Chronic Pain

Low Back Pain in Primary Care: A Description of 1250 Patients

By Frank M. Painter|October 17, 2015|Chiropractic Care, Chronic Pain, Low Back Pain|

Low Back Pain in Primary Care: A Description of 1250 Patients with Low Back Pain in Danish General and Chiropractic Practice

SOURCE: Int J Family Med. 2014 (Nov 4); 2014: 106102 ~ FULL TEXT

Lise Hestbaek, Anders Munck, Lisbeth Hartvigsen,
Dorte Ejg Jarbøl, Jens Søndergaard, and Alice Kongsted

Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
5230 Odense, Denmark
l.hestbaek@nikkb.dk

Study Design. Baseline description of a multicenter cohort study.

Objective. To describe patients with low back pain (LBP) in both chiropractic and general practice in Denmark.

Background. To optimize standards of care in the primary healthcare sector, detailed knowledge of the patient populations in different settings is needed. In Denmark, most LBP-patients access primary healthcare through chiropractic or general practice.

Methods. Chiropractors and general practitioners recruited adult patients seeking care for LBP. Extensive baseline questionnaires were obtained and descriptive analyses presented separately for general and chiropractic practice patients, Mann-Whitney rank sum test and Pearson’s chi-square test, were used to test for differences between the two populations.

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Prognostic Factors for Recurrences in Neck Pain Patients Up to 1 Year After Chiropractic Care

By Frank M. Painter|September 28, 2015|Chronic Pain, Neck Pain|

Prognostic Factors for Recurrences in Neck Pain Patients Up to 1 Year After Chiropractic Care

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2015 (Sep 15 ~ FULL TEXT

Anke Langenfeld, MS, B. Kim Humphreys, DC, PhD,
Jaap Swanenburg, PhD, Cynthia K. Peterson, RN, DC, MMedEd, PhD

PhD Student,
CAPHRI School of Public Health and Primary Care,
Department of Epidemiology,
Maastricht University,
Maastricht, The Netherlands

OBJECTIVE: Information about recurrence and prognostic factors is important for patients and practitioners to set realistic expectations about the chances of full recovery and to reduce patient anxiety and uncertainty. Therefore, the purpose of this study was to assess recurrence and prognostic factors for neck pain in a chiropractic patient population at 1 year from the start of the current episode.

METHODS: Within a prospective cohort study, 642 neck pain patients were recruited by chiropractors in Switzerland. After a course of chiropractic therapy, patients were followed up for 1 year regarding recurrence of neck pain. A logistic regression analysis was used to assess prognostic factors for recurrent neck pain. The independent variables age, pain medication usage, sex, work status, duration of complaint, previous episodes of neck pain and trauma onset, numerical rating scale, and Bournemouth questionnaire for neck pain were analyzed. Prognostic factors that have been identified in previous studies to influence recovery of neck pain are psychologic distress, poor general health at baseline, and a previous history of pain elsewhere.

RESULTS: Five hundred forty five patients (341 females), with a mean age of 42.1 years (SD, 13.1) completed the 1-year follow-up period. Fifty-four participants (11%) were identified as “recurrent.” Prognostic factors associated with recurrent neck pain were previous episodes of neck pain and increasing age.

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Spinal Manipulative Therapy and Exercise For Seniors with Chronic Neck Pain

By Frank M. Painter|March 6, 2015|Chiropractic Care, Chronic Pain, Neck Pain|

Spinal Manipulative Therapy and Exercise For Seniors with Chronic Neck Pain

The Chiro.Org Blog

SOURCE: Spine J. 2014 (Sep 1); 14 (9): 1879–1889

Michele Maiers, DC, MPH, Gert Bronfort, DC, PhD,
Roni Evans, DC, MS, Jan Hartvigsen, DC, PhD,
Kenneth Svendsen, MS, Yiscah Bracha, MS,
Craig Schulz, DC, MS, Karen Schulz, DC,
Richard Grimm, MD, PhD

Northwestern Health Sciences University,
Wolfe-Harris Center for Clinical Studies,
2501 W. 84th St, Bloomington, MN 55431, USA
mmaiers@nwhealth.edu

BACKGROUND CONTEXT: Neck pain, common among the elderly population, has considerable implications on health and quality of life. Evidence supports the use of spinal manipulative therapy (SMT) and exercise to treat neck pain; however, no studies to date have evaluated the effectiveness of these therapies specifically in seniors.

PURPOSE: To assess the relative effectiveness of SMT and supervised rehabilitative exercise, both in combination with and compared to home exercise (HE) alone for neck pain in individuals ages 65 years or older.

STUDY DESIGN/SETTING: Randomized clinical trial.

PATIENT SAMPLE: Individuals 65 years of age or older with a primary complaint of mechanical neck pain, rated =3 (0-10) for 12 weeks or longer in duration.

