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The Obstacles and Barriers to CAM or Alt-Med Research

By Frank M. Painter|August 3, 2011|Editorial, Research|

The Obstacles and Barriers to CAM or Alt-Med Research

SOURCE: Testimony to the White House Commission On Complementary and Alternative Medicine Policy

By Anthony L. Rosner, Ph.D.

FCER Director of Research and Education

Introduction:

Until 25 years ago, chiropractic research was vastly underdeveloped and appeared to some as an oxymoron. In 1975, a conference at the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institutes of Health (NIH) concluded that “There are little scientific data of significance to evaluate this (chiropractic’s) clinical approach to health and to the treatment of disease.” [1] From that time onward, both clinical and basic research have advanced to the point at which:

(i) over 40 randomized clinical trials comparing spinal manipulation with other treatments in the management of back pain have been published in the scientific literature, [2, 3](ii) meta-analysis and systematic reviews attesting to the support of spinal manipulation in the management of back pain [4, 5] have also appeared, and(iii) multidisciplinary panels representing the governments of the United States, [6] Canada, [7] Great Britain, [8] Sweden, [9] Denmark, [10] Australia, [11] and New Zealand [12] have expressed similar recognition of the robust evidence base in support of spinal manipulation for managing low back conditions.Barriers:

The efforts to launch and develop a National Center for Complementary and Alternative Medicine (NCCAM) within the framework of the NIH are indeed admirable, taking the Center from a humble $2 million annual budget in 1991 to one that approaches $70 million today. This has taken place despite the comments of highly visible and influential individuals within the medical community to discredit alternative medicine in virtually any shape or form, a topic that I shall return to momentarily.

The following are what I believe to be the most significant barriers to research efforts in alternative medicine, the barriers having either remained in place or only recently having been removed.

1. Collaborative Arrangements: (more…)

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Symptomatic Classification of Whiplash Injury and the Implications for Treatment

By Frank M. Painter|August 1, 2011|Whiplash|

Symptomatic Classification of Whiplash Injury and the Implications for Treatment

The Chiro.Org Blog

SOURCE: J Orthopaedic Medicine 1999; 21 (1): 22–25

Khan S, Cook J, Gargan M, Bannister G

University Department of Orthopaedic Surgery,
Bristol, UK

Gargan and Bannister are renowned orthopedic trauma researchers from the Department of Orthopedic Surgery, John Radcliffe Hospital in Bristol, Oxford, England. In 1994, they published a paper in the European Spine Journal on the recovery rate of patients with whiplash injuries, and discovered that IF a patient was still symptomatic after three months, there was almost a 90% chance they would remain so. [1]

In 1995 they co-published a study with Woodward [2] that found that 93% of the chronic whiplash patients they studied experienced significant improvements with chiropractic care.

Chiropractic care in this study consisted of spinal manipulation, PNF and cryotherapy. Most of these 28 patients had already had prior medical treatment with NSAIDs, soft collars and physiotherapy.

Their third study reviewed conventional medical treatment for whiplash care, finding that it “was disappointing.”

The authors also found that:

“Chiropractic is the only proven effective treatment in chronic cases.”

The objective of their new study was to determine which type of chronic whiplash patient would benefit the most from chiropractic treatment. [3]

They separated patients into one of 3 groups:

Group 1: patients with “neck pain radiating in a ‘coat hanger’ distribution, associated with restricted range of neck movement but with no neurological deficit.”

Group 2: patients with “neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement.”

Group 3: patients who described “severe neck pain but all of whom had a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes.” These patients also “described an unusual complex of symptoms,” including “blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain.” (more…)

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Chiropractic Care for Spinal Whiplash Injuries

By Frank M. Painter|July 29, 2011|Whiplash|

Chiropractic Care for Spinal Whiplash Injuries

The Chiro.Org Blog

SOURCE: J Orthopaedic Medicine 1999; 21 (1): 22–25

By David BenEliyahu, D.C.

Studies on the efficacy of chiropractic care for patients suffering with pain secondary to whiplash injury are appearing in the literature. In 1996, Woodward et al. published a study in Injury on the efficacy of chiropractic treatment of whiplash injuries. [1] The authors of this study were from the Department of Orthopedic Surgery in Bristol, England.

In 1994, Gargan and Bannister published a paper on the recovery rate of patients with whiplash injuries and found that if patients were still symptomatic after three months, there was almost a 90% chance they would remain so. [2] No conventional medical treatment has been shown to be effective in these established chronic whiplash injury patients. [3, 4] However, most DCs treating whiplash injury patients have empirically found high success rates in the recovery of these types of patients.

In the Woodward study, 93% of the 28 patients studied retrospectively were found to have a statistically significant improvement following chiropractic care. [1] Chiropractic care in this study consisted of spinal manipulation, PNF and cryotherapy. Most of the 28 patients had prior treatment with NSAIDs, soft collars and physiotherapy. The average length of time before the patients began chiropractic care was 15.5 months post-MVA (range of 3-44 months).

This study clearly documented what most DCs experience in clinical practice: that chiropractic care is an effective modality for patients injured in a motor vehicle accident. Symptoms ranging from headaches to neck pain, back pain, interscapular pain and related extremity pain with paresthesias all respond to quality chiropractic care.

There are more articles like this @ our:

The Whiplash Page

(more…)

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Whiplash & Chiropractic

By Frank M. Painter|July 26, 2011|Whiplash|

Whiplash & Chiropractic

The Chiro.Org Blog

SOURCE: The ACA News

Whiplash is an enigmatic injury. We spend billions of dollars each year to treat it. Yet many lawyers, legislators, and medical doctors deny its existence. It affects millions of people around the world, yet research is severely under-funded. It is a largely preventable injury, yet we do little to prevent it. Fortunately, times are changing as whiplash enters a new phase of research and understanding.

