Chiropractic Care

A Systematic Review Comparing the Costs of Chiropractic Care to other Interventions for Spine Pain in the United States

By Frank M. Painter|February 24, 2017|Chiropractic Care, Cost-Effectiveness|

A Systematic Review Comparing the Costs of Chiropractic Care to other Interventions for
Spine Pain in the United States

SOURCE: BMC Health Serv Res. 2015 (Oct 19) ~ FULL TEXT

Simon Dagenais, O’Dane Brady, Scott Haldeman and Pran Manga

Spine Research LLC,
540 Main Street #7,
Winchester, MA, 01890, USA.

BACKGROUND: Although chiropractors in the United States (US) have long suggested that their approach to managing spine pain is less costly than other health care providers (HCPs), it is unclear if available evidence supports this premise.

METHODS: A systematic review was conducted using a comprehensive search strategy to uncover studies that compared health care costs for patients with any type of spine pain who received chiropractic care or care from other HCPs. Only studies conducted in the US and published in English between 1993 and 2015 were included. Health care costs were summarized for studies examining:

1. private health plans
2. workers’ compensation (WC) plans, and
3. clinical outcomes.

The quality of studies in the latter group was evaluated using a Consensus on Health Economic Criteria (CHEC) list.

RESULTS: The search uncovered 1,276 citations and 25 eligible studies, including 12 from private health plans, 6 from WC plans, and 7 that examined clinical outcomes. Chiropractic care was most commonly compared to care from a medical physician, with few details about the care received. Heterogeneity was noted among studies in patient selection, definition of spine pain, scope of costs compared, study duration, and methods to estimate costs. Overall, cost comparison studies from private health plans and WC plans reported that health care costs were lower with chiropractic care. In studies that also examined clinical outcomes, there were few differences in efficacy between groups, and health care costs were higher for those receiving chiropractic care. The effects of adjusting for differences in sociodemographic, clinical, or other factors between study groups were unclear.

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A Comparison of Chiropractic Manipulation Methods and Usual Medical Care for Low Back Pain

By Frank M. Painter|February 22, 2017|Chiropractic Care, Low Back Pain|

A Comparison of Chiropractic Manipulation Methods and Usual Medical Care for Low Back Pain: A Randomized Controlled Clinical Trial

The Chiro.Org Blog

SOURCE: J Altern Complement Med. 2014 (May); 20 (5): A22–23

Michael Schneider, Mitchell Haas, Joel Stevans,
Ronald Glick, Doug Landsittel

University of Pittsburgh,
Pittsburgh, PA, USA

Purpose: The primary aim of this study was to compare manual and mechanical methods of spinal manipulation (Activator) for patients with acute and sub-acute low back pain. These are the two most common methods of spinal manipulation used by chiropractors, but there is insufficient evidence regarding their comparative effectiveness against each other. Our secondary aim was to compare both methods with usual medical care.

Methods: In a randomized comparative effectiveness trial, we randomized 107 participants with acute and sub-acute low back pain to: 1) usual medical care; 2) manual side-posture manipulation; and 3) mechanical manipulation (Activator). The primary outcome was self-reported disability (Oswestry) at four weeks. Pain was rated on a 0 to 10 numerical rating scale. Pain and disability scores were regressed on grouping variables adjusted for baseline covariates.

Results: Manual manipulation demonstrated a clinically important and statistically significant reduction of disability and pain compared to Activator (adjusted mean difference=7.9 and 1.3 points respectively, P<.05) and compared to usual medical care (7.0 and 1.8 points respectively, P<.05). There were no significant adjusted mean differences between Activator and usual medical care in disability and pain (0.9 and 0.5 points respectively, P>.05).

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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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Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex

By Frank M. Painter|January 11, 2017|Chiropractic Care, Neurology|

Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex: A Brain Source Localization Study

The Chiro.Org Blog

SOURCE: Neural Plast. 2016 (Mar 7); 2016: 3704964 ~ FULL TEXT

Dina Lelic, Imran Khan Niazi, Kelly Holt, Mads Jochumsen, Kim Dremstrup, Paul Yielder, Bernadette Murphy, Asbjørn Mohr Drewes, and Heidi Haavik

Mech-Sense,
Department of Gastroenterology and Hepatology,
Aalborg University Hospital,
9000 Aalborg, Denmark

Objectives. Studies have shown decreases in N30 somatosensory evoked potential (SEP) peak amplitudes following spinal manipulation (SM) of dysfunctional segments in subclinical pain (SCP) populations. This study sought to verify these findings and to investigate underlying brain sources that may be responsible for such changes.

