Chiropractic Care

Chronic Low-Back Pain: Is Infection a Common Cause?

By Frank M. Painter|September 6, 2013|Chiropractic Care, Low Back Pain|

Chronic Low-Back Pain: Is Infection a Common Cause?

SOURCE: ACA News ~ September 2013

By Daniel Redwood, DC

Background:

A 2013 randomized trial by Hanne Albert and colleagues at the University of Southern Denmark, published in the European Spine Journal, [1] found that 100 days of treatment with a disc-penetrating antibiotic was significantly more effective than a placebo for relief of chronic low-back pain (CLBP) in people whose MRI exam showed Modic Type 1 changes, which are associated with degeneration and inflammation. If confirmed by other studies, this would mean that disc infection is a far more common cause of CLBP than previously known.

Rare indeed is the publication of a Research paper with the potential to overturn long-standing, fundamental assumptions about the nature of a disease. Virtually all clinical research is incremental in its expansion of our knowledge — by evaluating the effectiveness of treatment methods, demonstrating the conditions under which they are most likely to be beneficial and exploring the physical mechanisms through which they work. But every now and then, a study like Marshall and Warren’s 1982 discovery [2] of the association between the heliobacter pylori bacterium and peptic ulcers appears out of left field to upend what previously passed for conventional wisdom.

In recent years, arguably the only publication to trigger a major reorientation of our understanding in an area critical to chiropractic practice was the 2008 Cassidy et al. paper in Spine, [3] in which the investigators examined nine years of medical records in the Canadian province of Ontario (covering 100 million patient years) and were able to definitively demonstrate that the likelihood of a stroke is no greater if one visits a doctor of chiropractic (DC) than if one visits a medical doctor. Overnight, this study shifted our understanding of stroke vis-à-vis chiropractic, with the authors concluding: “The increased risks of VBA (vertebrobasilar artery) stroke associated with chiropractic and PCP (primary care physician) visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated (with) chiropractic care compared to primary care.”

There’s a lot more material like this @:

Low Back Pain and Chiropractic Page

Is the Albert et al. study on antibiotics treatment of CLBP this kind of game-changer?

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New Chiropractic and Radicular Pain Study

By Frank M. Painter|August 31, 2013|Chiropractic Care, Disc Injury, Radiculopathy|

New Chiropractic and Radicular Pain Study

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2013 (Aug 12)

Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up

Cynthia K. Peterson, RN, DC, M.Med.Ed, Christof Schmid, DC,
Serafin Leemann, DC, Bernard Anklin, DC, B. Kim Humphreys, DC, PhD

Professor, Department of Chiropractic Medicine,
Faculty of Medicine,
Orthopedic University Hospital Balgrist,
University of Zürich,
Zürich, Switzerland.
xraydcpeterson@yahoo.ca

This newly published prospective cohort study with 3-Month follow-up reports on the outcomes of 50 patients with MRI-confirmed cervical disc herniation who were also experiencing radiculopathy. Some of them were acute cases, but many of them also happened to be chronic pain patients.

A short, 3 month trial of chiropractic care led to significant improvements in all those individuals, and this improvement was sustained 3 months after care ceased.

OBJECTIVE: The purpose of this study was to investigate outcomes of patients with cervical radiculopathy from cervical disk herniation (CDH) who are treated with spinal manipulative therapy.

METHODS: Adult Swiss patients with neck pain and dermatomal arm pain; sensory, motor, or reflex changes corresponding to the involved nerve root; and at least 1 positive orthopaedic test for cervical radiculopathy were included. Magnetic resonance imaging-confirmed CDH linked with symptoms was required. Baseline data included 2 pain numeric rating scales (NRSs), for neck and arm, and the Neck Disability Index (NDI). At 2 weeks, 1 month, and 3 months after initial consultation, patients were contacted by telephone, and the NDI, NRSs, and patient’s global impression of change data were collected. High-velocity, low-amplitude spinal manipulations were administered by experienced doctors of chiropractic. The proportion of patients responding “better” or “much better” on the patient’s global impression of change scale was calculated. Pretreatment and posttreatment NRSs and NDIs were compared using the Wilcoxon test. Acute vs subacute/chronic patients’ NRSs and NDIs were compared using the Mann-Whitney U test.

RESULTS: Fifty patients were included. At 2 weeks, 55.3% were “improved,” 68.9% at 1 month and 85.7% at 3 months. Statistically significant decreases in neck pain, arm pain, and NDI scores were noted at 1 and 3 months compared with baseline scores (P < .0001). Of the subacute/chronic patients, 76.2% were improved at 3 months.

