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Bad is More Powerful Than Good: The Nocebo Response in Medical Consultations

By Frank M. Painter|February 28, 2018|Nocebo|

Bad is More Powerful Than Good: The Nocebo Response in Medical Consultations

SOURCE: Am J Med. 2015 (Feb); 128 (2): 126–9

Maddy Greville-Harris, PhD, Paul Dieppe, MD

School of Psychology,
University of Southampton,
United Kingdom.

Although there has been a lot of research looking at the placebo response, nocebo responses in the healthcare setting have been largely overlooked. This article explores the potential role of negative patient-doctor communication in facilitating nocebo responses in the medical consultation. We suggest that invalidation, that is, communicating a lack of understanding and acceptance to the patient (albeit unintentionally), is a key factor in understanding the nocebo response. This article reviews evidence from the experimental and healthcare setting, which suggests that the negative effects of invalidation may be stronger than we think.

KEYWORDS: Communicating understanding; Doctor–patient interaction; Health communication; Invalidation; Nocebo response; Placebo response; Validation

Much attention has been given to the so-called placebo response, that is, people getting better in response to sham or dummy treatments that contain no active ingredient. [1] The opposite nocebo response, that is, people getting worse in response to sham interventions, has also been recognized for a long time, but has resulted in less attention from health researchers, [2, 3] who often focus on the ethical concerns around knowingly inducing such responses. [4–6]

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The Use of Nutritional Guidance Within Chiropractic Patient Management

By Frank M. Painter|February 26, 2018|Nutrition|

The Use of Nutritional Guidance Within Chiropractic Patient Management: A Survey of 333 Chiropractors from the ACORN Practice-based Research Network

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2018 (Feb 20); 26: 7

Mi Kyung Lee, Lyndon Amorin-Woods, Vincenzo Cascioli, and Jon Adams

School of Health Professions,
Murdoch University,
Perth, Australia.

BACKGROUND: Food consumption and nutritional status affect an individual’s health throughout their life-course and an unhealthy diet is a major risk factor for the current global burden of chronic disease. The promotion of health and good nutrition through healthy eating requires the active involvement of all health professionals including chiropractors. This paper reports findings from the first nationally representative examination of the use of nutritional guidance within chiropractic patient management in Australia.

METHODS: A sample of 1000 practising chiropractors was randomly selected from the Australian Chiropractic Research Network (ACORN) practice-based research network database for a cross-sectional study and 33% participated in the online survey in November 2016. The questionnaire, based on previous designs used in similar surveys and nutrition resources developed by the National Health and Medical Research Council, was pretested prior to the survey. Pearson’s Chi square and bivariate logistic regression were undertaken to explore relationships with variables of interest.

RESULTS: The demographic details of the respondents are similar to those of the chiropractic workforce registered in Australia. Most chiropractors provided nutritional advice as part of their patient care and around a quarter provided specific dietary advice to their patients, including the use of nutrition supplements. Nutrition-related conditions most commonly encountered by the chiropractors were musculoskeletal, usually inflammatory in origin. Common nutritional assessment methods used included questioning patients to assess their nutritional and health status and physical appearance. Most of the participants provided nutritional resources to their patients in their clinics. However, the Australian Dietary Guidelines and the accompanying Australian Guide to Healthy Eating were not well utilised by the respondents. Australian chiropractors often referred patients with nutrition issues to qualified dietitians and other health professionals when deemed necessary.

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Nutrition Section

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Move the fig leaf – how to bend properly

By John Wiens DC|February 26, 2018|Posture|

Source NPR

By Michaeleen Doucleff

To see if you’re bending correctly, try a simple experiment.

“Stand up and put your hands on your waist,” says Jean Couch, who has been helping people get out of back pain for 25 years at her studio in Palo Alto, Calif.

“Now imagine I’ve dropped a feather in front of your feet and asked to pick it up,” Couch says. “Usually everybody immediately moves their heads and looks down.”

That little look down bends your spine and triggers your stomach to do a little crunch. “You’ve already started to bend incorrectly — at your waist,” Couch says. “Almost everyone in the U.S. bends at the stomach.”

