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Best and worst jobs for people in pain

By John Wiens DC|December 23, 2012|General Health|

Going to work when you have a chronic pain-causing condition can be difficult or even downright impossible, depending on the job. Studies have shown that people with rheumatoid arthritis are more likely to change jobs, reduce their hours, be fired, and retire early than people without the condition.

If you have chronic pain and are in the workforce, you should try to find an occupation that isn’t too physically demanding and allows you to work at your own pace.

Best: Administrative assistant
Sitting at a desk all day is not ideal for someone with painful joints. Working as an administrative assistant, however, could have its benefits. You may not have to perform a lot of repetitive movements, unless it’s typing. Also, this position probably comes with some flexibility—it’s important to be able to move around when you need to and take breaks as necessary.

A 2012 study out of the University of Georgia found that administrative assistants and office staff in general had the fewest reported injuries of the occupations studied.

Worst: Landscaping
If you have a green thumb, it’s wise to limit your talents to your own yard. Landscaping tasks like pruning that involve frequent use of hand tools can cause pain in the small joints.

Landscaping also requires a lot of bending, stooping over, and kneeling, which can cause pain in joints, particularly the knees. Finally, it also involves lifting and hauling, sometimes in wheelbarrows, which can cause back pain. (more…)

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Choice: It Really Does Matter!

By Frank M. Painter|December 19, 2012|Chiropractic Care, Spinal Manipulation, Unnecessary Surgery|

Choice: It Really Does Matter!

The Chiro.Org Blog

SOURCE: Spine (Phila Pa 1976). 2012 Dec 12. [Epub ahead of print]

Keeney, Benjamin J. PhD; Fulton-Kehoe, Deborah PhD, MPH; Turner, Judith A. PhD; Wickizer, Thomas M. PhD; Chan, Kwun Chuen Gary PhD; Franklin, Gary M. MD, MPH

Department of Orthopaedics, Geisel School of Medicine at Dartmouth College, Lebanon, NH 03756, USA. Benjamin.J.Keeney@Dartmouth.edu

This review, by scientists at the Department of Orthopaedics at the Geisel School of Medicine, clearly suggests that the first doctor you choose to see will have a profound effect on whether you end up having spinal surgery.

Just look at these stats:

42.7% of workers who first saw a surgeon ended in surgery, as opposed to only

1.5% of those who (first) saw a chiropractor.

The authors conclude: “There was a very strong association between surgery and first provider seen for the injury, even after adjustment for other important variables.”

The Abstract:

Study Design Prospective population-based cohort study

Objective To identify early predictors of lumbar spine surgery within 3 years after occupational back injury (more…)

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New Oregon LBP Guidelines: Try Chiropractic First

By Frank M. Painter|December 17, 2012|Chiropractic Care, Guidelines, Low Back Pain|

New Oregon LBP Guidelines: Try Chiropractic First

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

By Vern Saboe, DC, DACAN, DABFP, FACO

Lobbyist, Oregon Chiropractic Association

The new State of Oregon Evidence-Based Clinical Guidelines for the Evaluation and Management of Low Back Pain recommends spinal manipulation as the only nonpharmacological treatment for acute lower back pain. The guidelines, which have been adopted by the Oregon Health Authority, are a collaborative effort between the Center for Evidence-Based Practice, Oregon Corporation for Health Care Quality, Oregon Health and Sciences University’s Center for Evidence-based Policy, and the new Oregon Health Evidence Review Commission.

The Oregon Chiropractic Association (OCA) repeatedly gave written and oral testimony that the original draft guidelines placed too much emphasis on drugs and surgery. A close review of the original algorithm, “Management of Low Back Pain (LBP) (Image 2), relative to “#23 Signs or symptoms of radiculopathy or spinal stenosis,” reveals this. For example, if subsequent special imaging (MRI) revealed concordant nerve root impingement or spinal stenosis (#25), the original draft algorithm led the clinician into a surgical or other invasive procedure “dead end,” meaning there was no contingency for conservative chiropractic treatment (#26).

Image 2 (above)
—> Is Now Discontinued

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Earn 1 Credit of CE for Reading This Medscape Article on Fibromyalgia: “No Offense, Doctor, But I Want a Referral for My Pain”

By Frank M. Painter|December 10, 2012|Clinical Decision-making|

“No Offense, Doctor, But I Want a Referral for My Pain”

The Chiro.Org Blog

SOURCE: Medscape Education Community CME
NOTE: Establish your free account with Medscape to participate

Charles P. Vega, MD

Case Presentation

You are seeing a 42-year-old woman whom you diagnosed with fibromyalgia 4 weeks ago. Her main complaint continues to be diffuse, dull body pain, but she also reports occasional numbness in both hands. She says that she has felt fatigue for the past several years, and she blames poor sleep for this. She denies depression but says that she gets tearful when she thinks about her chronic symptoms and how they have limited her from what she has wanted to accomplish.

The patient was treated initially with some education regarding fibromyalgia and its manifestations, followed by several supporting phone calls from your staff. She was given a prescription for an exercise program, which she tried twice but could not continue due to exacerbation of her symptoms. She was also given a prescription for amitriptyline 50 mg at bedtime, which she stopped after 2 days due to dry mouth and increased fatigue.