There are many more articles like this at our:

Radiculopathy and Chiropractic Page

and our:

Chronic Neck Pain and Chiropractic Page

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A Framework For Chiropractic Training In Clinical Preventive Services

By Frank M. Painter|August 25, 2013|Chiropractic Care, Prevention|

A Framework For Chiropractic Training In Clinical Preventive Services

The Chiro.Org Blog

Chiropractic & Manual Therapies 2013 (Aug 20); 21: 28

Cheryl Hawk and Marion Willard Evans

Cheryl Hawk cheryl.hawk@logan.edu
Logan College of Chiropractic, 1851 Schoettler Rd, 63017 Chesterfield, MO, USA

The 2010 Patient Protection and Affordable Care Act provides incentives for both patients and providers to engage in evidence-based clinical preventive services recommended by the United States Preventive Services Task Force (USPSTF). Depending upon the application of the new health care act, Doctors of Chiropractic (DC) may be considered to be covered providers of many of these services. It is therefore essential that DCs’ training prepare them to competently deliver them. The aim of this commentary is to describe a framework for training in clinical preventive services, based largely on the USPSTF recommendations, which could be readily integrated into existing DC educational programs.

From the Full-Text Article:

Background

The necessity for preventive care

The United States, despite spending more money on health care than any other country, has a population with shorter life expectancy and greater morbidity than any other wealthy nation [1]. The areas in which the U.S. lags behind its 16 peer nations are all lifestyle-related to a great degree [1]. Clearly this situation requires an approach that engages people in modifying their health behavior, as early as possible, rather than relying on heroic measures once conditions have become chronic and life-threatening. That approach is systematically addressed in the science of health promotion and disease prevention, often simply called “prevention” or “preventive care”. [2]

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Chiropractic Cost-Effectiveness Supplement

By Frank M. Painter|August 17, 2013|Chiropractic Care, Chronic Pain, Cost-Effectiveness, Low Back Pain|

Chiropractic Cost-Effectiveness Supplement

The Chiro.Org Blog

SOURCE: Virginia Chiropractic Association

The following studies detail the cost effectiveness and overall efficacy of chiropractic care, and the procedures that doctors of chiropractic provide their patients.

This presentation is divided into several parts:

Background studies, detailing that LBP is much more complex than the literature leads us to believe;
Cost-Effectiveness Studies;
Worker’s Compensation Studies (National studies) and
Worker’s Compensation Studies (State specific studies)

GENERAL BACKGROUND STUDIES:

Prognosis in Patients with Recent Onset Low Back Pain in Australian Primary Care: Inception Cohort Study
British Medical Journal 2008 (Jul 7); 337: a171 ~ FULL TEXT

This study contradicts the Clinical Practice Guidelines that maintain that recovery from acute low back pain is usually rapid and complete. Their findings with 973 consecutive primary care patients was that recovery was slow for most patients, and almost 1/3 of patients did not recover within one year (when following standard medical recommendations).

This study was designed to determine the one year prognosis of patients with low back pain. 973 patients with low back pain that had lasted less than 2 weeks completed a baseline questionnaire. Patients were reassessed through a phone interview at six weeks, three months and 12 months. The study found that the prognosis claimed in clinical guidelines was more favorable than the actual prognosis for the patients in the study. Recovery was slow for most patients and almost 1/3 of patients did not recover within one year.

Low Back Pain In A General Population. Natural Course And Influence Of Physical Exercise–A 5-Year Follow-Up
Spine. 2006 (Dec 15); 31 (26): 3045-51

This study contradicts the common belief that low back pain will extinguish with simple core exercises. This study provided significant benefits for only 1 out of 5 LPB sufferers. Researchers followed 790 patients who initially sought care for low back pain from 70 different caregivers. After 5 years, only 21% of patients studied reported no continued pain while only 37% reported no disability. Pain and disability scores dropped significantly at 6 months, then remained flat at 2 yrs and 5 yrs. Nonspecific regular exercise did not affect recovery. Between 27% and 66% of the study population experienced a recurrence of low back pain.

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Bulletproof Your Documentation

By Frank M. Painter|July 13, 2013|Chiropractic Care, Documentation|

Bulletproof Your Documentation

The Chiro.Org Blog

SOURCE: Chiropractic Economics

By Kathy Mills Chang

Part 1: Ensure your admitting and ongoing paperwork isn’t slipping through the cracks

Because of the many different techniques and philosophies involved in chiropractic, you can be assured different doctors utilize different admitting and ongoing paperwork.

A recent survey of 80 chiropractors revealed that 72 percent of them collected paperwork for their clinic from various sources, creating a patchwork effect. Because very few utilized an actual system of paperwork, they admitted concern that some documentation could fall through the cracks.

So, what paperwork should you have in your office?

History

Most state chiropractic boards that have a standard of care for patients include taking patient history. If one were to follow the evaluation and management documentation guidelines, history is a significant portion of the value.

