Support Chiropractic Research!
Facebook

BLOG

Provider and Patient Perspectives on Opioids

By |October 28, 2017|Chronic Low Back Pain, Chronic Neck Pain, Chronic Pain|

Provider and Patient Perspectives on Opioids and Alternative Treatments for Managing Chronic Pain:
A Qualitative Study

The Chiro.Org Blog

SOURCE:   BMC Fam Pract. 2017 (Mar 24); 17 (1): 164

Lauren S. Penney, Cheryl Ritenbaugh, Lynn L. DeBar,
Charles Elder and Richard A. Deyo

South Texas Veterans Health Care System,
7400 Merton Minter Blvd,
San Antonio, TX, 78229, USA

BACKGROUND:   Current literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. The objective of this study was to identify the practical issues patients and providers face when accessing alternatives to opioids, and how multiple parties view these issues.

METHODS:   Qualitative data were gathered to evaluate the outcomes of acupuncture and chiropractic (A/C) services for chronic musculoskeletal pain (CMP) using structured interview guides among patients with CMP (n = 90) and primary care providers (PCPs) (n = 25) purposively sampled from a managed care health care system as well as from contracted community A/C providers (n = 14). Focus groups and interviews were conducted patients with CMP with varying histories of A/C use. Plan PCPs and contracted A/C providers took part in individual interviews. All participants were asked about their experiences managing chronic pain and experience with and/or attitudes about A/C treatment. Audio recordings were transcribed and thematically coded. A summarized version of the focus group/interview guides is included in the Additional file 1.

RESULTS:   We identified four themes around opioid use:

(1)   attitudes toward use of opioids to manage chronic pain;

(2)   the limited alternative options for chronic pain management;

(3)   the potential of acupuncture and chiropractic (A/C) care as a tool to help manage pain; and

(4)   the complex system around chronic pain management.

Despite widespread dissatisfaction with opioid medications for pain management, many practical barriers challenged access to other options. Most of the participants’ perceived A/C care as helpful for short term pain relief. We identified that problems with timing, expectations, and plan coverage limited A/C care potential for pain relief treatment.

There are more articles like this @ our:

Chiropractic and Spinal Pain Management

(more…)

Read More
 0

Feeling Stiffness in the Back

By |October 25, 2017|Low Back Pain|

Feeling Stiffness in the Back: A Protective Perceptual Inference in Chronic Back Pain

The Chiro.Org Blog

SOURCE:   Sci Rep. 2017 (Aug 29);   7 (1):   9681

Tasha R. Stanton, G. Lorimer Moseley,
Arnold Y. L. Wong & Gregory N. Kawchuk

The Sansom Institute for Health Research,
School of Health Sciences & Pain Adelaide Consortium,
The University of South Australia,
Adelaide, SA, Australia.

Does feeling back stiffness actually reflect having a stiff back? This research interrogates the long-held question of what informs our subjective experiences of bodily state. We propose a new hypothesis: feelings of back stiffness are a protective perceptual construct, rather than reflecting biomechanical properties of the back.

This has far-reaching implications for treatment of pain/stiffness but also for our understanding of bodily feelings. Over three experiments, we challenge the prevailing view by showing that feeling stiff does not relate to objective spinal measures of stiffness and objective back stiffness does not differ between those who report feeling stiff and those who do not. Rather, those who report feeling stiff exhibit self-protective responses: they significantly overestimate force applied to their spine, yet are better at detecting changes in this force than those who do not report feeling stiff.

This perceptual error can be manipulated: providing auditory input in synchrony to forces applied to the spine modulates prediction accuracy in both groups, without altering actual stiffness, demonstrating that feeling stiff is a multisensory perceptual inference consistent with protection. Together, this presents a compelling argument against the prevailing view that feeling stiff is an isomorphic marker of the biomechanical characteristics of the back.

