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Multidisciplinary Integrative Care Versus Chiropractic Care for Low Back Pain: A Randomized Clinical Trial

By |March 9, 2022|Chiropractic Management, Low Back Pain|

Multidisciplinary Integrative Care Versus Chiropractic Care for Low Back Pain: A Randomized Clinical Trial

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2022 (Mar 1); 30: 10

Gert Bronfort, Michele Maiers, Craig Schulz, Brent Leininger, Kristine Westrom, Greg Angstman & Roni Evans

University of Minnesota,
Mayo Building C504,
420 Delaware Street SE,
Minneapolis, MN, 55455, USA.

Read the 2 previous papers associated with this study:

Maiers et. al.; BMC Health Serv Res. 2010 (Oct 29) and

Westrom et al.; Trials. 2010 (Mar 8)



Background:   Low back pain (LBP) is influenced by interrelated biological, psychological, and social factors, however current back pain management is largely dominated by one-size fits all unimodal treatments. Team based models with multiple provider types from complementary professional disciplines is one way of integrating therapies to address patients’ needs more comprehensively.

Methods:   This parallel group randomized clinical trial conducted from May 2007 to August 2010 aimed to evaluate the relative clinical effectiveness of 12 weeks of monodisciplinary chiropractic care (CC), versus multidisciplinary integrative care (IC), for adults with sub-acute and chronic LBP. The primary outcome was pain intensity and secondary outcomes were disability, improvement, medication use, quality of life, satisfaction, frequency of symptoms, missed work or reduced activities days, fear avoidance beliefs, self-efficacy, pain coping strategies and kinesiophobia measured at baseline and 4, 12, 26 and 52 weeks. Linear mixed models were used to analyze outcomes.

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LOW BACK PAIN Section

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Effects of Spinal Manipulative Therapy on Inflammatory Mediators in Patients with Non-specific Low Back Pain: A Non-randomized Controlled Clinical Trial

By |January 13, 2022|Low Back Pain|

Effects of Spinal Manipulative Therapy on Inflammatory Mediators in Patients with Non-specific Low Back Pain: A Non-randomized Controlled Clinical Trial

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2021 (Jan 8); 29 (1): 3

Julita A. Teodorczyk-Injeyan, John J. Triano, Robert Gringmuth, Christopher DeGraauw, Adrian Chow & H.

Graduate Education and Research Programs,
Canadian Memorial Chiropractic College,
Toronto, Ontario, Canada



Background:   The inflammatory profiles of patients with acute and chronic nonspecific low back pain (LBP) patients are distinct. Spinal manipulative therapy (SMT) has been shown to modulate the production of nociceptive chemokines differently in these patient cohorts. The present study further investigates the effect(s) of SMT on other inflammatory mediators in the same LBP patient cohorts.

Methods:   Acute (n = 22) and chronic (n = 25) LBP patients with minimum pain scores of 3 on a 10-point numeric scale, and asymptomatic controls (n = 24) were recruited according to stringent exclusion criteria. Blood samples were obtained at baseline and after 2 weeks during which patients received 6 SMTs in the lumbar or lumbosacral region. The in vitro production of tumor necrosis factor (TNFα), interleukin-1 β (IL-1β), IL-6, IL-2, interferon γ (IFNγ), IL-1 receptor antagonist (IL-1RA), TNF soluble receptor type 2 (sTNFR2) and IL-10 was determined by specific immunoassays. Parametric as well as non-parametric statistics (PAST 3.18 beta software) was used to determine significance of differences between and within study groups prior and post-SMT. Effect size (ES) estimates were obtained using Cohen’s d.

