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Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain

By Frank M. Painter|February 15, 2017|Guidelines, Low Back Pain|

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

SOURCE: Annals of Internal Medicine 2017 (Apr 4); 166 (7): 514–530 ~ FULL TEXT

Amir Qaseem, MD, PhD, MHA; Timothy J. Wilt, MD, MPH;
Robert M. McLean, MD; Mary Ann Forciea, MD;
for the Clinical Guidelines Committee of the American College of Physicians (*)

From the American College of Physicians
and Penn Health System,
Philadelphia, Pennsylvania;
Minneapolis Veterans Affairs Medical Center,
Minneapolis, Minnesota; and
Yale School of Medicine,
New Haven, Connecticut.

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.

Chiropractors, who diagnose and treat musculoskeletal disorders, are experts in spinal manipulation.

This is just one article from a series of 5:

The Non-pharmacologic Therapies Low Back Pain

On May 1, 2017, the New York Times published an editorial by Aaron E. Carroll, M.D., that mentions the new guideline in a generally positive light. The article appeared in a major, mainstream publication read by millions of people. “Spinal manipulation — along with other less traditional therapies like heat, meditation and acupuncture — seems to be as effective as many other more medical therapies we prescribe, and as safe, if not safer,” he wrote.

Talking points on new ACP guideline:

The chiropractic profession has advocated for decades that conservative care choices such as chiropractic be the first line of treatment for low-back pain. Now, with this new guideline, the medical profession is recognizing the benefits of conservative care for this common problem.
Thanks to this guideline, it’s possible more medical doctors will choose to refer their patients with low-back pain to chiropractors.
The ACP guideline was adopted by the American Chiropractic Association, which also adopted the Clinical Compass guidelines on chiropractic for LBP at its HOD meeting in March.

DESCRIPTION: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain.

METHODS: Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain. Updated searches were performed through November 2016. Clinical outcomes evaluated included reduction or elimination of low back pain, improvement in back-specific and overall function, improvement in health-related quality of life, reduction in work disability and return to work, global improvement, number of back pain episodes or time between episodes, patient satisfaction, and adverse effects.

TARGET AUDIENCE AND PATIENT POPULATION: The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute, subacute, or chronic low back pain.

RECOMMENDATION 1: Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation).

WARNING: Before following Recommendation #1,
please review the Contra-indications to NSAIDS use.

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Guidelines Section

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Glucose Metabolic Changes in the Brain and Muscles of Patients with Nonspecific Neck Pain Treated by Spinal Manipulation Therapy

By Frank M. Painter|February 11, 2017|Chiropractic Care|

Glucose Metabolic Changes in the Brain and Muscles of Patients with Nonspecific Neck Pain Treated by Spinal Manipulation Therapy: A [18F]FDG PET Study

The Chiro.Org Blog

SOURCE: Evid Based Complement Alternat Med 2017 (Jan 12); 2017: 4345703 ~ FULL TEXT

Akie Inami, Takeshi Ogura,
Shoichi Watanuki, Md. Mehedi Masud,
Katsuhiko Shibuya, Masayasu Miyake, et al.

Division of Cyclotron Nuclear Medicine,
Cyclotron and Radioisotope Center,
Tohoku University,
Sendai, Japan.

Objective. The aim of this study was to investigate changes in brain and muscle glucose metabolism that are not yet known, using positron emission tomography with [18F]fluorodeoxyglucose ([18F]FDG PET).

Methods. Twenty-one male volunteers were recruited for the present study. [18F]FDG PET scanning was performed twice on each subject: once after the spinal manipulation therapy (SMT) intervention (treatment condition) and once after resting (control condition). We performed the SMT intervention using an adjustment device. Glucose metabolism of the brain and skeletal muscles was measured and compared between the two conditions. In addition, we measured salivary amylase level as an index of autonomic nervous system (ANS) activity, as well as muscle tension and subjective pain intensity in each subject.