Because the requirements entail collecting information about the chief complaint; the history of the present illness; a review of systems; and the patient’s past, family, and social history, there is a substantial amount of information that can and should come from the patient.

Having information laid out in a clear fashion on your admitting paperwork allows the patient to answer the majority of the essential initial consultation questions. Using your admitting paperwork as a template allows you to ensure the required bullet points will be answered by the patient and reviewed by the physician.

There are many more articles like this @ our:

Chiropractic Assistant Page

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The Prevalence and Progression of Neck and Back Pain in Children Over Time

By Frank M. Painter|July 3, 2013|Chiropractic Care, Neck Pain, Pediatrics|

The Prevalence and Progression of Neck and Back Pain in Children Over Time

The Chiro.Org Blog

SOURCE: Musculoskelet Disord. 2011 (May 16); 12: 98

Per Kjaer, Niels Wedderkopp, Lars Korsholm,
and Charlotte Leboeuf-Yde

Institute of Sports Science and Clinical Biomechanics,
Part of Clinical Locomotion Network,
University of Southern Denmark,
Campusvej 55, DK-5230, Odense, Denmark

The following article appears to be the first study to track and review the progression of back pain in the same group of children, over a prolonged period, to see how (or if) it is a contributor to those same complains in adulthood.

Of particular interest is Table 2, because it breaks down and tracks complaints of either neck, mid back, or low back pain in the same group of children at 3 different time periods: ages 9, 13 and 15 years old.

Table 2: Prevalence rates of different types of back pain in a cohort of Danish children/adolescents surveyed at three time points

Age Group	Age 9	Age 13	Age 15
Neck Pain
All children Boys Girls	10%9%11%	7%5%9%	15%13%18%
Mid Back Pain
All children Boys Girls	20%22%19%	13%13%13%	28%22%32%
Low Back Pain
All children Boys Girls	33%32%34%	28%26%30%	48%39%54%

The Abstract:

BACKGROUND: It is generally acknowledged that back pain (BP) is a common condition already in childhood. However, the development until early adulthood is not well understood and, in particular, not the individual tracking pattern. The objectives of this paper are to show the prevalence estimates of BP, low back pain (LBP), mid back pain (MBP), neck pain (NP), and care-seeking because of BP at three different ages (9, 13 and 15 years) and how the BP reporting tracks over these age groups over three consecutive surveys.

METHODS: A longitudinal cohort study was carried out from the years of 1997 till 2005, collecting interview data from children who were sampled to be representative of Danish schoolchildren. BP was defined overall and specifically in the three spinal regions as having reported pain within the past month. The prevalence estimates and the various patterns of BP reporting over time are presented as percentages.

RESULTS: Of the 771 children sampled, 62%, 57%, and 58% participated in the three back surveys and 34% participated in all three. The prevalence estimates for children at the ages of 9, 13, and 15, respectively, were for BP 33%, 28%, and 48%; for LBP 4%, 22%, and 36%; for MBP 20%, 13%, and 35%; and for NP 10%, 7%, and 15%. Seeking care for BP increased from 6% and 8% at the two youngest ages to 34% at the oldest. Only 7% of the children who participated in all three surveys reported BP each time and 30% of these always reported no pain. The patterns of development differed for the three spinal regions and between genders. Status at the previous survey predicted status at the next survey, so that those who had pain before were more likely to report pain again and vice versa. This was most pronounced for care-seeking.

CONCLUSION: It was confirmed that BP starts early in life, but the patterns of onset and development over time vary for different parts of the spine and between genders. Because of these differences, it is recommended to report on BP in youngsters separately for the three spinal regions, and to differentiate in the analyses between the genders and age groups. Although only a small minority reported BP at two or all three surveys, tracking of BP (particularly NP) and care seeking was noted from one survey to the other. On the positive side, individuals without BP at a previous survey were likely to remain pain free at the subsequent survey.

Background

It is well known that back pain (BP) is a common and costly problem in the general population. Previously, BP in children was considered rare and a sign of a potentially serious disorder [1,2]. Today, according to a recent systematic review, the general opinion would be that BP, including low back pain (LBP), mid back pain (MBP) and neck pain (NP), starts already early in life to accelerate during the early teens up till early adulthood [3] and that its presence in young age is a precursor for BP also in adulthood [4]. In order to approach the issues of prevention and treatment it is helpful to understand the extent and course of a disease, particularly around the time of its onset and that picture is, presently, far from clear. Methodological and definition issues can partly explain this [3]. However, this is also a question of the study objectives and design. It is therefore not surprising that the estimates from various studies vary and that often they make no sense. Also, there appears to be no credible data on the true incidence for each spinal region in young people.

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