Kongsted, Viktor von Wyl, Milo A. Puhan & Cesar A. Hincapié

EBPI-UWZH Musculoskeletal Epidemiology Research Group,
University of Zurich and Balgrist University Hospital,
Forchstrasse 340, 8008,
Zurich, Switzerland.

FROM: BMJ Open 2022

The Swiss chiropractic practice-based research network (PBRN) is a nationwide project developed in collaboration with patients, clinicians, and academic stakeholders to advance musculoskeletal epidemiologic research. The aim of this study was to describe the clinician population recruited and representativeness of this PBRN to inform future collaboration. A population-based cross-sectional study was performed. PBRN clinician characteristics were described and factors related to motivation (operationalised as VAS score ≥ 70) to participate in a subsequent patient cohort pilot study were assessed. Among 326 eligible chiropractors, 152 enrolled in the PBRN (47% participation). The PBRN was representative of the larger Swiss chiropractic population with regards to age, language, and geographic distribution. Of those enrolled, 39% were motivated to participate in a nested patient cohort pilot study. Motivation was associated with age 40 years or older versus 39 years or younger (OR 2.3, 95% CI 1.0–5.2), and with a moderate clinic size (OR 2.4, 95% CI 1.1–5.7) or large clinic size (OR 2.8, 95% CI 1.0–7.8) versus solo practice. The Swiss chiropractic PBRN has enrolled almost half of all Swiss chiropractors and has potential to facilitate collaborative practice-based research to improve musculoskeletal health care quality.

Trial registration: Swiss chiropractic PBRN
(ClinicalTrials.gov identifier: NCT05046249);
Swiss chiropractic cohort (Swiss ChiCo) pilot study
(ClinicalTrials.gov identifier: NCT05116020).

From the FULL TEXT Article:

Introduction

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Examining Clinical Opinion and Experience Regarding Utilization of Plain Radiography of the Spine: Evidence from Surveying the Chiropractic Profession

By Frank M. Painter|March 29, 2023|Chiropractic Care, Radiology|

Examining Clinical Opinion and Experience Regarding Utilization of Plain Radiography of the Spine: Evidence from Surveying the Chiropractic Profession

The Chiro.Org Blog

SOURCE: J Clinical Medicine 2023 (Mar 10); 12 (6): 2169

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Philip A Arnone, Steven J Kraus, Derek Farmen, Douglas F Lightstone, Jason Jaeger, Christine Theodossis

Community Based Internship Program, Associate Faculty,
Southern California University of Health Sciences,
Whittier, CA 90604, USA.

FROM: Umeå University, Sweden 2008

Plain Radiography of the spine (PROTS) is utilized in many forms of healthcare including the chiropractic profession; however, the literature reflects conflicting opinions regarding utilization and value. Despite being an essential part of Evidence-Based Practice (EBP), few studies assess Doctors of Chiropractic (DCs) clinical opinions and experience regarding the utilization of (PROTS) in practice. In this study, DCs were surveyed regarding utilization of PROTS in practice. The survey was administered to an estimated 50,000 licensed DCs by email. A total of 4,301 surveys were completed, of which 3,641 were United States (US) DCs. The Clinician Opinion and Experience on Chiropractic Radiography (COECR) scale was designed to analyze survey responses. This valid and reliable scale demonstrated good internal consistency using confirmatory factor analysis and the Rasch model.

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Treatment Targets of Exercise for Persistent Non-specific Low Back Pain: A Consensus Study

By Frank M. Painter|March 24, 2023|Chiropractic Management, Exercise and Chiropractic, Low Back Pain|

Treatment Targets of Exercise for Persistent Non-specific Low Back Pain: A Consensus Study

The Chiro.Org Blog

SOURCE: Physiotherapy 2021 (Sep); 112: 78–86
Lianne Wood, Annette Bishop, Martyn Lewis, Rob J E M Smeets, Gert Bronfort, Jill A Hayden, Nadine E Foster

Primary Care Centre Versus Arthritis,
School of Primary, Community and Social Care,
Faculty of Medicine and Health Sciences,
Keele University,
Newcastle-under-Lyme ST5 5BG, UK

FROM: Br J Sports Med 2020

Objectives: Despite several hundred previous randomised controlled trials (RCTs), the key treatment targets of exercise for persistent non-specific low back pain (NSLBP) remain unclear. This study aimed to generate consensus about the key treatment targets of exercise interventions for patients with NSLBP.

