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Steroid Injections Offer Little Relief for Lower Back Pain

By Frank M. Painter|August 21, 2011|Low Back Pain|

Steroid Injections Offer Little Relief for Lower Back Pain

SOURCE: Amer Acad Orthop Surgeons March 10-14 · San Francisco, CA

“Effects of Epidural Steroids in the Lumbar Spine: A Double Blind Randomized Control Trial”

Podium Presentation

By Andrew Skelly

SAN FRANCISCO – A randomized, controlled trial has shown an epidural or translaminar steroid injection is ineffective for the relief of lower back pain.

“I’m not saying that steroids don’t work. I’m just saying there’s definite reason to question whether they work or not,” Dr. Daniel Steinitz, an orthopedic surgeon at Belleville General Hospital in Ontario, said in an interview after his presentation at the American Academy of Orthopedic Surgeons meeting here.

Dr. Steinitz, who worked on the study during his residency at McGill University in Montreal, said steroid injections for lumbar pain are popular but research on their use over the past 40 years has produced conflicting results. Nor is the procedure benign, with dural puncture leading to headache being one of the more common complications. (more…)

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The Evolution of Chiropractic — Science & Theory

By Frank M. Painter|August 20, 2011|Research|

The Evolution of Chiropractic — Science & Theory

The Chiro.Org Blog

By Scott Haldeman, D.C., M.D., Ph.D.

Keynote Presentation
International Conference on Spinal Manipulation

I have had the privilege of being associated with chiropractic and chiropractic ideas all of my life through my father and grandmother, both of whom were practicing chiropractors. I have also been lucky to have participated in one of the most exciting phases in the evolution of chiropractic over the past 35 years. I thought that it would be of interest to younger researchers and clinicians to present my views on how the profession has evolved to its current position in society and how this evolution has impacted our understanding of chiropractic. I plan to discuss how we can put the changes in the role of science over the past 100 years in perspective and how these changes are likely to impact our lives as researchers, chiropractors, and physicians studying and treating patients with spinal disorders. (more…)

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Spinal Manipulation May Help Reduce Spinal Degenerative Joint Disease and Disability

By Frank M. Painter|August 18, 2011|Degenerative Joint Disease, Spinal Manipulation|

Spinal Manipulation May Help Reduce Spinal Degenerative Joint Disease and Disability: PART I and II

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

By James Brantingham, DC, CCF , Randy Snyder, DC, CCFC, and David Biedebach, DC, CCFC

Has the hypomobile manipulable joint lesion been demonstrated to exist? Historically the manipulable joint lesion has, from the beginning of the chiropractic profession, been described as a painful stiff joint. [1, 2] Joint stiffness, commonly called hypomobility (also known in the chiropractic profession as “fixation”) has become by consensus one of the most important aspects of the manipulable joint lesion in the professions of chiropractic, osteopathy, and manual medicine. [3, 4] Nearly 100 years of clinical agreement between three separate professions supports the existence of such a lesion although research now supports its existence.

Loss of full, or global, range of motion in the lumbar or cervical spines is an indirect proof that the segmental hypomobile manipulable vertebral joint lesion exists, because it is a fact that loss of full global range of motion occurs and such stiffness is considered an objective factor in chronic back pain. [5] therefore, even if this decreased range of motion is a mixture of hypermobile and hypomobile joints (i.e., a mixture of loose and stiff joints) there must be intervertebral hypomobility for global hypomobility to exist. Randomized controlled trials of manipulation documenting decreased global range of motion, and post-treatment global range of motion are growing. [6-12]

A meta-analysis of clinical trials of spinal manipulation performed by Anderson et al., clearly and strongly demonstrated that spinal manipulation is effective in restoring or increasing global, and therefore segmental lumbar mobility. Mead et al., documented post-manipulation treatment restored or increased lumbar mobility: data proving that the hypomobile manipulable joint lesion must have existed prior to treatment, and that manipulation restored to these hypomobile joints fuller mobility (Fig 1.). [6] Other studies have documented similar results. Nansel and his associates have demonstrated in three, multiply blinded, controlled studies, in which goniometer measurements confirmed cervical range of motion or global end range asymmetries or hypomobility, that after chiropractic high velocity low amplitude manipulation, statistically significant increased mobility was restored to the global and therefore segmental hypomobility areas: proof that global and therefore segmental hypomobility was returned to more normal mobility by manipulation. [14-16] (more…)

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Bipartisan Group Urges Pentagon to Examine Chiropractic Provider Status

By Frank M. Painter|August 16, 2011|Announcement, News|

Bipartisan Group Urges Pentagon to Examine Chiropractic Provider Status

The Chiro.Org Blog

Fifteen Members of the House Defense Panel Advocate for Fair, and Equitable Treatment of DCs in the Military Health Care System

August 15, 2011 — In an effort strongly supported by the American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC), 15 members of the U.S. House of Representatives Armed Services Committee have requested that the Department of Defense (DoD) address disparities in its treatment of doctors of chiropractic.

In an Aug. 5 letter to Dr. Jonathan Woodson, Assistant Secretary of Defense for Health Affairs, the bipartisan group noted that pay and job classification disparities have resulted in doctors of chiropractic (DCs) who treat patients at military treatment facilities (MTFs) being compensated at much lower rates than providers with comparable, or even lesser, training, skill sets and responsibilities. They urged Woodson to examine the more equitable system used by the Department of Veteran Affairs health care system to integrate chiropractic and adopt a similar approach.

