Support Chiropractic Research!
Facebook

BLOG

Brain Mechanisms of Anticipated Painful Movements and Their Modulation by Manual Therapy in Chronic Low Back Pain

By |September 3, 2025|Chronic Low Back Pain, Fear Avoidance, Neurology|

Brain Mechanisms of Anticipated Painful Movements and Their Modulation by Manual Therapy in Chronic Low Back Pain

The Chiro.Org Blog

SOURCE:   J Pain 2018 (Nov); 19 (11): 1352–1365

Dan-Mikael Ellingsen • Vitaly Napadow • Ekaterina Protsenko • Ishtiaq Mawla • Matthew H Kowalski • David Swensen • Deanna O’Dwyer-Swensen • Robert R Edwards • Norman Kettner • Marco L Loggia

A. A. Martinos Center for Biomedical Imaging,
Department of Radiology,
Massachusetts General Hospital,
Harvard Medical School,
Boston, Massachusetts.

Heightened anticipation and fear of movement-related pain has been linked to detrimental fear-avoidance behavior in chronic low back pain (cLBP). Spinal manipulative therapy (SMT) has been proposed to work partly by exposing patients to nonharmful but forceful mobilization of the painful joint, thereby disrupting the relationship among pain anticipation, fear, and movement. Here, we investigated the brain processes underpinning pain anticipation and fear of movement in cLBP, and their modulation by SMT, using functional magnetic resonance imaging. Fifteen cLBP patients and 16 healthy control (HC) subjects were scanned while observing and rating video clips depicting back-straining or neutral physical exercises, which they knew they would have to perform at the end of the visit. This task was repeated after a single session of spinal manipulation (cLBP and HC group) or mobilization (cLBP group only), in separate visits. Compared with HC subjects, cLBP patients reported higher expected pain and fear of performing the observed exercises. These ratings, along with clinical pain, were reduced by SMT. Moreover, cLBP, relative to HC subjects, demonstrated higher blood oxygen level-dependent signal in brain circuitry that has previously been implicated in salience, social cognition, and mentalizing, while observing back straining compared with neutral exercises. The engagement of this circuitry was reduced after SMT, and especially the spinal manipulation session, proportionally to the magnitude of SMT-induced reduction in anticipated pain and fear. This study sheds light on the brain processing of anticipated pain and fear of back-straining movement in cLBP, and suggests that SMT may reduce cognitive and affective-motivational aspects of fear-avoidance behavior, along with corresponding brain processes. PERSPECTIVE: This study of cLBP patients investigated how SMT affects clinical pain, expected pain, and fear of physical exercises. The results indicate that one of the mechanisms of SMT may be to reduce pain expectancy, fear of movement, and associated brain responses.

Keywords:   Expectation; Fear-avoidance; Pain anticipation; Physical exercise; Spinal Manipulative Therapy; chronic Low Back Pain; functional Magnetic Resonance Imaging.

From the FULL TEXT Article:

Background

There are more articles like this @

LOW BACK PAIN Section

(more…)

Read More
 0

Barriers and Facilitators to Self-management in People With Back-related Leg Pain

By |July 27, 2025|Uncategorized|

Barriers and Facilitators to Self-management in People With Back-related Leg Pain

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2025 (May 5); 33: 17 ~ FULL TEXT

  OPEN ACCESS   

Anna-Marie L Ziegler • Don Thorpe • Douglas Kennedy • Craig Schulz
Stacie A Salsbury • Gert Bronfort • Roni Evans

Integrative Health and Wellbeing Research Program
University of Minnesota,
Mayo Memorial Building C504,
420 Delaware Street,
Minneapolis, MN, 55414, USA.

Background:   Back related leg pain (BRLP) is a problematic subset of low back pain, leading to greater pain, loss of function and health related care costs. While evidence suggests self-management is effective, patient implementation can be sub-optimal. The purpose of this study is to identify barriers and facilitators to self-management for persons experiencing BRLP within the context of a controlled clinical trial and to map these to theory-informed intervention elements that can be addressed by front-line healthcare providers, informing the design and implementation of future theory-driven self-management interventions for this population.

Methods:   This study was a qualitative secondary analysis of a 2-site, pragmatic, parallel group, randomized clinical trial (participants enrolled 2007-10) of spinal manipulative therapy (SMT) and home exercise and advice (HEA) compared to HEA alone for persons with subacute or chronic BRLP. We used deductive and inductive content analysis, to describe self-management facilitators and barriers among trial participants, map these to behavior change elements in the Behavior Change Wheel (BCW) Framework, and identify potentially modifiable, theory-intervention elements which may be addressed with guidance by healthcare providers. Baseline characteristics of participants were descriptively analyzed using SAS (University Edition).

