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Concurrent Bell’s Palsy and Facial Pain Improving with Multimodal Chiropractic Therapy: A Case Report and Literature Review

By |October 3, 2022|Bell's Palsy, Chiropractic Management|

Concurrent Bell’s Palsy and Facial Pain Improving with Multimodal Chiropractic Therapy: A Case Report and Literature Review

The Chiro.Org Blog


SOURCE:   Am J Case Rep 2022 (Sep 19); 23: e937511

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Eric Chun-Pu Chu, Robert J Trager, Alan Te-Chang Chen

New Chiropractic and Physiotherapy Centre,
EC Healthcare,
Kowloon, Hong Kong.



BACKGROUND   Bell’s palsy, also called facial nerve palsy, occasionally   co-occurs with trigeminal neuropathy, which presents as additional facial sensory symptoms and/or neck pain. Bell’s palsy has a proposed viral etiology, in particular when occurring after dental manipulation.

CASE REPORT   A 52-year-old Asian woman presented to a chiropractor with a 3-year history of constant neck pain and left-sided maxillary, eyebrow, and temporomandibular facial pain, paresis, and paresthesia, which began after using a toothpick, causing possible gum trauma. She had previously been treated with antiviral medication and prednisone, Chinese herbal medicine, and acupuncture, but her recovery plateaued at 60% after 1 year. The chiropractor ordered cervical spine magnetic resonance imaging, which demonstrated cervical spondylosis, with no evidence of myelopathy or major pathology. Treatment involved cervical and thoracic spinal manipulation, cervical traction, soft-tissue therapy, and neck exercises. The patient responded positively. At 1-month follow-up, face and neck pain and facial paresis were resolved aside from residual eyelid synkinesis. A literature review identified 12 additional cases in which chiropractic spinal manipulation with multimodal therapies was reported to improve Bell’s palsy. Including the current case, 85% of these patients also had pain in the face or neck.

CONCLUSIONS   This case illustrates improvement of Bell’s palsy and concurrent trigeminal neuropathy with multimodal chiropractic care including spinal manipulation. Limited evidence from other similar cases suggests a role of the trigeminal pathway in these positive treatment responses of Bell’s palsy with concurrent face/neck pain. These findings should be explored with research designs accounting for the natural history of Bell’s palsy.

Keywords:   Bell Palsy, Chiropractic, Manipulation, Spinal, Musculoskeletal Manipulations, Neck Pain, Trigeminal Nerve Diseases


From the Full-Text Article:

Background

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Low-value Care in Musculoskeletal Health Care: Is There a Way Forward?

By |September 20, 2022|Chiropractic Management, Musculoskeletal Pain|

Low-value Care in Musculoskeletal Health Care: Is There a Way Forward?

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SOURCE:   Pain Practice 2022 (Sep); 22 (Suppl 2): 65–70

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Jan Hartvigsen PhD, Steven J. Kamper PhD, Simon D. French PhD

Department of Sports Science and Clinical Biomechanics,
Center for Muscle and Joint Health,
University of Southern Denmark,
Odense M, Denmark.



Background:   Low-value care that wastes resources and harms patients is prevalent in health systems everywhere.

Methods:   As part of an invited keynote presentation at the Pain in Motion IV conference held in Maastricht, Holland, in May 2022, we reviewed evidence for low-value care in musculoskeletal conditions and discussed possible solutions.

Results:   Drivers of low-value care are diverse and affect patients, clinicians, and health systems everywhere. We show that low-value care for back pian, neck pain, and osteoarthritis is prevalent in all professional groups involved in caring for people who seek care for these conditions. Implementation efforts that aim to reverse low-value care seem to work better if designed using established conceptual and theoretical frameworks.

Conclusion:   Low-value care is prevalent in the care of people with musculoskeletal conditions. Reducing low-value care requires behaviour change among patients and clinicians as well as in health systems. There is evidence that behaviour change can be facilitated through good conceptual and theoretical frameworks but not convincing evidence that it changes patient outcomes.

Keywords:   back pain; clinical guidelines; evidence-based practice; low-value care; osteoarthritis.