 

From the FULL TEXT Article:

Introduction

Bodily feelings constitute a fundamental aspect of self-awareness and provide critical homeostatic functions – e.g., feeling cold makes one seek warmth [1]; feeling pain makes one seek protection [2]; feeling parched makes one drink. [3] We assume that these bodily feelings reflect the biological state of our body tissues – a ‘read-out’, so to speak, of somatosensory and visceral input – particularly when the feeling is located somewhere in the body, as it is for pain or stiffness. There is growing evidence for pain however, that it is highly modulated by a wide range of cognitive and contextual variables. [4, 5] For example, visually manipulating the perceived size of one’s hand alters the pain experienced in experimental contexts [6] and during movement of a chronically painful limb [7], and illuminating a blue or red light in synchrony with delivering a noxious cold stimulus can transform the feeling evoked from uncomfortably cold to painfully hot. [5]

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

(more…)

Read More
 0

Tissue Loading Created During Spinal Manipulation

By |October 24, 2017|Adverse Events, Disc Derangement|

Tissue Loading Created During Spinal Manipulation in Comparison to Loading Created by Passive Spinal Movements

The Chiro.Org Blog

SOURCE:   Sci Rep. 2016 (Dec 1);   6:   38107

Martha Funabashi, Gregory N. Kawchuk, Albert H. Vette,
Peter Goldsmith, and Narasimha Prasad

Department of Physical Therapy,
University of Alberta,
Edmonton, AB, Canada

Spinal manipulative therapy (SMT) creates health benefits for some while for others, no benefit or even adverse events. Understanding these differential responses is important to optimize patient care and safety. Toward this, characterizing how loads created by SMT relate to those created by typical motions is fundamental. Using robotic testing, it is now possible to make these comparisons to determine if SMT generates unique loading scenarios. In 12 porcine cadavers, SMT and passive motions were applied to the L3/L4 segment and the resulting kinematics tracked. The L3/L4 segment was removed, mounted in a parallel robot and kinematics of SMT and passive movements replayed robotically. The resulting forces experienced by L3/L4 were collected. Overall, SMT created both significantly greater and smaller loads compared to passive motions, with SMT generating greater anterioposterior peak force (the direction of force application) compared to all passive motions. In some comparisons, SMT did not create significantly different loads in the intact specimen, but did so in specific spinal tissues. Despite methodological differences between studies, SMT forces and loading rates fell below published injury values. Future studies are warranted to understand if loading scenarios unique to SMT confer its differential therapeutic effects.

 

From the FULL TEXT Article:

Introduction

Spinal manipulative therapy (SMT) is a clinical intervention for low back pain which, by some estimates, is the most frequently used form of complementary and alternative medicine (CAM). [1] Similarly, SMT is also one of the most studied CAM interventions with over 250 systematic reviews and 550 randomized controlled trials since 2000.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

and the:

Disc Herniation and Chiropractic Page

(more…)

Read More
 0

Chiropractic Care and Risk for Acute Lumbar Disc Herniation

By |October 23, 2017|Disc Derangement|

Chiropractic Care and Risk for Acute Lumbar Disc Herniation: A Population-based Self-controlled Case Series

The Chiro.Org Blog

SOURCE:   European Spine Journal 2017 (Oct 17) [Epub]

Cesar A. Hincapie, A. Tomlinson, Pierre Cote,
Raja Rampersaud, Alejandro R. Jadad, J. David Cassidy

Injury Prevention Research Office,
Division of Neurosurgery,
Li Ka Shing Knowledge Institute
St. Michael’s Hospital
Toronto, Canada

Purpose   Chiropractic care is popular for low back pain, but may increase the risk for acute lumbar disc herniation (LDH). Low back pain is a common early (prodromal) symptom of LDH and commonly precedes LDH diagnosis. Our objective was to investigate the association between chiropractic care and acute LDH with early surgical intervention, and contrast this with the association between primary care physician (PCP) care and acute LDH with early surgery.

Methods   Using a self-controlled case series design and population-based healthcare databases in Ontario, Canada, we investigated all adults with acute LDH requiring emergency department (ED) visit and early surgical intervention from April 1994 to December 2004. The relative incidence of acute LDH with early surgery in exposed periods after chiropractic visits relative to unexposed periods was estimated within individuals, and compared with the relative incidence of acute LDH with early surgery following PCP visits.

