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Measuring Musculoskeletal Pain in Infants, Children, and Adolescents

By Frank M. Painter|December 26, 2022|Chronic Pain, Musculoskeletal Pain, Pediatrics|

Measuring Musculoskeletal Pain in Infants, Children, and Adolescents

SOURCE: J Orthop Sports Phys Ther 2017 (Oct); 47 (10): 712–730

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Zoe A. Michaleff, BAppSc (Phty), PhD, Steven J. Kamper, BSc, BAppSc, PhD, et al.

Primary Care Centre,
Research Institute for Primary Care and Health Sciences,
Keele University,
Keele, Staffordshire
ST5 5BG United Kingdom.

Accurate, reliable, and timely assessment of pain is critical for effective management of musculoskeletal pain conditions. The assessment of pain in infants, children, and adolescents with and without cognitive impairment can be particularly challenging to clinicians for a number of reasons, including factors related to the consultation (eg, heterogeneous patient population, time constraints), the clinician (eg, awareness/knowledge of available pain scales), standardized assessment scales (eg, availability, psychometric properties, and application of each scale), the patient (eg, developmental stage, ability to communicate), and the context in which the interaction took place (eg, familiarity with the setting and physiological and psychological state).

As a result, pain is frequently not assessed or measured during the consultation and, in many instances, underestimated and undertreated in this population. The purpose of this article is to provide clinicians with an overview of scales that may be used to measure pain in infants, children, and adolescents.

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Chiropractic Clinical Outcomes Among Older Adult Male Veterans With Chronic Lower Back Pain: A Retrospective Review of Quality-Assurance Data

By Frank M. Painter|December 14, 2022|Nonpharmacologic Therapies, Veterans|

Chiropractic Clinical Outcomes Among Older Adult Male Veterans With Chronic Lower Back Pain: A Retrospective Review of Quality-Assurance Data

The Chiro.Org Blog

SOURCE: J Chiropractic Medicine 2022 (Jun); 21 (2): 77–82

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Brian A. Davis, DC, Andrew S.Dunn, DC, MS, MEd, Derek J. Golley, DC, MS, Dave R. Chicoine, DC, MS

Chiropractic Department,
VA Western New York Healthcare System,
Buffalo, New York.

FROM: Nahin ~ Pain 2017

Objective: The purpose of this study was to determine whether a sample of older adult male U.S. veterans demonstrated clinically and statistically significant improvement in chronic lower back pain on validated outcome measures after a short course of chiropractic care.

Methods: We performed a retrospective review of a quality-assurance data set of outcome metrics for male veterans, aged 65 to 89 years, who had chronic low back pain, defined as pain in the lower back region present for at least 3 months before evaluation. We included those who received chiropractic management from January 1, 2010, to December 31, 2018. Paired t tests were used to compare outcomes after 4 treatments on both a numeric rating scale (NRS) and the Back Bournemouth Questionnaire (BBQ). The minimum clinically important difference (MCID) was set at 30% change from baseline.

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We Built It, But Did They Come: Veterans’ Use of VA Healthcare System-Provided Complementary and Integrative Health Approaches

By Frank M. Painter|December 8, 2022|Veterans|

We Built It, But Did They Come: Veterans’ Use of VA Healthcare System-Provided Complementary and Integrative Health Approaches

The Chiro.Org Blog

SOURCE: J Gen Intern Med 2022 (Nov 30); 1-8
Stephanie L. Taylor, PhD, Hannah M. Gelman, PhD, Rian DeFaccio, MS, Jamie Douglas, MA, Matthew J. Hawrilenko, PhD, Nathan K. McGinty, BA, Adam Resnick, PhD,et al.

Center for the Study of Healthcare Innovation,
Implementation and Policy, Health Services Research & Development,
Greater Los Angeles VA Healthcare System, MC 151,
11301 Wilshire, Bldg. 206, 2nd Floor,
Los Angeles, CA, 90073, USA.

FROM: Nahin ~ Pain 2017

Background: Interest in complementary and integrative health (CIH) approaches, such as meditation, yoga, and acupuncture, continues to grow. The evidence of effectiveness for some CIH approaches has increased in the last decade, especially for pain, with many being recommended in varying degrees in national guidelines. To offer nonpharmacological health management options and meet patient demand, the nation’s largest integrated healthcare system, the Veterans Health Administration (VA), greatly expanded their provision of CIH approaches recently.

Objective: This paper addressed the questions of how many VA patients might use CIH approaches and chiropractic care if they were available at modest to no fee, and would patients with some health conditions or characteristics be more likely than others to use these therapies.

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Compliance with Clinical Practice Guidelines in Family Physicians Managing Worker’s Compensation Board Patients with Acute Lower Back Pain

By Frank M. Painter|November 23, 2022|Chiropractic Management, Workers' Compensation|

Compliance with Clinical Practice Guidelines in Family Physicians Managing Worker’s Compensation Board Patients with Acute Lower Back Pain

The Chiro.Org Blog

SOURCE: Spine J 2003 (Nov); 3 (6): 442–450

Paul B. Bishop, DC, MD, PhD, Peter C. Wing, MB, MSc, ChB, FRCS(C)

Combined Neurosurgical and Orthopaedic Spine Program,
Heather Pavilion, Vancouver General Hospital,
Vancouver, BC, Canada

Background context: Family physician compliance with acute lower back pain clinical practice guidelines remains uncertain.

