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Association Between Chiropractic Spinal Manipulation for Sciatica and Opioid-related Adverse Events: A Retrospective Cohort Study

By |January 31, 2025|Adverse Drug Reactions, Adverse Events, Chiropractic Management, Low Back Pain, Opioid Epidemic, Sciatica|

Association Between Chiropractic Spinal Manipulation for Sciatica and Opioid-related Adverse Events: A Retrospective Cohort Study

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SOURCE:   PLoS One 2025 (Jan 28); 20 (1): e0317663

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Robert J. Trager • Zachary A. Cupler • Roshini Srinivasan • Elleson G. Harper • Jaime A. Perez

Connor Whole Health,
University Hospitals Cleveland Medical Center,
Cleveland, Ohio, United States of America.

Background:   Patients receiving chiropractic spinal manipulation (CSM) for spinal pain are less likely to be prescribed opioids, and some evidence suggests that these patients have a lower risk of any type of adverse drug event. We hypothesize that adults receiving CSM for sciatica will have a reduced risk of opioid-related adverse drug events (ORADEs) over a one-year follow-up compared to matched controls not receiving CSM.

Methods:   We searched a United States (US) claims-based data resource (Diamond Network, TriNetX, Inc.) of more than 216 million patients, yielding data ranging from 2009 to 2024. We included patients aged ?18 years with sciatica, excluding those post-spine surgery, prior anesthesia, serious pathology, high risk of ORADEs, and an ORADE ? 1-year prior. Patients were divided into two cohorts: (1) CSM and (2) usual medical care. We used propensity score matching to control for confounding variables associated with ORADEs. Comparative outcomes were analyzed by calculating risk ratios (RRs) and 95% confidence intervals (CIs) for the incidence of ORADEs and oral opioid prescription between cohorts.

Results:   372,471 patients per cohort remained after matching. The incidence of ORADEs over 1-year follow-up was less in the CSM cohort compared to the usual medical care cohort (CSM: 0.09%; usual medical care: 0.30%), yielding an RR of 0.29 (95% CI: 0.25-0.32; P < .00001). CSM patients had a lower risk of receiving an oral opioid prescription (RR of 0.68 [95% CI: 0.68-0.69; P < .00001]).

Conclusions:   This study found that adults with sciatica who initially received CSM had a lower risk of an ORADE compared to matched controls not initially receiving CSM, likely explained by a lower probability of opioid prescription. These findings corroborate existing practice guidelines which recommend adding CSM to the management of sciatica when appropriately indicated.

From the FULL TEXT Article:

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Clinician Experiences in Providing Reassurance for Patients with Low Back Pain in Primary Care: a Qualitative Study

By |December 24, 2024|Low Back Pain|

Clinician Experiences in Providing Reassurance for Patients with Low Back Pain in Primary Care: a Qualitative Study

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SOURCE:   J Physiotherapy 2024 (Dec 12): [EPUB]

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Anika Young • Simon D French • Adrian C Traeger< Julie Ayre • Mark Hancock • Hazel J Jenkins
Department of Chiropractic,
Faculty of Medicine, Health and Health Science,
Macquarie University,
Sydney, Australia.

Questions:   What reassurance is being delivered by physiotherapists and chiropractors to people with non-specific low back pain? How is it being delivered? What are the barriers and enablers to delivering reassurance to people with non-specific low back pain?

Design:   A qualitative study.

Participants:   Thirty-two musculoskeletal clinicians (16 physiotherapists and 16 chiropractors) who manage low back pain in primary care.

Method:   Semi-structured interviews were conducted about their experiences delivering reassurance. The interview schedule was developed using the Theoretical Domains Framework and analysed using framework thematic analysis.

Results:   Four themes were identified: giving reassurance is a core clinical skill for delivering high-quality care; it takes practice and experience to confidently deliver reassurance; despite feeling capable and motivated, clinicians identified situations that challenge the delivery of reassurance; and reassurance needs to be contextualised to the individual.

Conclusion:   Clinicians possess a strong understanding of reassurance but require clinical experience to confidently deliver it. This study provides insights into how reassurance is individualised in clinical practice, including suggestions for clinicians about how to implement reassurance effectively for people with low back pain.