Results. Changes in brain activity after SMT included activation of the dorsal anterior cingulate cortex, cerebellar vermis, and somatosensory association cortex and deactivation of the prefrontal cortex and temporal sites. Glucose uptake in skeletal muscles showed a trend toward decreased metabolism after SMT, although the difference was not significant. Other measurements indicated relaxation of cervical muscle tension, decrease in salivary amylase level (suppression of sympathetic nerve activity), and pain relief after SMT.

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Neurology subsection

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Individual Courses of Low Back Pain in Adult Danes

By Frank M. Painter|February 7, 2017|Low Back Pain|

Individual Courses of Low Back Pain in Adult Danes: A Cohort Study with 4-Year and 8-Year Follow-up

The Chiro.Org Blog

SOURCE: BMC Musculoskelet Disord. 2017 (Jan 21); 18 (1): 28

Per Kjaer, Lars Korsholm, Charlotte Leboeuf-Yde, Lise Hestbaek and Tom Bendix

Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Campusvej 55, DK-5230,
Odense M, Denmark.

BACKGROUND: Few longitudinal studies have described the variation in LBP and its impact over time at an individual level. The aims of this study were to:

1) determine the prevalence of LBP in three surveys over a 9-year period in the Danish general population, using five different definitions of LBP,

2) study their individual long-term courses, and

3) determine the odds of reporting subsequent LBP when having reported previous LBP.

METHODS: A cohort of 625 men and women aged 40 was sampled from the general population. Questions about LBP were asked at ages 41, 45 and 49, enabling individual courses to be tracked across five different definitions of LBP. Results were reported as percentages and the prognostic influence on future LBP was reported as odds ratios (OR).

RESULTS: Questionnaires were completed by 412 (66%), 348 (56%) and 293 (47%) persons respectively at each survey. Of these, 293 (47%) completed all three surveys. The prevalence of LBP did not change significantly over time for any LBP past year: 69, 68, 70%; any LBP past month: 42, 48, 41%; >30 days LBP past year: 25, 27, 24%; seeking care for LBP past year: 28, 30, 36%; and non-trivial LBP, i.e. LBP >30 days past year including consequences: 18, 20, 20%. For LBP past year, 2/3 remained in this category, whereas four out of ten remained over the three time-points for the other definitions of LBP. Reporting LBP defined in any of these ways significantly increased the odds for the same type of LBP 4 years later. For those with the same definition of LBP at both 41 and 45 years, the risk of also reporting the same at 49 years was even higher, regardless of definition, and most strongly for seeking care and non-trivial LBP (OR 17.6 and 18.4) but less than 11% were in these groups.

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Low Back Pain and Chiropractic

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Australian Study Indicates Common Painkillers Ineffective for Back Pain

By John Wiens DC|February 7, 2017|NSAIDs|

Commonly used non-steroidal anti-inflammatory drugs used to treat back pain provide little benefit and may make things worse according to new research from The George Institute for Global Health.

The findings of the systematic review, published in the Annals of the Rheumatic Diseases, reveal only one in six patients treated with the pills, also known as NSAIDs, achieve any significant reduction in pain.

The study is the latest work from The George Institute questioning the effectiveness of existing medicines for treating back pain. Earlier research has already demonstrated paracetamol does not speed recovery or reduce pain for acute low back pain, and opioids provide minimal benefit over placebo.

Lead author Associate Professor Manuela Ferreira says the study highlights an urgent need to develop new therapies to treat back pain which affects 80 per cent of Australians during their lifetime.

A/Prof Ferreira, Senior Research Fellow at The George Institute and at the Institute of Bone and Joint Research, said: “Back pain is the leading cause of disability worldwide and is commonly managed by prescribing medicines such as anti-inflammatories. But our results show anti-inflammatory drugs actually only provide very limited short term pain relief. They do reduce the level of pain, but only very slightly, and arguably not of any clinical significance.”

