Chiropractic Care

Chiropractic Care of a Female Veteran After Cervical Total Disk Replacement: A Case Report

By Frank M. Painter|May 7, 2023|Chiropractic Care, Chronic Neck Pain, Radiculopathy, Veterans|

Chiropractic Care of a Female Veteran After Cervical Total Disk Replacement: A Case Report

SOURCE: J Chiropractic Medicine 2022 (Mar); 21 (1): 60–65

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Michael Mortenson DC, Anna Montgomery MPH, Glenn Buttermann MD

Whole Health Department,
Fargo VA Healthcare System,
Fargo, North Dakota.

Objective: The purpose of this case study is to describe chiropractic care of the cervical spine for a patient who previously underwent cervical total disk replacement (CTDR) of the C5–6 and C6–7 disks.

Clinical features: A 42–year-old female veteran of the U.S. Army presented to a Veterans Affairs chiropractic clinic with chronic cervical pain and radiculopathy. She had previously undergone CTDR surgery of the C5–6 disk 9 years earlier, but the pain had become severe and radicular symptoms had returned in the upper left extremity. Imaging taken before the chiropractic referral demonstrated significant joint space narrowing and disk herniation of the C6–7 disk with protrusion to the left side.

Intervention and outcome: The patient received spinal manipulative therapy, trigger-point therapy, and manual traction to the cervical spine. However, these treatments were not effective in reducing her cervical pain and radiculopathy. She then opted for CTDR of the C6–7 disk. After surgery, the patient reported that radicular symptoms were mostly relieved and cervical pain had decreased by 50%. After 6 additional spinal manipulative therapy treatments, she reported having no neurologic symptoms and that her pain had decreased more than 70% from presurgery levels.

Conclusion: This case report is the first reported example of chiropractic care after cervical total disk replacement (CTDR) within an integrated health care environment. The patient’s cervical pain and radiculopathy improved with CTDR along with postsurgical chiropractic care.

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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|May 6, 2023|Chiropractic Care, Chiropractic Management, Veterans|

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

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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: Military.com 2019

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.

Results: There were 217 individuals who met the inclusion criteria. The mean NRS score change from baseline was 2.2 points, representing a 34.1% reduction (t = 13.5, P < .001). The mean score change for BBQ was 14.7 points, representing a 35.9% reduction (t = 16.7, P < .001). The percentage of participants reaching the MCID for the NRS was 57% (n = 124) and for the BBQ was 59% (n = 126), with 41% (n = 90) of the sample reaching the MCID for both the NRS and BBQ.

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Examining Clinical Opinion and Experience Regarding Utilization of Plain Radiography of the Spine: Evidence from Surveying the Chiropractic Profession

By Frank M. Painter|March 29, 2023|Chiropractic Care, Radiology|

Examining Clinical Opinion and Experience Regarding Utilization of Plain Radiography of the Spine: Evidence from Surveying the Chiropractic Profession

The Chiro.Org Blog

SOURCE: J Clinical Medicine 2023 (Mar 10); 12 (6): 2169

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Philip A Arnone, Steven J Kraus, Derek Farmen, Douglas F Lightstone, Jason Jaeger, Christine Theodossis

Community Based Internship Program, Associate Faculty,
Southern California University of Health Sciences,
Whittier, CA 90604, USA.

FROM: Umeå University, Sweden 2008

Plain Radiography of the spine (PROTS) is utilized in many forms of healthcare including the chiropractic profession; however, the literature reflects conflicting opinions regarding utilization and value. Despite being an essential part of Evidence-Based Practice (EBP), few studies assess Doctors of Chiropractic (DCs) clinical opinions and experience regarding the utilization of (PROTS) in practice. In this study, DCs were surveyed regarding utilization of PROTS in practice. The survey was administered to an estimated 50,000 licensed DCs by email. A total of 4,301 surveys were completed, of which 3,641 were United States (US) DCs. The Clinician Opinion and Experience on Chiropractic Radiography (COECR) scale was designed to analyze survey responses. This valid and reliable scale demonstrated good internal consistency using confirmatory factor analysis and the Rasch model.

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Acute Inflammatory Response via Neutrophil Activation Protects Against the Development of Chronic Pain

By Frank M. Painter|June 12, 2022|Chiropractic Care, Chronic Pain Management|

Acute Inflammatory Response via Neutrophil Activation Protects Against the Development of Chronic Pain

The Chiro.Org Blog

SOURCE: Science Translational Medicine 2022 (May 11)

Marc Parisien, Lucas V Lima, Concetta Dagostino, Nehme El-Hachem, Gillian L Drury, et. al.