Keywords:   Low back pain; Primary healthcare; Qualitative research; Reassurance.

From the FULL TEXT Article:

Introduction

Low back pain (LBP) is common and is associated with substantial disability. Worldwide, 619 million people experienced back pain in 2020, [1] and there are significant personal and societal costs related to LBP. [2, 3] In Australia, back pain continues to be the second leading cause of disability [4] and back pain management cost AU$3.36 billion in 2020. [4] The prevalence of LBP has been projected to increase over the next 25 years, with associated increases in disability with healthcare costs. [1] Most LBP is non-specific low back pain (NSLBP), referring to LBP that does not have a known pathoanatomical cause. [5] LBP is a complex condition that is multifactorial in nature, where a person’s pain experience is influenced by biological, psychological and social factors. [6] Recovery from an episode of LBP is also complex; approximately 25% of people with LBP experience recurrence within 12 months [7] and 44% of people can still experience pain at 12 months. [8]

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New WHO Guideline on Chronic LBP: Global Impact

By |November 7, 2024|Guidelines, Low Back Pain|

New WHO Guideline on Chronic LBP: Global Impact
World Health Organization Guideline:
Yes to Chiropractic; No to Most Drugs

The Chiro.Org Blog

SOURCE:   Dynamic Chiropractic ~ February 2024

WHAT YOU NEED TO KNOW

  • “Spinal manipulative therapy” which includes chiropractic, is among the interventions the guideline recommends for all adults, including older adults.

  • The chiropractic profession was represented by several noted DCs in all aspects of development and review.

  • Within the short list of recommended interventions, most DCs provide at least three. Thus, it is not hard to conclude that doctors of chiropractic should be the first choice for chronic low-back pain management.

On Dec. 7, 2023, the World Health Organization (WHO) released its “Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings.” [1] The purpose of the 244-page document is to “provide evidence-based recommendations on nonsurgical interventions for chronic primary LBP in adults” that will improve outcomes. “Spinal manipulative therapy” which includes chiropractic, is among the interventions the guideline recommends for all adults, including older adults.

The guideline reviews both the benefits and the harms of nonsurgical interventions in the management of chronic primary LBP. In addition to spinal manipulative therapy, the guideline is also in favor of structured exercise, acupuncture, massage, NSAIDs and topical cayenne pepper (Capsicum frutescens).

NSAIDs continue to be the only recommended pharmacotherapy. Among the medication interventions the guideline recommends against are opioids, antidepressants (tricyclic, serotonin and noradrenaline reuptake inhibitor), skeletal muscle relaxants, injectable local anaesthetics and pharmacological weight-loss medications.

Acetaminophen, benzodiazepines and cannabis-related pharmaceutical preparations received “no recommendation,” while listing potential harmful effects including “cardiovascular, renal and gastrointestinal harms and increased mortality risk” for acetaminophen; “potential harms including memory impairment, misuse, overdose deaths from respiratory depression, somnolence, fatigue and light-headedness potentially leading to falls” for benzodiazepines; and “evidence of possible adverse events, including harms associated with its nonmedicinal use” for cannabis-related pharmaceutical preparations.

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Development, Validation and Use of Custom Software for the Analysis of Pain Trajectories

By |August 18, 2024|Low Back Pain, Trajectories of Back Pain|

Development, Validation and Use of Custom Software for the Analysis of Pain Trajectories

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SOURCE:   Sci Rep 2024 (Aug 12); 14 (1): 18719

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M. R. van Ittersum • A. de Zoete • M. Rubinstein • Al-Madfai
A. Kongsted • P. McCarthy

Chiropractie Groesbeek,
Nijmeegsebaan 32, 6561 KG,
Groesbeek, The Netherlands.