Two weeks ago, you prescribed duloxetine 20 mg daily. She comes to your clinic today to tell you that this medication has had no effect on her symptoms. She tells you that she likes you as a person, but she requests that she be referred to someone who can treat her illness more effectively. (more…)

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Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial

By Frank M. Painter|November 25, 2012|Chiropractic Care, Colic, Pediatrics|

Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2012 (Oct); 35 (8): 600–607

Joyce E. Miller, BS, DC, David Newell, PhD, and
Jennifer E. Bolton, PhD

Associate Professor,
Anglo-European College of Chiropractic,
Bournemouth, UK.
jmiller@aecc.ac.uk.

Dr. Miller wrote a follow-up to this study, a cost comparison of the medical and chiropractic care provided in her earlier RTC study, titled:

Costs of Routine Care For Infant Colic in the UK and Costs of Chiropractic Manual Therapy as a Management Strategy Alongside a RCT For This Condition
J Clinical Chiropractic Peds 2013 (Jun); 14 (1): 1063–1069

This RTC cast new and significant insights into previous colic trials:

Chiropractic care lowered overall costs more than 400% compared with medical management
The current study revealed that excessively crying infants were 5 times less likely to cry significantly, if they were treated with chiropractic manual therapy, and that chiropractic care reduced their crying times by about 50%, compared with those infants provided solely medical management.

OBJECTIVE: The purpose of this study was to determine the efficacy of chiropractic manual therapy for infants with unexplained crying behavior and if there was any effect of parental reporting bias.

METHODS: Infants with unexplained persistent crying (infant colic) were recruited between October 2007 and November 2009 at a chiropractic teaching clinic in the United Kingdom. Infants younger than 8 weeks were randomized to 1 of 3 groups: (i) infant treated, parent aware; (ii) infant treated, parent unaware; and (iii) infant not treated, parent unaware. The primary outcome was a daily crying diary completed by parents over a period of 10 days. Treatments were pragmatic, individualized to examination findings, and consisted of chiropractic manual therapy of the spine. Analysis of covariance was used to investigate differences between groups.

RESULTS: One hundred four patients were randomized. In parents blinded to treatment allocation, using 2 or less hours of crying per day to determine a clinically significant improvement in crying time, the increased odds of improvement in treated infants compared with those not receiving treatment were statistically significant at day 8 (adjusted odds ratio [OR], 8.1; 95% confidence interval [CI], 1.4-45.0) and at day 10 (adjusted OR, 11.8; 95% CI, 2.1-68.3). The number needed to treat was 3. In contrast, the odds of improvement in treated infants were not significantly different in blinded compared with nonblinded parents (adjusted ORs, 0.7 [95% CI, 0.2-2.0] and 0.5 [95% CI, 0.1-1.6] at days 8 and 10, respectively).

CONCLUSIONS: In this study, chiropractic manual therapy improved crying behavior in infants with colic. The findings showed that knowledge of treatment by the parent did not appear to contribute to the observed treatment effects in this study. Thus, it is unlikely that observed treatment effect is due to bias on the part of the reporting parent.

Introduction

Excessive infant crying in otherwise healthy infants, traditionally called infant colic, continues to be an enigmatic condition with no known cause and no known cure. [1-3] Afflicting between 10% to 30% of all infants and consuming significant health care resources, [2] infant colic is a problem for parents and clinicians, both of whom try a wide range of therapies with often disappointing results.

You may review the earlier Colic studies at:

The Infantile Colic and Chiropractic Page

and you may also enjoy our

Chiropractic Pediatrics Page

Despite decades of research, a clear pathogenesis has not been elucidated. Notwithstanding, what is clear is that underlying disease is rare in the excessively crying baby [4] and that half of those affected recover by 6 months of age, [5] with a small proportion at risk of injury [6] or long-term developmental problems. [7-9] In an effort to help their child with what appears to be a painful condition, some parents choose complementary and alternative medicine (CAM), including chiropractic manual therapy. [9-12] To date, several randomized trials have been reported, [13-19] and although these trials demonstrate some reduction in crying, weaknesses in study methodologies have compromised their contribution to the evidence base. [20-23]

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Vertebral artery strains during high-speed, low amplitude cervical spinal manipulation.

By John Wiens DC|November 23, 2012|Research|

J Electromyogr Kinesiol . 2012 Oct;22(5):740-6. doi: 10.1016/j.jelekin.2012.03.005. Epub 2012 Apr 5.

Herzog W, Leonard TR, Symons B, Tang C, Wuest S.

Abstract

Spinal manipulative therapy (SMT) has been recognized as an effective treatment modality for many back, neck and musculoskeletal problems. One of the major issues of the use of SMT is its safety, especially with regards to neck manipulation and the risk of stroke. The vast majority of these accidents involve the vertebro-basilar system, specifically the vertebral artery (VA) between C2/C1. However, the mechanics of this region of the VA during SMT are unexplored. Here, we present first ever data on the mechanics of this region during cervical SMT performed by clinicians. VA strains obtained during SMT are significantly smaller than those obtained during diagnostic and range of motion testing, and are much smaller than failure strains. We conclude from this work that cervical SMT performed by trained clinicians does not appear to place undue strain on VA, and thus does not seem to be a factor in vertebro-basilar injuries.

The October 2012 issue is devoted to the study of spinal manipulation.

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