Chronic Low Back Pain

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

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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Care Outcomes for Chiropractic Outpatient Veterans (COCOV): A Single-arm, Pragmatic, Pilot Trial of Multimodal Chiropractic Care for U.S. Veterans with Chronic Low Back Pain

By Frank M. Painter|March 11, 2022|Chiropractic Management, Chronic Low Back Pain|

Care Outcomes for Chiropractic Outpatient Veterans (COCOV): A Single-arm, Pragmatic, Pilot Trial of Multimodal Chiropractic Care for U.S. Veterans with Chronic Low Back Pain

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SOURCE: Pilot and Feasibility Studies 2022 (Mar 7); 8 (1): 54

Cynthia R. Long, PhD, Stacie A. Salsbury, PhD, RN, Robert D. Vining, DC, Anthony J. Lisi, DC, et al.

Palmer Center for Chiropractic Research, Davenport,
Palmer College of Chiropractic,
741 Brady St, Davenport, IA, 52803

Background: Over 25% of veterans seeking care at U.S. Veterans Health Administration facilities have chronic low back pain (LBP), with high rates of mental health comorbidities. The primary objective of this study was to assess the feasibility of participant recruitment, retention, and electronic data collection to prepare for the subsequent randomized trial of multimodal chiropractic care for pain management of veterans with chronic low back pain. The secondary objectives were to estimate effect sizes and variability of the primary outcome and choose secondary outcomes for the full-scale trial.

Methods: This single-arm pilot trial enrolled 40 veterans with chronic LBP at one Veterans Health Administration facility for a 10–week course of pragmatic multimodal chiropractic care. Recruitment was by (1) provider referral, (2) invitational letter from the electronic health record pre-screening, and (3) standard direct recruitment. We administered patient-reported outcome assessments through an email link to REDCap, an electronic data capture platform, at baseline and 5 additional timepoints. Retention was tracked through adherence to the treatment plan and completion rates of outcome assessments. Descriptive statistics were calculated for baseline characteristics and outcome variables.

Results: We screened 91 veterans over 6 months to enroll our goal of 40 participants. Seventy percent were recruited through provider referrals. Mean age (range) was 53 (22–79) years and 23% were female; 95% had mental health comorbidities. The mean number of chiropractic visits was 4.5 (1–7). Participants adhered to their treatment plan, with exception of 3 who attended only their first visit. All participants completed assessments at the in-person baseline visit and 80% at the week 10 final endpoint. We had no issues administering assessments via REDCap. We observed clinically important improvements on the Roland-Morris Disability Questionnaire [mean change (SD): 3.6 (6.1)] and on PROMIS® pain interference [mean change (SD): 3.6 (5.6)], which will be our primary and key secondary outcome, respectively, for the full-scale trial.

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Prevalence and Characteristics of Chronic Spinal Pain Patients with Different Hopes (Treatment Goals) for Ongoing Chiropractic Care

By Frank M. Painter|January 14, 2022|Chronic Low Back Pain, Chronic Neck Pain, Spinal Pain Management|

Prevalence and Characteristics of Chronic Spinal Pain Patients with Different Hopes (Treatment Goals) for Ongoing Chiropractic Care

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SOURCE: J Alternative and Complementary Medicine 2019 (Oct 1); 25 (10): 1015–1025

Patricia M. Herman, ND, PhD, Sarah E. Edgington, MA, Gery W. Ryan, PhD, and Ian D. Coulter, PhD

RAND Corporation,
Santa Monica, CA.

Objectives: The treatment goals of patients successfully using ongoing provider-based care for chronic spinal pain

Design: Multinomial logistical hierarchical linear models were used to examine the characteristics of patients with

Settings/Location: Observational data from a large national sample of patients from 125 chiropractic clinics clustered in 6 U.S. regions.

Subjects: Patients with nonwork-injury-related nonspecific chronic low-back pain (CLBP) and chronic neck pain (CNP).

Interventions: All were receiving ongoing chiropractic care.

Outcome measures: Primary outcomes were patient endorsement of one of four goals for their treatment. Explanatory variables included pain characteristics, pain beliefs, goals for mobility/flexibility, demographics, and other psychological variables.

Results: Across our sample of 1614 patients (885 with CLBP and 729 with CNP) just under one-third endorsed a treatment goal of having their pain go away permanently (cure). The rest had goals of preventing their pain from coming back (22% CLBP, 16% CNP); preventing their pain from getting worse (14% CLBP, 12% CNP); or temporarily relieving their pain (31% CLBP, 41% CNP). In univariate analysis across these goals, patients differed significantly on almost all variables. In the multinomial logistic models, a goal of cure was associated with shorter pain duration and more belief in a medical cure; a goal of preventing pain from coming back was associated with lower pain levels; and those with goals of preventing their pain from getting worse or temporarily relieving pain were similar, including in having their pain longer.