In chronic musculoskeletal conditions, the prognosis tends to be more informative than the diagnosis for the future course of the disease. Many studies have identified clusters of patients who seemingly share similar pain trajectories. In a dataset of low back pain (LBP) patients, pain trajectories have been identified, and distinct trajectory types have been defined, making it possible to create pattern recognition software that can classify patients into respective pain trajectories reflecting their condition. It has been suggested that the classification of pain trajectories may create clinically meaningful subgroups of patients in an otherwise heterogeneous population of patients with LBP. A software tool was created that combined the ability to recognise the pain trajectory of patients with a system that could create subgroups of patients based on their characteristics. This tool is primarily meant for researchers to analyse trends in large heterogeneous datasets without large losses of data. Prospective analysis of pain trajectories is not directly helpful for clinicians. However, the tool might aid in the identification of patient characteristics which have predictive capabilities of the most likely trajectory a patient might experience in the future. This will help clinicians to tailor their advice and treatment for a specific patient.

Subject terms:   Data mining, Chronic pain, Prognosis

From the FULL TEXT Article:

Introduction

In chronic musculoskeletal diseases, diagnosis alone is often insufficient to inform patients and clinicians about the future course of the disease. [1] Most chronic musculoskeletal diseases, such as low back pain (LBP), are caused by a complex combination of biological, psychological, social, and genetic factors that influence the course of the disease. [2] It is therefore argued that prognosis, which considers all of these elements, might be a better framework to inform patients and clinicians about the likely course of the disease. [1]

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MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis

By |June 26, 2024|Low Back Pain, Radiology|

MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis

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SOURCE:   AJNR Am J Neuroradiol 2015 (Dec)

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W. Brinjikji • F.E. Diehn • Jarvik
C.M. Carr • Murad • P.H. Luetmera

Department of Neurological Surgery and Health Services,
Comparative Effectiveness Cost and Outcomes Research Center (J.G.J.)
Department of Radiology (J.G.J.),
University of Washington,
Seattle, Washington.

Background and purpose:   Imaging features of spine degeneration are common in symptomatic and asymptomatic individuals. We compared the prevalence of MR imaging features of lumbar spine degeneration in adults 50 years of age and younger with and without self-reported low back pain.

Materials and methods:   We performed a meta-analysis of studies reporting the prevalence of degenerative lumbar spine MR imaging findings in asymptomatic and symptomatic adults 50 years of age or younger. Symptomatic individuals had axial low back pain with or without radicular symptoms. Two reviewers evaluated each article for the following outcomes: disc bulge, disc degeneration, disc extrusion, disc protrusion, annular fissures, Modic 1 changes, any Modic changes, central canal stenosis, spondylolisthesis, and spondylolysis. The meta-analysis was performed by using a random-effects model.

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Association Between Chiropractic Spinal Manipulation and Cauda Equina Syndrome in Adults With Low Back Pain: Retrospective Cohort Study of US Academic Health Centers

By |March 17, 2024|Cauda Equina Syndrome, Low Back Pain|

Association Between Chiropractic Spinal Manipulation and Cauda Equina Syndrome in Adults With Low Back Pain: Retrospective Cohort Study of US Academic Health Centers

The Chiro.Org Blog

SOURCE:   PLoS One 2024 (Mar 11); 19 (3): e0299159
Robert J. Trager • Anthony N. Baumann • Jaime A. Perez
Jeffery A. Dusek • Romeo-Paolo T. Perfecto • Christine M. Goertz

Connor Whole Health,
University Hospitals Cleveland Medical Center,
Cleveland, Ohio, United States of America.

Background:   Cauda equina syndrome (CES) is a lumbosacral surgical emergency that has been associated with chiropractic spinal manipulation (CSM) in case reports. However, identifying if there is a potential causal effect is complicated by the heightened incidence of CES among those with low back pain (LBP). The study hypothesis was that there would be no increase in the risk of CES in adults with LBP following CSM compared to a propensity-matched cohort following physical therapy (PT) evaluation without spinal manipulation over a three-month follow-up period.

Methods:   A query of a United States network (TriNetX, Inc.) was conducted, searching health records of more than 107 million patients attending academic health centers, yielding data ranging from 20 years prior to the search date (July 30, 2023). Patients aged 18 or older with LBP were included, excluding those with pre-existing CES, incontinence, or serious pathology that may cause CES.
Patients were divided into two cohorts:

(1)   LBP patients receiving CSM or
(2)   LBP patients receiving PT evaluation without spinal manipulation.

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