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Association of Initial Provider Type on Opioid Fills for Individuals With Neck Pain

By Frank M. Painter|July 3, 2021|Initial Provider, Opioid Epidemic|

Association of Initial Provider Type on Opioid Fills for Individuals With Neck Pain

SOURCE: Archives of Phys Med and Rehabilitation 2020 (Aug)

Christopher J. Louis, PhD, Carolina-Nicole S. Herrera, MA, et. al.

Department of Health Law, Policy, and Management,
Boston University School of Public Health,
Boston, Massachusetts.

Objective: To determine whether the initial care provider for neck pain was associated with opioid use for individuals with neck pain.

Design: Retrospective cohort study.

Setting: Marketscan research databases.

Participants : Patients (N=427,966) with new-onset neck pain from 2010-2014.

Main outcome measures: Opioid use was defined using retail pharmacy fills. We performed logistic regression analysis to assess the association between initial provider and opioid use. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using bootstrapping logistic models. We performed propensity score matching as a robustness check on our findings.

Results: Compared to patients with neck pain who saw a primary health care provider, patients with neck pain who initially saw a conservative therapist were 72%–91% less likely to fill an opioid prescription in the first 30 days, and between 41%–87% less likely to continue filling prescriptions for 1 year. People with neck pain who initially saw emergency medicine physicians had the highest odds of opioid use during the first 30 days (OR, 3.58; 95% CI, 3.47–3.69; P<.001).

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Back and Neck Pain: In Support of Routine Delivery of Non-pharmacologic Treatments as a way to Improve Individual and Population Health

By Frank M. Painter|June 8, 2021|Nonpharmacologic Therapies|

Back and Neck Pain: In Support of Routine Delivery of Non-pharmacologic Treatments as a way to Improve Individual and Population Health

The Chiro.Org Blog

SOURCE: Translational Research 2021 (Apr 24);

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Steven Z George, Trevor A Lentz, Christine M Goertz

Department of Orthopaedic Surgery and
Duke Clinical Research Institute,
Duke University,
Durham, North Carolina.

Chronic back and neck pain are highly prevalent conditions that are among the largest drivers of physical disability and cost in the world. Recent clinical practice guidelines recommend use of non-pharmacologic treatments to decrease pain and improve physical function for individuals with back and neck pain. However, delivery of these treatments remains a challenge because common care delivery models for back and neck pain incentivize treatments that are not in the best interests of patients, the overall health system, or society. This narrative review focuses on the need to increase use of non-pharmacologic treatment as part of routine care for back and neck pain.

First, we present the evidence base and summarize recommendations from clinical practice guidelines regarding non-pharmacologic treatments. Second, we characterize current use patterns for non-pharmacologic treatments and identify potential barriers to their delivery. Addressing these barriers will require coordinated efforts from multiple stakeholders to prioritize evidence-based non-pharmacologic treatment approaches over low value care for back and neck pain. These stakeholders include patients, health care providers, health care organizations, administrators, payers, policymakers and researchers.

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Physiological Responses Induced by Manual Therapy in Animal Models: A Scoping Review

By Frank M. Painter|June 1, 2021|Uncategorized|

Physiological Responses Induced by Manual Therapy in Animal Models: A Scoping Review

The Chiro.Org Blog

SOURCE: Frontiers in Neuroscience 2020 (May 8); 14: 430

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Carla Rigo Lima, Daniel Fernandes Martins and William Ray Reed

Rehabilitation Science Program,
University of Alabama at Birmingham,
Birmingham, AL, United States

Background: Physiological responses related to manual therapy (MT) treatment have been investigated over decades using various animal models. However, these studies have not been compiled and their collective findings appraised. The purpose of this scoping review was to assess current scientific knowledge on the physiological responses related to MT and/or simulated MT procedures in animal models so as to act as a resource to better inform future mechanistic and clinical research incorporating these therapeutic interventions

Methods: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, and Index of Chiropractic Literature (ICL) were searched from database inception to August 2019. Eligible studies were:

(a) published in English;
(b) non-cadaveric animal-based;
(c) original data studies;
(d) included a form of MT or simulated MT as treatment;
(e) included quantification of at least one delivery parameter of MT treatment;
(f) quantification of at least one physiological measure that could potentially contribute to therapeutic mechanisms of action of the MT.