Methods. Nineteen subclinical pain volunteers attended two experimental sessions, SM and control in random order. SEPs from 62-channel EEG cap were recorded following median nerve stimulation (1000 stimuli at 2.3 Hz) before and after either intervention. Peak-to-peak amplitude and latency analysis was completed for different SEPs peak. Dipolar models of underlying brain sources were built by using the brain electrical source analysis. Two-way repeated measures ANOVA was used to assessed differences in N30 amplitudes, dipole locations, and dipole strengths.

Results. SM decreased the N30 amplitude by 16.9 ± 31.3% (P = 0.02), while no differences were seen following the control intervention (P = 0.4). Brain source modeling revealed a 4-source model but only the prefrontal source showed reduced activity by 20.2 ± 12.2% (P = 0.03) following SM.

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Clinical Practice Guidelines for the Noninvasive Management of Low Back Pain

By Frank M. Painter|December 2, 2016|Chiropractic Care, Guidelines, Low Back Pain|

Clinical Practice Guidelines for the Noninvasive Management of Low Back Pain: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

The Chiro.Org Blog

Eur J Pain. 2016 (Oct 6) ~ FULL TEXT

J.J. Wong, P. Côté, D.A. Sutton, K. Randhawa, H. Yu, S. Varatharajan, R. Goldgrub, M. Nordin, D.P.

UOIT-CMCC Centre for the Study of
Disability Prevention and Rehabilitation,
University of Ontario Institute of Technology (UOIT)
Canadian Memorial Chiropractic College (CMCC),
Oshawa, ON, Canada.

BACKGROUND: &nbsp Low back pain (LBP) is a major health problem, having a substantial effect on peoples’ quality of life and placing a significant economic burden on healthcare systems and, more broadly, societies. Many interventions to alleviate LBP are available but their cost effectiveness is unclear.

We conducted a systematic review of guidelines on the management of low back pain (LBP) to assess their methodological quality and guide care. We synthesized guidelines on the management of LBP published from 2005 to 2014 following best evidence synthesis principles. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, DARE, National Health Services Economic Evaluation Database, Health Technology Assessment Database, Index to Chiropractic Literature and grey literature. Independent reviewers critically appraised eligible guidelines using AGREE II criteria. We screened 2504 citations; 13 guidelines were eligible for critical appraisal, and 10 had a low risk of bias.

According to high-quality guidelines:

(1) all patients with acute or chronic LBP should receive education, reassurance and instruction on self-management options;

(2) patients with acute LBP should be encouraged to return to activity and may benefit from paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), or spinal manipulation;

(3) the management of chronic LBP may include exercise, paracetamol or NSAIDs, manual therapy, acupuncture, and multimodal rehabilitation (combined physical and psychological treatment); and

(4) patients with lumbar disc herniation with radiculopathy may benefit from spinal manipulation.

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Cost Analysis Related to Dose-response of Spinal Manipulative Therapy for Chronic Low Back Pain

By Frank M. Painter|November 12, 2016|Chiropractic Care, Chronic Low Back Pain, Cost-Effectiveness|

Cost Analysis Related to Dose-response of Spinal Manipulative Therapy for Chronic Low Back Pain: Outcomes from a Randomized Controlled Trial

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2014 (Jun); 37 (5): 300–311

Darcy A. Vavrek, ND, MS, Rajiv Sharma, PhD,
Mitchell Haas, DC, MA

University of Western States,
Portland, OR.

OBJECTIVE: The purpose of this analysis is to report the incremental costs and benefits of different doses of spinal manipulative therapy (SMT) in patients with chronic low back pain (LBP).

METHODS: We randomized 400 patients with chronic LBP to receive a dose of 0, 6, 12, or 18 sessions of SMT. Participants were scheduled for 18 visits for 6 weeks and received SMT or light massage control from a doctor of chiropractic. Societal costs in the year after study enrollment were estimated using patient reports of health care use and lost productivity. The main health outcomes were the number of pain-free days and disability-free days. Multiple regression was performed on outcomes and log-transformed cost data.

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