Results:   Of 40 participants, the majority identified as white (n = 24, 85%) and of non-Hispanic or Latino ethnicity (n = 38, 95%). Average participant age was 57 years old (range 29-80). Frequent facilitators included ease of exercises, knowing how to manage condition, atmosphere created by staff, therapeutic alliance, effectiveness of exercises or treatment, goal of reducing pain, and intentions of continuing exercises. Frequent barriers included time constraints, pain, and lacking confidence in treatment. Barriers were mapped to all 9 Intervention Functions, most common being modelling and education. Frequently identified Behavior Change Techniques included information, feedback, self-monitoring, graded tasks, restructuring, social support, goal setting, reviewing goals, and action planning.

Conclusion:   This study identified barriers and facilitators to engaging in self-management for participants in a pragmatic, randomized clinical trial. A rigorous systematic intervention mapping process utilizing the BCW was used for describing what participants need and how their needs may be met. These findings may support the design of future self-management interventions for persons experiencing BRLP.

There is more like this @ our

LOW BACK PAIN Section and the

CHIROPRACTIC + SCIATICA Section

(more…)

Read More
 0

Retrospective Review of Case Records of School-aged Children Receiving Chiropractic Care

By |May 11, 2025|Chiropractic Care, Pediatrics|

Retrospective Review of Case Records of School-aged Children Receiving Chiropractic Care

The Chiro.Org Blog

SOURCE:   J Bodyw Mov Ther 2025 (Jun): 42: 948–954

  OPEN ACCESS   

Jenna Duehr • Lona Cook • Amanda Blonigen • Alice Cade • Tanja Glucina • Monika Buerger
Stephanie Sullivan • Tyson Perez • Muhammed Samran Navid
Imran Khan Niazi • Heidi Haavik

Centre for Chiropractic Research,
New Zealand College of Chiropractic,
Auckland, 1060, New Zealand

Background:   Chiropractic care is utilized in school aged children for a variety of health complaints, including headaches, postural issues, nocturnal enuresis, neurodevelopmental disorders, and back pain. Chiropractic care, with its ability to impact sensorimotor integration, motor control and the prefrontal cortex, could therefore potentially benefit school aged children.

Methods:   In this retrospective case series, records of patients presenting for chiropractic care at an onsite school chiropractic clinic were reviewed. Patients underwent 12 weeks of chiropractic care and completed three questionnaires and two sets of neurophysiological scans. The data from these questionnaires and scans were combined, averaged, and statistically analyzed.

Results:   One hundred and eighty records of children aged 5-18 years from nine schools were included in the overall analyses. Statistically significant improvements were noted in the ‘health and activities’ sub-section and overall score of the Pediatric Quality of Life Inventory™ and in the hyperactivity domain of the Strengths and Difficulties questionnaire.

Conclusion:   This retrospective review of case records from children attending an onsite school chiropractic clinic has demonstrated some changes in health-related quality of life following a period of 12 weeks of chiropractic care. Further research using a clinical trial design is needed to extrapolate the findings and to assess causation.

Keywords:   Chiropractic; Heart-rate variability; Neurodevelopmental disorders; Neurophysiology; Quality of life; School children; Surface electromyography; Thermography.

From the Full-Text Article:

Introduction

Childhood is a period of huge growth and development. The health and experiences of children during this critical time can have long-term impacts on disease rates, mental health, and overall well-being for the rest of their lives(Drozdz et al., 2021; Goodman et al., 2011; Middlebrooks., 2007; Marcus et al., 2022; Bellis et al., 2019). However, the health and wellbeing of children today is showing some alarming areas of decline and concern (Lebrun-Harris et al., 2022). Data from the National Survey of Children’s health in the US from 2016 to 2020 showed an increase in rates of anxiety, depression, behavioral disorders, and obesity (Lebrun-Harris et al., 2022)). The survey also showed declining rates of preventative medical visits, daily physical activity, and parents mental health (Lebrun-Harris et al., 2022). The decline in key areas of health is also evident from more historical data from the 2007 and 2011/2012 National Survey of Children’s Health (Initiative et al., 2024) which showed higher rates in many of the domains related to good health (preventative medical visits, physical activity) and lower rates of obesity, suggesting that the decline in key areas of children’s health has been evident for nearly two decades.