The group also pointed out that institutional bias against doctors of chiropractic among DoD health care officials has resulted in the active-duty military patient population having greater difficulty accessing chiropractic care and in unnecessary restrictions placed on DCs in performing their services. To address this, the legislators asked Woodson to evaluate the current supervisory procedures of DCs and to give serious consideration to having a DC as the chiropractic service leader for each branch of the military, as is the case with other specialty groups in TRICARE, the military’s health care system.

“I would like to thank congressmen Mike Rogers and Dave Loebsack for spearheading this effort,” said ACA President Dr. Rick A. McMichael. “The benefit provided by doctors of chiropractic to our brave men and women in uniform is integral to their recovery from injuries and their overall health and well-being. Impeding DCs from providing this care is a disservice to our troops.” (more…)

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The Inherent Problems With Randomized Controlled Trials

By Frank M. Painter|August 15, 2011|Editorial, Research|

The Inherent Problems With Randomized Controlled Trials (RCTs)

The Chiro.Org Blog

SOURCE: J Manip Physiol Ther 2003 (Sep); 26 (7): 460–467

Anthony Rosner, PhD

Foundation for Chiropractic Research and Education,
1330 Beacon Street, Suite 315,
Brookline, MA 02446, USA.

For 50 years, the accepted standard by which the usefulness of a therapeutic treatment is judged has been the randomized controlled trial (RCT), building from Hippocrates’ premise 2000 years ago that experience combined with reason was the therapy of choice for patients; that is, any treatment plan should both seem reasonable in theory and then be tested experimentally. Assuming that threats to both internal and external validity could be ruled out, the RCT became what is commonly regarded as the highest quality of clinical outcome study that could be mounted to allow inferences about cause and effect relationships to be drawn. The thinking was that the more rigorous and fastidious the design, the more credibility could be attached to the conclusions drawn from the outcomes of the study and the more likely the intervention was thought to have brought about those outcomes. [1] One of the strongest proponents of the RCT through the 1950s and 1960s was the British epidemiologist Archie Cochrane, who held that this type of experimental approach was essential for upgrading the quality of medical evidence. [2] In common hierarchical schemes of clinical experimental design, the RCT has been ranked the highest in rigor, as shown in Table 1.3 Even greater rigor has been presumed to occur with the statistical combination and weighting of the results of multiple RCTs in a meta-analysis to generate a more conclusive estimate of effect size. [4-5]

Table 1. Hierarchy of Experimental Designs [3]

Control group outcomes study (including RCTs).
Single-subject experiment, replicated single-subject experiments.
Single-group outcome study.
Systematic case study.
Anecdotal case report.

Designs are presented in descending order of rigor.

(more…)

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Chiropractic Research Testimony at the National Institute of Medicine

By Frank M. Painter|August 8, 2011|Editorial, Research|

Director of Chiropractic Research Testifies at the National Institute of Medicine

The Chiro.Org Blog

Anthony L. Rosner, Ph.D.

Foundation for Chiropractic Education and Research

Anthony Rosner, Ph.D., Director of Research and Education for the Foundation for Chiropractic Education and Research, presented testimony on behalf of chiropractic research and practice standards at hearings conducted at the Institute of Medicine (IOM) headquarters in Washington, D.C., on February 27, 2003. The occasion marked the first of six meetings of a study committee planned by the IOM over the next 18 months to explore the scientific and policy implications of the use of complementary and alternative medicine (CAM) therapies by the American public.

The objectives of the study committee are as follows:

To describe the use of CAM therapies by the American public, including the populations that use them and what is known about how they are provided;

To identify major scientific and policy issues related to CAM research (including gender effects), regulation, interactions with conventional medicine, and training and certification; and

To develop conceptual frameworks for guiding decision-making on these issues and questions.

The Institute of Medicine is a private, non-governmental organization that initiates studies in areas of medical care out of appropriations made available to federal agencies. It is a branch of the National Academy of Sciences, which was created by the federal government to be an advisor on scientific and technological matters.

The following is Dr. Rosner’s presentation to the Institute of Medicine.

The Use of CAM by the American Public

INTRODUCTION

My dear colleagues:

I want to thank the Institute of Medicine (IOM) for two reasons; first, for inviting my testimony this afternoon, but especially for carrying what I believe is the unfulfilled work of both the National Center for Complementary and Alternative Medicine and the White House Commission on Complementary and Alternative Medicine an essential step forward by calling us to the table today.

I also want to offer my strongest assent and congratulations to the Institute for its most pertinent and insightful assessment of American healthcare — first, in its forthright reporting of medical errors in 1999; [1] second, in providing one of the most equitable definitions among the many offered for “primary care; [1] [2] ” and finally, for having published two years ago the most candid and uncompromising assessments of U.S. healthcare, Crossing the Quality Chasm: A New Health System for the 21st Century. [3]

This last publication courageously concluded that “the American healthcare system is in need of a fundamental change,” especially because “what is perhaps most disturbing is the absence of real progress toward restructuring health care systems to address both quality and cost concerns. . . .” [3] (more…)

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