From the Full-Text Article:

Low-Value Care Is Prevalent In Health Systems

Low-value care is defined as health services that confer little or no benefit to patients or where risk of harm exceeds probable benefit, according to best available evidence. [1] Low-value care is common across health systems globally and includes ineffective screening programs, unnecessary diagnostic testing and imaging, ineffective and harmful treatments, and inefficient organization of health systems. [2, 3] It is estimated that only around 60% of services are in line with best available evidence, 30% is waste, duplication, or low value, and 10% is harmful. [4] Low-value care is not a trivial issue; it adds cost and consumes resources, causes iatrogenic harm, and impedes delivery of high-value care that reliably provides health benefits for individuals and populations. [5]

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Chiropractic Management of Neck Pain Complicated by Symptomatic Vertebral Artery Stenosis and Dizziness

By |September 15, 2022|Chiropractic Management, Stroke and Chiropractic|

Chiropractic Management of Neck Pain Complicated by Symptomatic Vertebral Artery Stenosis and Dizziness

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SOURCE:   American Journal of Case Reports (Sep 14) 2022 [Epub]


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Eric Chun-Pu Chu, Robert J. Trager, Cliff Tao, Linda Yin-King Lee

New York Chiropractic and Physiotherapy Centre,
EC Healthcare,
Kowloon, Hong Kong



BACKGROUND   Vertebrobasilar insufficiency (VBI) is most often caused by vertebrobasilar atherosclerosis, often presenting with dizziness and occasionally neck pain. Little research or guidelines regarding management of neck pain in affected patients exists.

CASE REPORT   A 62–year-old male hypertensive smoker presented to a chiropractor with a 13–year history of insidious-onset neck pain, dizziness, and occipital headache with a Dizziness Handicap Inventory (DHI) of 52%. The patient had known VBI, caused by bilateral vertebral artery plaques, and cervical spondylosis, and was treated with multiple cardiovascular medications. The chiropractor referred patient to a neurosurgeon, who cleared him to receive manual therapies provided manual-thrust cervical spinal manipulative therapy (SMT) was not performed. The chiropractor administered thoracic SMT and cervicothoracic soft tissue manipulation. The neck pain and dizziness mostly resolved by 1 month. At 1–year follow-up, DHI was 0%; at 2 years it was 8%. A literature search revealed 4 cases in which a chiropractor used manual therapies for a patient with VBI. Including the present case, all patients had neck pain, 60% had dizziness, and all were treated with SMT either avoiding manual cervical manipulation altogether or modifying it to avoid or limit cervical rotation, yielding positive outcomes.

CONCLUSIONS   The present and previous cases provide limited evidence that some carefully considered chiropractic manual therapies can afford patients with VBI relief from concurrent neck pain and possibly dizziness. Given the paucity of research, cervical SMT cannot be recommended in such patients. These findings do not apply to vertebral artery dissection, for which SMT is an absolute contraindication.

KEYWORDS: &nbsp Chiropractic; Dizziness; Headache; Manipulation, Spinal; Neck Pain; Vertebral Artery


From the FULL TEXT Article:

Background

Vertebrobasilar insufficiency (VBI), also called posterior circulation insufficiency or vertebrobasilar transient ischemic attack, is defined as a transitory ischemia of the vertebrobasilar circulation [1–3] and is a risk factor for vertebrobasilar stroke. [4, 5]

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A Systematic Review of Chiropractic Care for Fall Prevention: Rationale, State of the Evidence, and Recommendations for Future Research

By |September 14, 2022|Balance, Chiropractic Management, Fall Prevention|

A Systematic Review of Chiropractic Care for Fall Prevention: Rationale, State of the Evidence, and Recommendations for Future Research

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SOURCE:   BMC Musculoskelet Disord 2022 (Sep 5); 23 (1): 844


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Weronika Grabowska, Wren Burton, Matthew H. Kowalski, Robert Vining, Cynthia R. Long, Anthony Lisi, Jeffrey M. Hausdorff, Brad Manor, Dennis Muñoz-Vergara & Peter M. Wayne

Brigham and Women’s Hospital and
Harvard Medical School Division of Preventive Medicine,
Osher Center for Integrative Medicine,
900 Commonwealth Avenue, 3rd Floor,
Boston, MA, 02215, USA.