Design: Consensus was generated using modified nominal group technique in two, sequential, workshops. The results of a previous systematic review informed the first, national, workshop idea generation and the results of this workshop informed the second, international, workshop. The authors generated a starting list of 30 treatment targets from the systematic review. A pre-specified consensus threshold of 75% was used in the voting stage.

Participants: Workshop participants included people with experience of using exercise to manage their persistent NSLBP, clinicians who prescribe exercise for persistent NSLBP, and researchers who design and evaluate exercise interventions in RCTs. All participants generated, voted and ranked the treatment targets in each workshop using an online platform.

Results: A total of 39 participants contributed to the consensus (15 in the national workshop and 24 in the international workshop), comprising two people with NSLBP, six clinicians and 31 researchers/clinicians. A total of 40 exercise treatment targets were generated, and 25 were retained after voting and ranking. The prioritised targets of exercise for persistent NSLBP were: improving function, improving quality of life, reducing pain, meeting patient-specific goals and reducing fear of movement.

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Happy St. Patricks Day

By Frank M. Painter|March 15, 2023|Announcement|

Happy St. Patricks Day

The Chiro.Org Blog

May the road rise up to meet you.
May the wind always be at your back.
May the sun shine warm upon your face,
and rains fall soft upon your fields.
And until we meet again,
May God hold you in the palm of His hand.

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Mechanisms of Chiropractic Spinal Manipulative Therapy for Patients with Chronic Primary Low Back Pain: Protocol for a Mechanistic Randomized Placebo-controlled Trial

By Frank M. Painter|February 25, 2023|Chiropractic Management, Low Back Pain, Spinal Joint Pain|

Mechanisms of Chiropractic Spinal Manipulative Therapy for Patients with Chronic Primary Low Back Pain: Protocol for a Mechanistic Randomized Placebo-controlled Trial

The Chiro.Org Blog

SOURCE: BMJ Open 2023 (Feb 10); 13 (2): e065999

OPEN ACCESS

Carlos Gevers-Montoro, Arantxa Ortega-De Mues, Mathieu Piché

Real Centro Universitario Escorial Maria Cristina,
San Lorenzo de El Escorial, Spain.

Introduction: Chronic low back pain (CLBP) is a highly prevalent and disabling condition. Identifying subgroups of patients afflicted with CLBP is a current research priority, for which a classification system based on pain mechanisms was proposed. Spinal manipulative therapy (SMT) is recommended for the management of CLBP. Yet, little data are available regarding its mechanisms of action, making it difficult to match this intervention to the patients who may benefit the most. It was suggested that SMT may influence mechanisms associated with central sensitisation. Therefore, classifying patients with CLBP according to central sensitisation mechanisms may help predict their response to SMT.

Methods and analysis: This protocol describes a randomised placebo-controlled trial aiming to examine which variables linked to central sensitisation may help predict the clinical response to SMT in a cohort of patients with CLBP. One hundred patients with chronic primary low back pain will be randomised to receive 12 sessions of SMT or placebo SMT over a 4–week period. Pain intensity and disability will be assessed as primary outcomes after completing the 4–week treatment (primary endpoint), and at 4–week and 12–week follow-ups. Baseline values of two pain questionnaires, lumbar pressure pain thresholds, concentrations of an inflammatory cytokine and expectations of pain relief will be entered as predictors of the response to SMT in a multiple regression model. Changes in these variables after treatment will be used in a second multiple regression model. The reference values of these predictors will be measured from 50 age and sex-matched healthy controls to allow interpretation of values in patients. Mixed analyses of variance will also be conducted to compare the primary outcomes and the predictors between groups (SMT vs placebo) over time (baseline vs post-treatment).

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