In the process, our backs curve into the letter “C” — or, as Couch says, “We all look like really folded cashews.”

In other words, when we bend over in the U.S., most of us look like nuts!

But in many parts of the world, people don’t look like cashews when they bend over. Instead, you see something very different.

I first noticed this mysterious bending style back in 2014 while covering the Ebola outbreak. We were driving on a back road in the rainforest of Liberia and every now and then, we would pass women working in their gardens. The women had striking silhouettes: They were bent over with their backs nearly straight. But they weren’t squatting with a vertical back. Instead, their backs were parallel to the ground. They looked like tables.

After returning home, I started seeing this “table” bending in photos all around the world — an older woman planting rice in Madagascar, a Mayan woman bending over at a market in Guatemala and women farming grass in northern India. This bending seemed to be common in many places, except in Western societies.

“The anthropologists have noted exactly what you’re saying for years,” says Stuart McGill, at the University of Waterloo in Ontario, Canada, who has been studying the biomechanics of the spine for more than three decades.

“It’s called hip hinging,” McGill says. “And I’ve spent my career trying to prove it’s a better way of bending than what we do.” (more…)

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Blues Plans Issuing Denials for Certain Modifiers

By Frank M. Painter|February 24, 2018|CPT Coding|

Blues Plans Issuing Denials for Certain Modifiers

The Chiro.Org Blog

SOURCE: ACA Today ~ Feb 7, 2018

By Julie Lenhardt

ACA senior director of payment policy.

ACA has recently heard from members in a few states that some Blue Cross Blue Shield plans are automatically denying claims that contain the -25 and -59 modifiers. The states we have heard from to date include Illinois, Oklahoma and Texas. The Blues plans in these states are owned by Health Care Service Corporation (HCSC), an umbrella company that also owns the Blues plans in Montana and New Mexico.

ACA has since learned that during the fall, HCSC instituted a code-auditing enhancement to its claims system to “improve auditing of professional and outpatient facility claims that are submitted… by clinically validating modifiers submitted on such claims.” For many chiropractic clinics, this means E/M codes and CPT code 97140 (as well as a few others) may automatically be denied. However, it is important to note that this is not occurring only with chiropractic claims – the code-auditing enhancement applies to all claims with the specified modifiers submitted by any health care professional or outpatient facility.

In some cases, the denials state the modifiers are used inappropriately. In other cases, providers have received letters stating their utilization of the modifier is higher than average. In either case, ACA recommends that chiropractors who receive a denial based on the -25 and/or -59 modifiers appeal the denials if they feel their usage of the modifiers is appropriate.

Before submitting the appeal, review the claim to ensure the modifiers were used appropriately. For example, modifier -25 should be appended to E/M codes performed on the same date as CMT, “if the patient’s condition requires a separately identifiable E/M service, above and beyond the usual pre-service and post-service work associated with the procedure.”

Some specific examples of when it is appropriate to bill for both a CMT and E/M code on the same date of service are:

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A Tailored Exercise Program Versus General Exercise

By Frank M. Painter|February 24, 2018|Exercise and Chiropractic|

A Tailored Exercise Program Versus General Exercise for a Subgroup of Patients with Low Back Pain and Movement Control Impairment: A Randomised Controlled Trial with One-year Follow-up

The Chiro.Org Blog

SOURCE: Man Ther. 2015 (Oct); 20 (5): 672–679

Jeannette Saner, Jan Kool, Judith M. Sieben, Hannu Luomajoki, Carolien HG. Bastiaenen, Rob A. de Bie

Zurich University of Applied Sciences ZHAW,
School of Health Professions,
Institute of Physiotherapy,
Technikumstrasse 71,
Postfach 8401, Winterthur, Switzerland

BACKGROUND: Exercise is an effective treatment for patients with sub-acute and chronic non-specific low back pain (NSLBP). Previous studies have shown that a subgroup of patients with NSLBP and movement control impairment (MCI) can be diagnosed with substantial reliability. However, which type of exercises are most beneficial to this subgroup is still unknown.

OBJECTIVES: The effectiveness of a specific exercise treatment to improve movement control was tested in this study.