Results:   Compared with asymptomatic controls, SMT-related change scores were significant (P = 0.03–0.01) in reducing the production levels of TNFα in both patient cohorts and those of IL-6, IFNγ and sTNFR2 (P = 0.001–0.02) in patients with chronic LBP. Above-moderate to large ES (d > 0.6–1.4) was observed for these mediators. Compared with respective baselines, a significant post-SMT reduction (P = 0.01) of IL-6 production was detected only in patients with chronic LBP while a significant increase of IL-2 production (P = 0.001 vs. control, and P = 0.004 vs. chronic LBP group) and a large ES (d = 0.87) were observed in patients with acute LBP. Pain and disability scores declined significantly (P < 0.001) in all LBP patients, and were positively correlated (P = 0.03) with IFNγ and IL-2 levels in the acute LBP cohort.

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Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain

By |January 10, 2022|Chronic Neck Pain, Cost-Effectiveness of Chiropractic, Low Back Pain, Spinal Pain Management|

Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain

The Chiro.Org Blog


SOURCE:   Frontiers in Pain Ressearch 2021 (Oct 25); 2: 765921

Carlos Gevers-Montoro, Benjamin Provencher, Martin Descarreaux, Arantxa Ortega de Mues and Mathieu Piche

Department of Anatomy,
Université du Québec à Trois-Rivières,
Trois-Rivières, QC, Canada



Spine pain is a highly prevalent condition affecting over 11% of the world’s population. It is the single leading cause of activity limitation and ranks fourth in years lost to disability globally, representing a significant personal, social, and economic burden. For the vast majority of patients with back and neck pain, a specific pathology cannot be identified as the cause for their pain, which is then labeled as non-specific. In a growing proportion of these cases, pain persists beyond 3 months and is referred to as chronic primary back or neck pain. To decrease the global burden of spine pain, current data suggest that a conservative approach may be preferable. One of the conservative management options available is spinal manipulative

The aim of this narrative review is to highlight the most relevant and up-to-date evidence on the effectiveness (as it compares to other interventions in more pragmatic settings) and efficacy (as it compares to inactive controls under highly controlled conditions) of SMT for the management of neck pain and low back pain. Additionally, a perspective on the current recommendations on SMT for spine pain and the needs for future research will be

In summary, SMT may be as effective as other recommended therapies for the management of non-specific and chronic primary spine pain, including standard medical care or physical therapy. Currently, SMT is recommended in combination with exercise for neck pain as part of a multimodal approach. It may also be recommended as a frontline intervention for low back pain. Despite some remaining discrepancies, current clinical practice guidelines almost universally recommend the use of SMT for spine pain. Due to the low quality of evidence, the efficacy of SMT compared with a placebo or no treatment remains uncertain. Therefore, future research is needed to clarify the specific effects of SMT to further validate this intervention. In addition, factors that predict these effects remain to be determined to target patients who are more likely to obtain positive outcomes from SMT.

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LOW BACK PAIN Section and the:

CHRONIC NECK PAIN Section and the:

COST-EFFECTIVENESS Section and the:

SPINAL PAIN MANAGEMENT Section

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Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults

By |December 23, 2021|Cost-Effectiveness, Low Back Pain, Medicare|

Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther 2021 (Dec 5)

James M. Whedon, DC, MSm Anupama Kizhakkeveettil, PhD, Andrew Toler, MS, Todd A. MacKenzie, PhD, Jon D. Lurie, MD, MS, Serena Bezdjian, PhD, Scott Haldeman, DC, MD, PhD, Eric Hurwitz, DC, PhD, Ian Coulter, PhD

Health Services Research,
Southern California University of Health Sciences,
Whittier, California.


FROM:   The Facts on Medicare Spending (2019)


Objectives:   The purpose of this study was to compare Medicare healthcare expenditures for patients who received long-term treatment of chronic low back pain (cLBP) with either opioid analgesic therapy (OAT) or spinal manipulative therapy (SMT).

Methods:   We conducted a retrospective observational study using a cohort design for analysis of Medicare claims data. The study population included Medicare beneficiaries enrolled under Medicare Parts A, B, and D from 2012 through 2016. We assembled cohorts of patients who received long-term management of cLBP with OAT or SMT (such as delivered by chiropractic or osteopathic practitioners) and evaluated the comparative effect of OAT vs SMT upon expenditures, using multivariable regression to control for beneficiary characteristics and measures of health status, and propensity score weighting and binning to account for selection bias.