There are more articles like this @

PEDIATRICS Section

(more…)

Read More
 0

Trends in Chiropractic Care and Physical Rehabilitation Use Among Adults with Low Back Pain in the United States, 2002 to 2018

By |April 24, 2025|Chiropractic Care, Cost-Effectiveness, Low Back Pain|

Trends in Chiropractic Care and Physical Rehabilitation Use Among Adults with Low Back Pain in the United States, 2002 to 2018

The Chiro.Org Blog

SOURCE:   J Gen Intern Med. 2023 (Oct 19); 39 (4): 578–586

Eric J Roseen • Kushang V Patel • Rachel Ward • Xinyao de Grauw
Steven J Atlas • Stephen Bartels • Julie J Keysor • Jonathan F Bean

Section of General Internal Medicine,
Department of Medicine, Boston University,
Chobanian & Avedision School of Medicine and
Boston Medical Center,
Boston, MA, USA.

Background   While nonpharmacologic treatments are increasingly endorsed as first-line therapy for low back pain (LBP) in clinical practice guidelines, it is unclear if use of these treatments is increasing or equitable.

Objective   Examine national trends in chiropractic care and physical rehabilitation (occupational/physical therapy (OT/PT)) use among adults with LBP.

Design/Setting   Serial cross-sectional analysis of the National Health Interview Survey, 2002 to 2018.

Participants   146,087 adults reporting LBP in prior 3 months.

Methods   We evaluated the association of survey year with chiropractic care or OT/PT use in prior 12 months. Logistic regression with multilevel linear splines was used to determine if chiropractic care or OT/PT use increased after the introduction of clinical guidelines. We also examined trends in use by age, sex, race, and ethnicity. When trends were similar over time, we present differences by these demographic characteristics as unadjusted ORs using data from all respondents.

Results   Between 2002 and 2018, less than one-third of adults with LBP reported use of either chiropractic care or OT/PT. Rates did not change until 2016 when uptake increased with the introduction of clinical guidelines (2016–2018 vs 2002–2015, OR` =` 1.15; 95% CI: 1.10–1.19). Trends did not differ significantly by sex, race, or ethnicity (p for interactions` >` 0.05). Racial and ethnic disparities in chiropractic care or OT/PT use were identified and persisted over time. For example, compared to non-Hispanic adults, either chiropractic care or OT/PT use was lower among Hispanic adults (combined OR` =` 0.62, 95% CI: 0.65–0.73). By contrast, compared to White adults, Black adults had similar OT/PT use (OR` =` 0.98; 95% CI: 0.94–1.03) but lower for chiropractic care use (OR` =` 0.50; 95% CI: 0.47–0.53).

There are more articles like this @

LOW BACK PAIN Section

(more…)

Read More
 0

Identifying Patient-Reported Outcome Measure Documentation in Veterans Health Administration Chiropractic Clinic Notes: Natural Language Processing Analysis

By |April 13, 2025|Outcome Assessment, Patient Satisfaction, Veterans|

Identifying Patient-Reported Outcome Measure Documentation in Veterans Health Administration Chiropractic Clinic Notes: Natural Language Processing Analysis

The Chiro.Org Blog

SOURCE:   JMIR Medical Informatics 2025 (Apr 2): 13: e66466

Brian C Coleman • Kelsey L Corcoran • Cynthia A Brandt
Joseph L Goulet • Stephen L Luther • Anthony J Lisi

Pain Research, Informatics, Multimorbidities, and Education Center,
VA Connecticut Healthcare System,
950 Campbell Ave,
West Haven, CT, 06516

Background:   The use of patient-reported outcome measures (PROMs) is an expected component of high-quality, measurement-based chiropractic care. The largest health care system offering integrated chiropractic care is the Veterans Health Administration (VHA). Challenges limit monitoring PROM use as a care quality metric at a national scale in the VHA. Structured data are unavailable, with PROMs often embedded within clinic text notes as unstructured data requiring time-intensive, peer-conducted chart review for evaluation. Natural language processing (NLP) of clinic text notes is one promising solution to extracting care quality data from unstructured text.

Objective:   This study aims to test NLP approaches to identify PROMs documented in VHA chiropractic text notes.

Methods:   VHA chiropractic notes from October 1, 2017, to September 30, 2020, were obtained from the VHA Musculoskeletal Diagnosis/Complementary and Integrative Health Cohort. A rule-based NLP model built using medspaCy and spaCy was evaluated on text matching and note categorization tasks. SpaCy was used to build bag-of-words, convoluted neural networks, and ensemble models for note categorization. Performance metrics for each model and task included precision, recall, and F-measure. Cross-validation was used to validate performance metric estimates for the statistical and machine-learning models.