A/Prof Ferreira added: “When you factor in the side effects which are very common, it becomes clear that these drugs are not the answer to providing pain relief to the many millions of Australians who suffer from this debilitating condition every year.”

The team at The George Institute, which examined 35 trials involving more than 6000 people, also found patients taking anti-inflammatories were 2.5 times more likely to suffer from gastro-intestinal problems such as stomach ulcers and bleeding.

Research Fellow Gustavo Machado, of The George Institute and the School of Medicine at the University of Sydney, said: “Millions of Australians are taking drugs that not only don’t work very well, they’re causing harm. We need treatments that will actually provide substantial relief of these people’s symptoms.

“Better still we need a stronger focus on preventing back pain in the first place. We know that education and exercise programs can substantially reduce the risk of developing low back pain.”

Most clinical guidelines currently recommend NSAIDs as the second line analgesics after paracetamol, with opioids coming at third choice.

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Chiropractic Rehabilitation of a Scoliosis Family

By Frank M. Painter|February 4, 2017|Scoliosis|

Chiropractic Rehabilitation of a Scoliosis Family: Results from a 9-Year Follow-Up

The Chiro.Org Blog

SOURCE: Journal of Therapy and Rehab 2017 (Jan); 5 (1): 29–35

Mark W. Morningstar, Aatif Siddiqui,
Clayton Stitzel, Brian Dovorany

Natural Wellness & Pain Relief Center,
Grand Blanc, MI, USA

Scoliosis bracing is typically prescribed when the curvature reaches to between 30°–50°. Although there has been a vast amount of bracing literature published, the results remain equivocal. Many patients face issues of compliance, comfort, and decreased self-esteem due to social stigmas with bracing. This has caused many patients to seek non-bracing options. Although these treatments are plausible, they lack the research background that bracing has. Therefore, many physicians are reluctant to prescribe exercise-based rehabilitation for their scoliosis patients.

This study reports on 3 patients who sought non-bracing, exercise-based chiropractic rehabilitation for their scoliosis. Their results before, after, and at long term follow up are included.

Key words: Chiropractic, Scoliosis, Spine, Rehabilitation

From the Full-Text Article:

Introduction

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Scoliosis and Chiropractic Page

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Mild Traumatic Brain Injury After Motor Vehicle Collisions: What Are the Symptoms and Who Treats Them?

By Frank M. Painter|January 29, 2017|Chronic Neck Pain, Whiplash|

Mild Traumatic Brain Injury After Motor Vehicle Collisions: What Are the Symptoms and Who Treats Them? A Population-Based 1-Year Inception Cohort Study

The Chiro.Org Blog

SOURCE: Arch Phys Med Rehab 2014 (Mar); 95 (3 Sup): S286–294

Jan Hartvigsen, PhD, Eleanor Boyle, PhD, J. David Cassidy, PhD, DrMedSc, Linda J. Carroll, PhD

Institute of Sports Science and Clinical Biomechanics,
University of Southern Denmark, Odense, Denmark;
Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark.

OBJECTIVE: To describe the 1-year course of symptoms following mild traumatic brain injury (MTBI) sustained in a motor vehicle collision as well as patterns of care-seeking.

DESIGN: One-year follow-up of a population-based inception cohort.

SETTING: The province of Saskatchewan, Canada, with a population of about 1,000,000 inhabitants.

PARTICIPANTS: Persons (N=1716) sustaining an MTBI during a car collision between November 1997 and December 1999.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: We report the prevalence of sleep disturbances, tiredness, dizziness, forgetfulness, vision problems, hearing problems, headache, neck pain, mid back pain, and low back pain at 6 weeks and 3, 6, 9, and 12 months postcollision. At the same time points, we report self-reported care-seeking from registered health care professionals.

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The Whiplash Page and the:

Chronic Neck Pain and Chiropractic Page

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