OUTCOME MEASURES: Patient self-report outcomes were collected at baseline and 4, 12, 26, and 52 weeks after randomization. The primary outcome was pain, measured by an 11-box numerical rating scale. Secondary outcomes included disability (Neck Disability Index), general health status (Medical Outcomes Study Short Form-36), satisfaction (7-point scale), improvement (9-point scale), and medication use (days per week).

METHODS: This study was funded by the US Department of Health and Human Services, Health Resources and Services Administration. Linear mixed model analyses were used for comparisons at individual time points and for short- and long-term analyses. Blinded evaluations of objective outcomes were performed at baseline and 12 weeks. Adverse event data were collected at each treatment visit.

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A Randomised Controlled Trial of Preventive Spinal Manipulation with and without a Home Exercise Program for Patients with Chronic Neck Pain

By Frank M. Painter|December 25, 2013|Chiropractic Care, Chronic Pain, Evidence-based Medicine|

A Randomised Controlled Trial of Preventive Spinal Manipulation with and without a Home Exercise Program for Patients with Chronic Neck Pain

The Chiro.Org Blog

SOURCE: BMC Musculoskelet Disord. 2011 (Feb 8); 12: 41

Johanne Martel, Claude Dugas, Jean-Daniel Dubois, and Martin Descarreaux

Département de Chiropratique,
Université du Québec à Trois-Rivières,
Trois-Rivières G9A 5H7, Canada.

Background: Evidence indicates that supervised home exercises, combined or not with manual therapy, can be beneficial for patients with non-specific chronic neck pain (NCNP). The objective of the study is to investigate the efficacy of preventive spinal manipulative therapy (SMT) compared to a no treatment group in NCNP patients. Another objective is to assess the efficacy of SMT with and without a home exercise program.

Methods: Ninety-eight patients underwent a short symptomatic phase of treatment before being randomly allocated to either an attention-group (n = 29), a SMT group (n = 36) or a SMT + exercise group (n = 33). The preventive phase of treatment, which lasted for 10 months, consisted of meeting with a chiropractor every two months to evaluate and discuss symptoms (attention-control group), 1 monthly SMT session (SMT group) or 1 monthly SMT session combined with a home exercise program (SMT + exercise group). The primary and secondary outcome measures were represented by scores on a 10-cm visual analog scale (VAS), active cervical ranges of motion (cROM), the neck disability index (NDI) and the Bournemouth questionnaire (BQ). Exploratory outcome measures were scored on the Fear-avoidance Behaviour Questionnaire (FABQ) and the SF-12 Questionnaire.

Results: Our results show that, in the preventive phase of the trial, all 3 groups showed primary and secondary outcomes scores similar to those obtain following the non-randomised, symptomatic phase. No group difference was observed for the primary, secondary and exploratory variables. Significant improvements in FABQ scores were noted in all groups during the preventive phase of the trial. However, no significant change in health related quality of life (HRQL) was associated with the preventive phase.

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Central Hypersensitivity In Chronic Pain After Whiplash Injury

By Frank M. Painter|December 1, 2013|Chronic Pain, Whiplash|

Central Hypersensitivity In Chronic Pain After Whiplash Injury

The Chiro.Org Blog

SOURCE: Clin J Pain. 2001 (Dec); 17 (4): 306–315

Curatolo M, Petersen-Felix S, Arendt-Nielsen L,
Giani C, Zbinden AM, Radanov BP.

Department of Anesthesiology,
University Hospital of Bern,
Inselspital, Switzerland

OBJECTIVE: The mechanisms underlying chronic pain after whiplash injury are usually unclear. Injuries may cause sensitization of spinal cord neurons in animals (central hypersensitivity), which results in increased responsiveness to peripheral stimuli. In humans, the responsiveness of the central nervous system to peripheral stimulation may be explored by applying sensory tests to healthy tissues. The hypotheses of this study were:

(1) chronic whiplash pain is associated with central hypersensitivity;

(2) central hypersensitivity is maintained by nociception arising from the painful or tender muscles in the neck.

DESIGN: Comparison of patients with healthy controls.

SETTING: Pain clinic and laboratory for pain research, university hospital.

PATIENTS: Fourteen patients with chronic neck pain after whiplash injury (car accident) and 14 healthy volunteers.

OUTCOME MEASURES: Pain thresholds to: single electrical stimulus (intramuscular), repeated electrical stimulation (intramuscular and transcutaneous), and heat (transcutaneous). Each threshold was measured at neck and lower limb, before and after local anesthesia of the painful and tender muscles of the neck.

RESULTS: The whiplash group had significantly lower pain thresholds for all tests. except heat, at both neck and lower limb. Local anesthesia of the painful and tender points affected neither intensity of neck pain nor pain thresholds.

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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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