“We now have a completely new model of whiplash,” says Dr. Arthur Croft, researcher and co-author of the well-respected textbook, Whiplash Injuries: The Cervical Acceleration/Deceleration Syndrome. “Back in 1982, when I started practice, we had an extremely simplistic view of whiplash – you got hit from the rear; your head snapped back, which may have caused damage to ligaments, muscles, and tendons; your head snapped forward, which may have caused some additional damage; and then you had symptoms. We weren’t very sophisticated in terms of what we knew, because there hadn’t been much research.”

Researchers now believe that during a rear-end collision, the lower neck goes into hyperextension, while the upper goes into flexion. “That means the bottom and top parts of the neck are going in opposite directions during the initial phase of a whiplash, which forms the letter ‘S,'” explains ACA member Dan Murphy, DC, who teaches whiplash throughout the world, including a 120-hour certification course on spine trauma. “This sequence of events has been captured with cineradiography, which lets us look at the movement of each joint of the spine with motion x-ray. It’s remarkable what it shows-especially in the lower neck where people seem to have the most complaints and most findings on examination. In a 6.5g impact, for example, the motion between C7 and T1 is supposed to be about two degrees, but researchers are finding that the joint is moving about 20 degrees – or 10 times more than it is supposed to.”

There are many more articles like this @:

The Whiplash and Chiropractic Page

(more…)

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Primary Spine Care Practitioners

By Frank M. Painter|July 22, 2011|Evidence-based Medicine|

Primary Spine Care Practitioners

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2011 (Jul 22); 19: 17 ~ FULL TEXT

The following is an interesting and well crafted article that posits yet another fanciful way to bring chiropractic “out of the closet”. I do have some issues with a few of Dr. Murphy’s recommendations, however:

1. In the Necessary Skill Set section of the article under point#2, he states that the “primary spine care practitioner” would employ those methods shown to be evidence-based, minimally invasive and cost-effective…one of them being the prescription of non-steroidal anti-inflammatory and non-opioid analgesics to their patients.

Our Iatrogenic Injury Page contains numerous articles detailing how NSAIDs and other analgesics are associated with the death of tens of thousands of people every year, for solely relying on them for pain relief. I just don’t see me EVER recommending them.

This is a genuine scientific conundrum:
how can anything that kills that many people still be referred to as “evidence-based”?

UPDATE: (2-14-17) The Annals of Internal Medicine pre-published a new article titled:

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain:
A Clinical Practice Guideline From the American College of Physicians

and in it the authors stated:

The American College of Physicians (ACP) released updated guidelines this week that recommend the use of noninvasive, non-drug treatments for low back pain before resorting to drug therapies, which were found to have limited benefits. One of the non-drug options cited by ACP is spinal manipulation.

2. In the Obstacles To The Implementation section under point#5, Dr. Murphy states that “For whatever profession or professions that respond to the need for a primary spine care practitioner, this will be a significant disruption to the traditional practice patterns or self-image of these professions. As a result, the role that we are introducing here will be actively resisted”. Oh how true!

When you look closely at the “expanded practice” movement, the first thing I noticed was that this movement is being promoted by the chiropractic schools that have the lowest enrollment of students.

I suspect that they are hoping to (or already have) developed an “expanded practice” program that will attract more students, and that’s understandable, if expanding your income is your primary objective.

3. Finally, there is the subtle hint that becoming an “expanded practice chiropractor” (or “medi-practor”) will increase the doctor’s “market share”. That may even be true. But, if that also means embracing the kind of evidence-based care that kills thousands every year, I say “No thank you, sir”.

Please don’t get me wrong: I have tremendous respect for Dr. Murphy and the other authors of the following article.

This article is very well written and logical… up to a point. I am posting it on our blog because I agree that our profession needs to review this material and see if and how it can be tweaked. Most of their suggestions are valid. I just don’t see the need to grab for prescription rights….not when there’s such considerable scientific evidence for recommending Omega-3 fatty acids for pain relief.

I hope you will enjoy the following new article:

The Establishment of a Primary Spine Care Practitioner and its Benefits to Health Care Reform in the United States (more…)

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Certified Nurse-midwives Give Chiropractic The Thumbs-Up

By Frank M. Painter|July 21, 2011|Pediatrics, Research|

Certified Nurse-midwives Give Chiropractic The Thumbs-Up

The Chiro.Org Blog

SOURCE: Comp Therapies In Clinical Practice 2011 (Aug); 17 (3): 135–140

Linda Mullin, Joel Alcantara, Derek Bartonad, Lydia Deverae

Life University, College of Chiropractic, 1269 Barclay Circle, Marietta, GA 30060, USA.

187 certified nurse-midwives filled out an on-line, self-administered survey designed to gather their opinions on the safety of chiropractic, and the scope of chiropractic practice. It also captured demographic information relating to their professional training and their personal and professional clinical experiences with chiropractors.

The results were most revealing:

Responders were aware that chiropractors worked with “birthing professionals”
They were aware that DCs attended to patients for both musculoskeletal and non-musculoskeletal disorders
The vast majority indicated a positive personal and clinical experience with chiropractic
They also believed that chiropractic was safe for pregnant patients and for children

We want to thank the researchers at Life University and at the ICPA for their continued efforts to explain how (and why) chiropractic care is beneficial for pregnant mothers, as well as for their children. There has been a smattering of negative articles over the years trying to paint chiropractic as an unsupported “fringe” therapy, so articles like this help to set the record straight.

You may also enjoy reviewing these other relevant pages:

The Chiropractic Pediatrics Page

The “Kids Need Chiropractic, Too!” Page

The ADD/ADHD Page (more…)

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