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Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care

By Frank M. Painter|January 12, 2022|Chronic Low Back Pain|

Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care

The Chiro.Org Blog

SOURCE: JAMA Netw Open 2021 (Feb 1); 4 (2): e2037371

Joel M. Stevans, DC, PhD, Anthony Delitto, PT, PhD, Samannaaz S. Khoja, PT, PhD, Charity G. Patterson, PhD, Clair N. Smith, MS, Michael J. Schneider, DC, PhD, Janet K. Freburger, PT, PhD, et. al.

School of Health and Rehabilitation Sciences,
University of Pittsburgh,
Pittsburgh, Pennsylvania

Importance: Acute low back pain (LBP) is highly prevalent, with a presumed favorable prognosis; however, once chronic, LBP becomes a disabling and expensive condition. Acute to chronic LBP transition rates vary widely owing to absence of standardized operational definitions, and it is unknown whether a standardized prognostic tool (ie, Subgroups for Targeted Treatment Back tool [SBT]) can estimate this transition or whether early non-guideline concordant treatment is associated with the transition to chronic LBP.

Objective: To assess the associations between the transition from acute to chronic LBP with SBT risk strata; demographic, clinical, and practice characteristics; and guideline nonconcordant processes of care.

Design, setting, and participants: This inception cohort study was conducted alongside a multisite, pragmatic cluster randomized trial. Adult patients with acute LBP stratified by SBT risk were enrolled in 77 primary care practices in 4 regions across the United States between May 2016 and June 2018 and followed up for 6 months, with final follow-up completed by March 2019. Data analysis was conducted from January to March 2020.

Exposures: SBT risk strata and early LBP guideline nonconcordant processes of care (eg, receipt of opioids, imaging, and

Main outcomes and measures: Transition from acute to chronic LBP at 6 months using the National Institutes of Health Task Force on Research Standards consensus definition of chronic LBP. Patient demographic characteristics, clinical factors, and LBP process of care were obtained via electronic medical records.

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Revisiting Risk-stratified Whiplash-exposed Patients 12 to 14 Years After Injury

By Frank M. Painter|May 14, 2021|Chronic Low Back Pain, Chronic Neck Pain, Chronic Spinal Pain, Whiplash|

Revisiting Risk-stratified Whiplash-exposed Patients 12 to 14 Years After Injury

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SOURCE: Clinical Journal of Pain 2020 (Dec)

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Martin K Rasmussen 1 2, Alice Kongsted 3 4, Tina Carstensen 5 6, Troels S Jensen 1 6, Helge Kasch 6 7

1 Danish Pain Research Centre Aarhus University Hospital.

2 Center for Translational Neuromedicine, Copenhagen University, Copenhagen, Denmark.

3 Department of Sports Science and Clinical Biomechanics, University of Southern Denmark.

Objective: The objective of this study was to evaluate the long-term predictive value of the Danish Whiplash Group Risk Assessment Score (DWGRAS) with 7 risk strata.

Design: E-questionnaire-based follow-up study (n=927) combining 2 cohorts of whiplash-injured patients, 1 observational (n=187) and 1 interventional randomized controlled trial (n=740).

Methods: Nine hundred twenty-seven previously healthy persons exposed to acute whiplash injury during motor vehicle collision were sent letter by postal service asking the addressee if they would respond to an E-questionnaire. Outcome measures were: whiplash-related disability, pain, use of medication/nonmedical treatment, work capacity.

Results: The response rate was 37%. Fifty-five percent reported whiplash-related disability. Fourteen percent reported daily symptoms. A strong relationship was found between risk strata and impact of event and between risk strata and disabling symptoms.

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Predictors of Visit Frequency for Patients

By Frank M. Painter|May 20, 2020|Chronic Low Back Pain, Chronic Neck Pain|

Predictors of Visit Frequency for Patients Using Ongoing Chiropractic Care for Chronic Low Back and Chronic Neck Pain; Analysis of Observational Data

The Chiro.Org Blog

SOURCE: BMC Musculoskeletal Disorders 2020 (May 13); 21 (1): 298

Patricia M. Herman, PhD, Sarah E. Edgington, PhD, Eric L. Hurwitz, DC, PhD, & Ian D. Coulter, PhD

RAND Corporation,
Santa Monica, CA, USA.

Background: Chronic spinal pain is prevalent, expensive and long-lasting. Several provider-based nonpharmacologic therapies have now been recommended for chronic low-back pain (CLBP) and chronic neck pain (CNP). However, healthcare and coverage policies provide little guidance or evidence regarding the long-term use of this care. To provide one glimpse into the long-term use of nonpharmacologic provider-based care, this study examines the predictors of visit frequency in a large sample of patients with CLBP and CNP using ongoing chiropractic care.

Methods: Observational data were collected from a large national sample of chiropractic patients in the US with non-specific CLBP and CNP. Visit frequency was defined as average number of chiropractic visits per month over the 3-month study period. Potential baseline predictor variables were entered into two sets of multi-level models according to a defined causal theory-in this case, Anderson’s Behavioral Model of Health Services Use.

Results: Our sample included 852 patients with CLBP and 705 with CNP. Visit frequency varied significantly by chiropractor/clinic, so our models controlled for this clustering. Patients with either condition used an average of 2.3 visits per month. In the final models visit frequency increased (0.44 visits per month, p = .008)

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