Results   195 cases of acute LDH with early surgery (within 8 weeks) were identified in a population of more than 100 million person-years. Strong positive associations were found between acute LDH and both chiropractic and PCP visits. The risk for acute LDH with early surgery associated with chiropractic visits was no higher than the risk associated with PCP visits.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

and the:

Disc Herniation and Chiropractic Page

(more…)

Read More
 0

Patient Expectations of Benefit from Common Interventions

By |October 12, 2017|Patient Expectations, Spinal Pain|

Patient Expectations of Benefit from Common Interventions for Low Back Pain and Effects on Outcome: Secondary Analysis of a Clinical Trial of Manual Therapy Interventions

The Chiro.Org Blog

SOURCE:   J Man Manip Ther. 2011 (Feb);   19 (1):   20–25

Mark D Bishop, Joel E Bialosky & Josh A Cleland

Department of Physical Therapy,
University of Florida, USA.

OBJECTIVES:   The purpose of this secondary analysis was 1) to examine patient expectations related to a variety of common interventions for low back pain (LBP) and 2) to determine the influence that specific expectations about spinal manipulation might have had on self-report of disability.

METHODS:   We collected patients’ expectations about the benefit of specific interventions for low back pain. We also collected patients’ general expectations about treatment and tested the relationships among the expectation of benefit from an intervention, receiving that intervention and disability-related outcomes.

RESULTS:   Patients expected exercise and manual therapy interventions to provide more benefit than surgery and medication. There was a statistical association between expecting relief from thrust techniques and receiving thrust techniques, related to meeting the general expectation for treatment (chi-square: 15.5, P = 0.008). This was not the case for patients who expected relief from thrust techniques but did not receive it (chi-square: 6.9, P = 0.4). Logistic regression modeling was used to predict change in disability at treatment visit 5. When controlling for whether the general expectations for treatment were met, intervention assignment and the interaction between intervention assignment and expectations regarding thrust techniques, the parsimonious model only included intervention as the significant contributor to the model (P < 0.001). The adjusted odds ratio of success comparing thrust techniques to non-thrust in this study was 41.2 (11.0, 201.7).

There are more articles like this @:

Patient Expectations of Relief

a subsection of our
Chiropractic and Spinal Pain Page

(more…)

Read More
 0

Validity and Reliability of Clinical Prediction Rules

By |October 8, 2017|Clinical Prediction Rules|

Validity and Reliability of Clinical Prediction Rules used to Screen for Cervical Spine Injury in Alert Low-risk Patients with Blunt Trauma to the Neck: Part 2. A Systematic Review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration

The Chiro.Org Blog

SOURCE:   Eur Spine J. 2017 (Sep 22) [Epub]

N. Moser, N. Lemeunier, D. Southerst,
H. Shearer, K. Murnaghan, D. Sutton, P. Cote

Division of Graduate Education and Research,
Canadian Memorial Chiropractic College (CMCC),
6100 Leslie Street,
Toronto, ON, Canada.

PURPOSE:   To update findings of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) on the validity and reliability of clinical prediction rules used to screen for cervical spine injury in alert low-risk adult patients with blunt trauma to the neck.

METHODS:   We searched four databases from 2005 to 2015. Pairs of independent reviewers critically appraised eligible studies using the modified QUADAS-2 and QAREL criteria. We synthesized low risk of bias studies following best evidence synthesis principles.

RESULTS:   We screened 679 citations; five had a low risk of bias and were included in our synthesis. The sensitivity of the Canadian C-spine rule ranged from 0.90 to 1.00 with negative predictive values ranging from 99 to 100%. Inter-rater reliability of the Canadian C-spine rule varied from k = 0.60 between nurses and physicians to k = 0.93 among paramedics. The inter-rater reliability of the Nexus Low-Risk Criteria was k = 0.53 between resident physicians and faculty physicians.

There are more articles like this @ our:

Clinical Prediction Rule Page

(more…)

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