METHODS: Using a multicentre randomised controlled trial (RCT), we compared exercises that targeted movement control impairment (MCI) (MC) with a general exercise (GE) treatment. After randomisation, patients in both groups n(MC = 52; GE = 54) were treated in eight private physiotherapy practices and five hospital outpatient physiotherapy centres. Follow-up measurements were taken at post-treatment, six months and 12 months. The primary outcome measurement was the Patient Specific Function Scale (PSFS).

RESULTS: The Patient Specific Function Scale (PSFS) showed no difference between groups after treatment, or at six months and 12 months. Secondary outcome analysis for pain and disability, measured with the Graded Chronic Pain scale and the Roland Morris Disability Questionnaire respectively, showed that a small improvement post-treatment levelled off over the long term. Both groups improved significantly (p < 0.001) over the course of one year.

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Exercise and Chiropractic Page

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A Modern Neuroscience Approach to Chronic Spinal Pain

By Frank M. Painter|February 23, 2018|Chronic Spinal Pain|

A Modern Neuroscience Approach to Chronic Spinal Pain:
Combining Pain Neuroscience Education with Cognition-targeted Motor Control Training

The Chiro.Org Blog

SOURCE: Phys Ther. 2014 (May); 94 (5): 730–738

Jo Nijs, Mira Meeus, Barbara Cagnie, Nathalie A. Roussel, Mieke Dolphens, Jessica Van Oosterwijck, Lieven Danneels

Pain in Motion Research Group,
Departments of Human Physiology and Physiotherapy,
Faculty of Physical Education & Physiotherapy,
Vrije Universiteit
Brussels, Belgium

Chronic spinal pain (CSP) is a severely disabling disorder, including nontraumatic chronic low back and neck pain, failed back surgery, and chronic whiplash-associated disorders. Much of the current therapy is focused on input mechanisms (treating peripheral elements such as muscles and joints) and output mechanisms (addressing motor control), while there is less attention to processing (central) mechanisms. In addition to the compelling evidence for impaired motor control of spinal muscles in patients with CSP, there is increasing evidence that central mechanisms (ie, hyperexcitability of the central nervous system and brain abnormalities) play a role in CSP. Hence, treatments for CSP should address not only peripheral dysfunctions but also the brain. Therefore, a modern neuroscience approach, comprising therapeutic pain neuroscience education followed by cognition-targeted motor control training, is proposed. This perspective article explains why and how such an approach to CSP can be applied in physical therapist practice.

From the FULL TEXT Article:

Introduction

Chronic spinal pain (CSP) includes nonrecurrent chronic low back pain, failed back surgery, chronic whiplash-associated disorders, and chronic nontraumatic neck pain, among other conditions, and accounts for a large proportion of the chronic pain population. [1] Chronic spinal pain is a severely disabling disorder characterized by tremendous personal and socioeconomic impact, with long-term sick leave, low quality of life, and very high socioeconomic costs. [2]

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Spinal Pain Management Page

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Bad is More Powerful Than Good: The Nocebo Response in Medical Consultations

Bad is More Powerful Than Good: The Nocebo Response in Medical Consultations

The Use of Nutritional Guidance Within Chiropractic Patient Management

The Use of Nutritional Guidance Within Chiropractic Patient Management: A Survey of 333 Chiropractors from the ACORN Practice-based Research Network

Move the fig leaf – how to bend properly

Blues Plans Issuing Denials for Certain Modifiers

Blues Plans Issuing Denials for Certain Modifiers

A Tailored Exercise Program Versus General Exercise

A Tailored Exercise Program Versus General Exercise for a Subgroup of Patients with Low Back Pain and Movement Control Impairment: A Randomised Controlled Trial with One-year Follow-up

A Modern Neuroscience Approach to Chronic Spinal Pain

A Modern Neuroscience Approach to Chronic Spinal Pain: Combining Pain Neuroscience Education with Cognition-targeted Motor Control Training

A Modern Neuroscience Approach to Chronic Spinal Pain:
Combining Pain Neuroscience Education with Cognition-targeted Motor Control Training