Faculty of Dental Medicine and Oral Health Sciences,
Department of Anesthesia, Faculty of Medicine,
Alan Edwards Centre for Research on Pain,
McGill University,
Montreal, Quebec H3A 1G1, Canada.

Editorial Comment:

This novel new study suggests that prolonged NSAIDs use may be a cause of persistent pain. The authors stated:

“Analysis of pain trajectories of human subjects reporting acute back pain in the UK Biobank identified elevated risk of pain persistence for subjects taking NSAIDs. Thus, despite analgesic efficacy at early time points, the management of acute inflammation may be counterproductive for long-term outcomes of LBP sufferers.”

FROM: Pain Research Forum

Neutrophils Put the Brakes on Acute Pain Becoming Chronic

Neutrophils help prevent the transition from acute to chronic pain after injury.
Dampening their activity with anti-inflammatory drugs, like ibuprofen or diclofenac, can prolong pain duration.

by Fred Schwaller on 25 May 2022

In the last few weeks, several news outlets like The New York Times and The Guardian have published provocative stories warning their readers that taking analgesics, like ibuprofen, can lead to the development of chronic back pain.

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Spinal Manipulative Therapy in Older Adults with Chronic Low Back Pain: An Individual Participant Data Meta-analysis

By Frank M. Painter|June 5, 2022|Chiropractic Care, Chiropractic Management, Chronic Low Back Pain|

Spinal Manipulative Therapy in Older Adults with Chronic Low Back Pain: An Individual Participant Data Meta-analysis

The Chiro.Org Blog

SOURCE: European Spine Journal 2022 (May 28) [EPUB]

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Alan Jenks, Annemarie de Zoete, Maurits van Tulder, Sidney M Rubinstein, International IPD-SMT group

Faculty of Science,
Department of Health Sciences,
Vrije Universiteit,
Gebouw MF, Flexruimte,
Van der Boechorststraat 7,
1081 BT, Amsterdam,
The Netherlands.

Purpose: Many systematic reviews have reported on the effectiveness of spinal manipulative therapy (SMT) for low back pain (LBP) in adults. Much less is known about the older population regarding the effects of SMT.

Objective: To assess the effects of SMT on pain and function in older adults with chronic LBP in an individual participant data (IPD) meta-analysis.

Setting: Electronic databases from 2000 until June 2020, and reference lists of eligible trials and related reviews.

Design and subjects: Randomized controlled trials (RCTs) which examined the effects of SMT in adults with chronic LBP compared to interventions recommended in international LBP guidelines.

Methods: Authors of trials eligible for our IPD meta-analysis were contacted to share data. Two review authors conducted a risk of bias assessment. Primary results were examined in a one-stage mixed model, and a two-stage analysis was conducted in order to confirm findings.

Main outcomes and measures: Pain and functional status examined at 4, 13, 26, and 52 weeks.

Results: 10 studies were retrieved, including 786 individuals, of which 261 were between 65 and 91 years of age. There is moderate-quality evidence that SMT results in similar outcomes at 4 weeks (pain: mean difference [MD] – 2.56, 95% confidence interval [CI] – 5.78 to 0.66; functional status: standardized mean difference [SMD] – 0.18, 95% CI – 0.41 to 0.05). Second-stage and sensitivity analysis confirmed these findings.

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Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

By Frank M. Painter|May 8, 2022|Acute Neck Pain, Chiropractic Care, Chronic Neck Pain|

Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

The Chiro.Org Blog

SOURCE: J Clinical Medicine 2021 (Oct 28); 10 (21): 5011

Aleksander Chaibi, Knut Stavem and Michael Bjørn Russell

Head and Neck Research Group,
Division for Research and Innovation,
Akershus University Hospital,
1478 Oslo, Norway

Background: Acute neck pain is common and usually managed by medication and/or manual therapy. General practitioners (GPs) hesitate to refer to manual therapy due to uncertainty about the effectiveness and adverse events (AEs)

Method: To review original randomized controlled trials (RCTs) assessing the effect of spinal manipulative therapy (SMT) for acute neck pain. Data extraction was done in duplicate and formulated in tables. Quality and evidence were assessed using the Cochrane Back and

Results: Six studies were included. The overall pooled effect size for neck pain was very large –1.37 (95% CI, –2.41, –0.34), favouring treatments with SMT compared with controls. A single study that showed that SMT was statistically significantly better than medicine (30 mg ketorolac im.) one day post-treatment, ((–2.8 (46%) (95% CI, –2.1, –3.4) vs. –1.7 (30%) (95% CI, –1.1, –2.3), respectively; p = 0.02)). Minor transient AEs reported included increased pain and headache, while no serious AEs were reported.

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