Purpose: To determine the degree of guideline compliance of family physicians managing patients with workers’ compensation claims and acute mechanical lower back pain.

Study design: Observational study.

Patient sample: One hundred thirty-nine family physicians in British Columbia.

Outcome measures: Compliance with guideline recommendations for history, examination procedures, diagnostic testing and treatments.

Methods: Physician workers’ compensation board patient reports for acute lower back pain without leg symptoms and not greater than 2 to 3 weeks duration were scored for guideline adherence up until 12 weeks after onset.

Results: Physicians demonstrated a high degree of compliance with the guideline-recommended history, examination procedures and medications, but low compliance with recommended imaging and many treatment recommendations.

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Treatment of Lower Back Pain-The Gap between Guideline-Based Treatment and Medical Care Reality

By Frank M. Painter|November 17, 2022|Guidelines, Initial Provider, Low Back Pain|

Treatment of Lower Back Pain-The Gap between Guideline-Based Treatment and Medical Care Reality

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SOURCE: Healthcare (Basel) 2016 (Jul 15); 4 (3): 44 ~ FULL TEXT

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Andreas Werber and Marcus Schiltenwolf

Department of Orthopedics and Orthopedic Surgery,
University Hospital Giessen,
Klinikstr. 33, 35392
Giessen, Germany

Despite the fact that unspecific low back pain is of important impact in general health care, this pain condition is often treated insufficiently. Poor efficiency has led to the necessity of guidelines addressing evidence-based strategies for treatment of lower back pain (LBP). We present some statements of the German medical care reality. Self-responsible action of the patient should be supported while invasive methods in particular should be avoided due to lacking evidence in outcome efficiency. However, it has to be stated that no effective implementation strategy has been established yet. Especially, studies on the economic impact of different implementation strategies are lacking.

A lack of awareness of common available guidelines and an uneven distribution of existing knowledge throughout the population can be stated: persons with higher risk suffering from LBP by higher professional demands and lower educational level are not skilled in advised management of LBP. Both diagnostic imaging and invasive treatment methods increased dramatically leading to increased costs and doctor workload without being associated with improved patient functioning, severity of pain or overall health status due to the absence of a functioning primary care gate keeping system for patient selection.

Opioids are prescribed on a grand scale and over a long period. Moreover, opioid prescription is not indicated properly, when predominantly persons with psychological distress like somatoform disorders are treated with opioids.

Keywords: guideline-based treatment; low back pain; somatisation.

From the FULL TEXT Article:

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Adolescent Neck and Shoulder Pain–The Association with Depression, Physical Activity, Screen-based Activities, and Use of Health Care Services

By Frank M. Painter|November 11, 2022|Neck Pain, Pediatrics|

Adolescent Neck and Shoulder Pain–The Association with Depression, Physical Activity, Screen-based Activities, and Use of Health Care Services

The Chiro.Org Blog

SOURCE: J Adolesc Health 2014 (Sep); 55 (3): 366–372
Solbjørg Makalani Myrtveit, Børge Sivertsen, Ph.D., Jens Christoffer Skogen, Ph.D., Lisbeth Frostholm, Ph.D. et al

Department of Clinical Science,
University of Bergen,
Bergen, Norway

Purpose: Neck and shoulder pain is frequent in adolescents, and multiple factors seem to affect the risk of such symptoms. We aimed to investigate the prevalence of neck and shoulder pain in Norwegian adolescence and to examine whether behavioral and emotional factors were associated with the risk of neck and shoulder pain. Finally we aimed to investigate whether neck and shoulder pain was related to the use of health services.

Method: Data from the population-based study ung@hordaland were used. Participants were asked how often during the last 6 months they had experienced neck and shoulder pain. The association between frequent neck and shoulder pain and physical activity, symptoms of depression, and screen-based activities was evaluated using logistic regression analyses stratified by gender. The relative risk of visiting health services when reporting neck and shoulder pain was calculated using multiple logistic regression analyses.

Results: Frequent neck and shoulder pain was reported by 20.0% (1,797 of the total 8,990) and more often by girls than boys (p < .001). A high score of depressive symptoms was the strongest risk factor for neck and shoulder pain in both boys and girls (odds ratio = 6.14 [95% confidence interval 4.48-8.42] and odds ratio = 3.10 [95% confidence interval 2.63-3.67], respectively). Frequent screen-based activities slightly increased the risk while physical activity was protective. Individuals reporting neck and shoulder pain more often visited their general practitioner (47.1% vs. 31.8%) and school health services (24.6% vs. 13.5%).

Conclusion: Frequent neck and shoulder pain was reported in 20% of Norwegian adolescents. Symptoms of depression and screen-based activities increased the risk of neck and shoulder pain while physical activity was protective. Individuals reporting neck and shoulder pain visited health services more frequently than others.

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CHRONIC NECK PAIN Section

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