Results:   Our sample included 377,213 visit notes from 56,628 patients. The rule-based model performance was good for soft-boundary text-matching (precision=81.1%, recall=96.7%, and F-measure=88.2%) and excellent for note categorization (precision=90.3%, recall=99.5%, and F-measure=94.7%). Cross-validation performance of the statistical and machine learning models for the note categorization task was very good overall, but lower than rule-based model performance. The overall prevalence of PROM documentation was low (17.0%).

Conclusions:   We evaluated multiple NLP methods across a series of tasks, with optimal performance achieved using a rule-based method. By leveraging NLP approaches, we can overcome the challenges posed by unstructured clinical text notes to track documented PROM use. Overall documented use of PROMs in chiropractic notes was low and highlights a potential for quality improvement. This work represents a methodological advancement in the identification and monitoring of documented use of PROMs to ensure consistent, high-quality chiropractic care for veterans.

There is more like this @ our

NON-PHARMACOLOGIC THERAPY Section and the

CHIROPRACTIC CARE FOR VETERANS Section

(more…)

Read More
 0

Implementation of the American- College of Physicians Guideline for Low Back Pain (IMPACt-LBP):
Protocol for a Healthcare Systems Embedded Multisite Pragmatic Cluster-randomized Trialal

By |March 30, 2025|Initial Provider, Low Back Pain|

Implementation of the American- College of Physicians Guideline for Low Back Pain (IMPACt-LBP):
Protocol for a Healthcare Systems Embedded Multisite Pragmatic Cluster-randomized Trial

The Chiro.Org Blog

SOURCE:   BMJ Open 2025 (Mar 26); 15 (3): e097133
Adam P Goode • Christine Goertz • Hrishikesh Chakraborty • Stacie A Salsbury • Samuel Broderick
Barcey T Levy • Kelley Ryan • Sharon Settles • Shoshana Hort • Rowena J Dolor, et al.

Duke University School of Medicine,
Durham, North Carolina, USA

Introduction:   Low back pain (LBP) is a key source of medical costs and disability, impacting over 31 million Americans at any given time and resulting in US$100-US$200 billion per year in total healthcare costs. LBP is one of the leading causes of ambulatory care visits to US physicians; problematically, these visits often result in treatments such as opioids, surgery or advanced imaging that can lead to more harm than benefit. The American College of Physicians (ACP) Guideline for Low Back Pain recommends patients receive non-pharmacological interventions as a first-line treatment. Roadmaps exist for multidisciplinary collaborative care that include well-trained primary contact clinicians with specific expertise in the treatment of musculoskeletal conditions, such as physical therapists and doctors of chiropractic, as first-line providers for LBP. These clinicians, sometimes referred to as primary spine practitioners (PSPs) routinely employ many of the non-pharmacological approaches recommended by the ACP guideline, including spinal manipulation and exercise. Important foundational work has demonstrated that such care is feasible and safe, and results in improved physical function, less pain, fewer opioid prescriptions and reduced utilisation of healthcare services. However, this treatment approach for LBP has yet to be widely implemented or tested in a multisite clinical trial in real-world practice.

Methods and analysis:   The Implementation of the American College of Physicians Guideline for Low Back Pain trial is a health system-embedded pragmatic cluster-randomised trial that will examine the effect of offering initial contact with a PSP compared with usual primary care for LBP. Twenty-six primary care clinics within three healthcare systems were randomised 1:1 to PSP intervention or usual primary care.

Primary outcomes are pain interference and physical function using the Patient-Reported Outcomes Measurement Information System Short Forms collected via patient self-report among a planned sample of 1800 participants at baseline, 1, 3 (primary end point), 6 and 12 months. A subset of participants enrolled early in the trial will also receive a 24-month assessment. An economic analysis and analysis of healthcare utilisation will be conducted as well as an evaluation of the patient, provider and policy-level barriers and facilitators to implementing the PSP model using a mixed-methods process evaluation approach.

Ethics and dissemination:   The study received ethics approval from Advarra, Duke University, Dartmouth Health and the University of Iowa Institutional Review Boards. Study data will be made available on completion, in compliance with National Institutes of Health data sharing policies.

There are more articles like this @

LOW BACK PAIN Section

(more…)

Read More
 0
Copyright 1995 - Chiropractic Resource Organization | All Rights Reserved | Powered by Chirowebs.net | Disclaimer
Facebook