Background:   Falls in older adults are a significant and growing public health concern. There are multiple risk factors associated with falls that may be addressed within the scope of chiropractic training and licensure. Few attempts have been made to summarize existing evidence on multimodal chiropractic care and fall risk mitigation. Therefore, the broad purpose of this review was to summarize this research to date.

Main text:   Systematic review was conducted following PRISMA guidelines. Databases searched included PubMed, Embase, Cochrane Library, PEDro, and Index of Chiropractic Literature. Eligible study designs included randomized controlled trials (RCT), prospective non-randomized controlled, observational, and cross-over studies in which multimodal chiropractic care was the primary intervention and changes in gait, balance and/or falls were outcomes. Risk of bias was also assessed using the 8-item Cochrane Collaboration Tool. The original search yielded 889 articles; 21 met final eligibility including 10 RCTs. One study directly measured the frequency of falls (underpowered secondary outcome) while most studies assessed short-term measurements of gait and balance. The overall methodological quality of identified studies and findings were mixed, limiting interpretation regarding the potential impact of chiropractic care on fall risk to qualitative synthesis.

Conclusion:   Little high-quality research has been published to inform how multimodal chiropractic care can best address and positively influence fall prevention. We propose strategies for building an evidence base to inform the role of multimodal chiropractic care in fall prevention and outline recommendations for future research to fill current evidence gaps.

Keywords:   Balance; Chiropractic; Chiropractic care; Fall prevention; Falls; Gait.

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VERTIGO and BALANCE Section

Associations Between Early Chiropractic Care and Physical Therapy on Subsequent Opioid Use Among Persons With Low Back Pain in Arkansas

By |July 5, 2022|Chiropractic Management, Nonpharmacologic Therapies|

Associations Between Early Chiropractic Care and Physical Therapy on Subsequent Opioid Use Among Persons With Low Back Pain in Arkansas

The Chiro.Org Blog


SOURCE:   J Chiropractic Medicine 2022 (Jun); 21 (2): 67–76
Mahip Acharya, BPharm, Dvyan Chopra, MS, Allen M. Smith, PharmD, Julie M. Fritz, PhD, PT, Bradley C. Martin, PharmD, PhD

Division of Pharmaceutical Evaluation and Policy,
University of Arkansas for Medical Sciences,
Little Rock, Arkansas.

Department of Physical Therapy and Athletic Training,
University of Utah,
Salt Lake City, Utah.



Editorial Comment:   These authors are to be praised for publishing this paper. When you look at their pedigrees, it’s reasonable to imagine that they may have been looking to see that physical therapy was associated with reduced opioid use. Numerous studies have shown that chiropractic already has a well-established track record for low- to no-opioid use, so they would be the perfect comparison group for a study like this. We all know that third parties are looking for safe and cost-effective alternatives to “usual care”.

In the past, a study favorable to chiropractic care, particularly one that used physical therapy as a comparison group, would never have been published, because of the long-standing medical bias against chiropractic care. So, let’s tip our hats to this group of researchers for their hard work and honesty!


Objective:   The objective of this study was to estimate the association between early use of physical therapy (PT) or chiropractic care and incident opioid use and long-term opioid use in individuals with a low back pain (LBP) diagnosis.

Methods:   A retrospective cohort study was conducted using data from Arkansas All Payers’ Claims Database. Adults with incident LBP diagnosed in primary care or emergency departments between July 1, 2013, and June 30, 2017, were identified. Participants were required to be opioid naïve in the 6-month baseline period and without cancer, cauda equina syndrome, osteomyelitis, lumbar fracture, and paraplegia/quadriplegia in the entire study period. PT and chiropractic treatment were documented over the ensuing 30 days starting on the date of LBP. Any opioid use and long-term opioid use (LTOU) in 1-year follow-up were assessed. Multivariable logistic regressions controlling for covariates were estimated.

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

By |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

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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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