MT studies were categorized according to three main intervention types:

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Memorial Day (2021) In Memory of Those Who Have Fallen

By Frank M. Painter|May 29, 2021|Uncategorized|

Memorial Day (2021) In Memory of Those Who Have Fallen

The Chiro.Org Blog

The Bivouac of the Dead

The muffled drum’s sad roll has beat
The soldier’s last tattoo’
No more on life’s parade shall meet
That brave and fallen few;

On Fame’s eternal camping ground
Their silent tents are spread;
But Glory guards with solemn round
The bivouac of the dead.

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Revisiting Risk-stratified Whiplash-exposed Patients 12 to 14 Years After Injury

By Frank M. Painter|May 14, 2021|Chronic Low Back Pain, Chronic Neck Pain, Chronic Spinal Pain, Whiplash|

Revisiting Risk-stratified Whiplash-exposed Patients 12 to 14 Years After Injury

The Chiro.Org Blog

SOURCE: Clinical Journal of Pain 2020 (Dec)

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Martin K Rasmussen 1 2, Alice Kongsted 3 4, Tina Carstensen 5 6, Troels S Jensen 1 6, Helge Kasch 6 7

1 Danish Pain Research Centre Aarhus University Hospital.

2 Center for Translational Neuromedicine, Copenhagen University, Copenhagen, Denmark.

3 Department of Sports Science and Clinical Biomechanics, University of Southern Denmark.

Objective: The objective of this study was to evaluate the long-term predictive value of the Danish Whiplash Group Risk Assessment Score (DWGRAS) with 7 risk strata.

Design: E-questionnaire-based follow-up study (n=927) combining 2 cohorts of whiplash-injured patients, 1 observational (n=187) and 1 interventional randomized controlled trial (n=740).

Methods: Nine hundred twenty-seven previously healthy persons exposed to acute whiplash injury during motor vehicle collision were sent letter by postal service asking the addressee if they would respond to an E-questionnaire. Outcome measures were: whiplash-related disability, pain, use of medication/nonmedical treatment, work capacity.

Results: The response rate was 37%. Fifty-five percent reported whiplash-related disability. Fourteen percent reported daily symptoms. A strong relationship was found between risk strata and impact of event and between risk strata and disabling symptoms.

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The Profile of Older Adults Seeking Chiropractic Care: A Secondary Analysis

By Frank M. Painter|May 9, 2021|Low Back Pain, Medicare|

The Profile of Older Adults Seeking Chiropractic Care: A Secondary Analysis

The Chiro.Org Blog

SOURCE: BMC Geriatrics 2021 (Apr 23); 21 (1): 271

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Katie de Luca, Sheilah Hogg-Johnson, Martha Funabashi, Silvano Mior & Simon D. French

Department of Chiropractic,
Faculty of Medicine,
Health and Human Sciences,
Macquarie University,
Sydney, Australia.

Background: Musculoskeletal conditions are the primary reason older adults seek general medical care, resulting in older adults as the highest consumers of health care services. While there is high use of chiropractic care by older adults, there is no recent, specific data on why older adults seek chiropractic care and how chiropractors manage conditions. Therefore, the purpose of this study was to describe the demographic characteristics of older adults seeking chiropractic care, and to report problems diagnosed by chiropractors and the treatment provided to older adults who seek chiropractic care.

Methods: A secondary data analysis from two, large cross-sectional observational studies conducted in Australia (COAST) and Canada (O-COAST). Patient encounter and diagnoses were classified using the International Classification of Primary Care, 2nd edition (ICPC-2), using the Australian ICPC-2 PLUS general practice terminology and the ICPC-2 PLUS Chiro terminology. Descriptive statistics were used to summarize chiropractor, patient and encounter characteristics. Encounter and patient characteristics were compared between younger (< 65 years old) and older (≥65 years old) adults using ?2 tests or t-tests, accounting for the clustering of patients and encounters within chiropractors.

Results: A total of 6,781 chiropractor-adult patient encounters were recorded. Of these, 1,067 encounters were for persons aged > 65 years (16%), from 897 unique older patients. The most common diagnosis within older adult encounters was a back problem (56%), followed by neck problems (10%). Soft tissue techniques were most frequently used for older patients (85 in every 100 encounters) and in 29 of every 100 encounters, chiropractors recommended exercise to older patients as a part of their treatment.

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