Results:   The study sample totaled 28,160 participants, of whom 77% initiated long-term care of cLBP with OAT, and 23% initiated care with SMT. For care of low back pain specifically, average long-term costs for patients who initiated care with OAT were 58% lower than those who initiated care with SMT. However, overall long-term healthcare expenditures under Medicare were 1.87 times higher for patients who initiated care via OAT compared with those initiated care with SMT (95% CI 1.65-2.11; P < .0001).

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Self-management at the Core of Back Pain Care:
10 Key Points for Clinicians

By |December 13, 2021|Biopsychosocial Model, Exercise and Chiropractic, Low Back Pain|

Self-management at the Core of Back Pain Care:
10 Key Points for Clinicians

The Chiro.Org Blog


SOURCE:   Braz J Phys Ther 2021 (Jul); 25 (4): 396–406

Alice Kongsted, Inge Ris, Per Kjaer, Jan Hartvigsen

Department of Sports Science and Clinical Biomechanics,
University of Southern Denmarkm
Odense M, Denmark;

Chiropractic Knowledge Hub,
Odense M, Denmark.



Background:   A paradigm shift away from clinician-led management of people with chronic disorders to people playing a key role in their own care has been advocated. At the same time, good health is recognised as the ability to adapt to changing life circumstances and to self-manage. Under this paradigm, successful management of persistent back pain is not mainly about clinicians diagnosing and curing patients, but rather about a partnership where clinicians help individuals live good lives despite back pain.

Objective:   In this paper, we discuss why there is a need for clinicians to engage in supporting self-management for people with persistent back pain and which actions clinicians can take to integrate self-management support in their care for people with back pain.

Discussion:   People with low back pain (LBP) self-manage their pain most of the time. Therefore, clinicians and health systems should empower them to do it well and provide knowledge and skills to make good decisions related to LBP and general health. Self-management does not mean that people are alone and without health care, rather it empowers people to know when to consult for diagnostic assessment, symptom relief, or advice. A shift in health care paradigm and clinicians’ roles is not only challenging for individual clinicians, it requires organisational support in clinical settings and health systems. Currently, there is no clear evidence showing how exactly LBP self-management is most effectively supported in clinical practice, but core elements have been identified that involve working with cognitions related to pain, behaviour change, and patient autonomy.

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The Profile of Older Adults Seeking Chiropractic Care: A Secondary Analysis

By |May 9, 2021|Low Back Pain, Medicare|

The Profile of Older Adults Seeking Chiropractic Care: A Secondary Analysis

The Chiro.Org Blog


SOURCE:   BMC Geriatrics 2021 (Apr 23);   21 (1):   271

   OPEN ACCESS   

Katie de Luca, Sheilah Hogg-Johnson, Martha Funabashi, Silvano Mior & Simon D. French

Department of Chiropractic,
Faculty of Medicine,
Health and Human Sciences,
Macquarie University,
Sydney, Australia.


Background:   Musculoskeletal conditions are the primary reason older adults seek general medical care, resulting in older adults as the highest consumers of health care services. While there is high use of chiropractic care by older adults, there is no recent, specific data on why older adults seek chiropractic care and how chiropractors manage conditions. Therefore, the purpose of this study was to describe the demographic characteristics of older adults seeking chiropractic care, and to report problems diagnosed by chiropractors and the treatment provided to older adults who seek chiropractic care.

Methods:   A secondary data analysis from two, large cross-sectional observational studies conducted in Australia (COAST) and Canada (O-COAST). Patient encounter and diagnoses were classified using the International Classification of Primary Care, 2nd edition (ICPC-2), using the Australian ICPC-2 PLUS general practice terminology and the ICPC-2 PLUS Chiro terminology. Descriptive statistics were used to summarize chiropractor, patient and encounter characteristics. Encounter and patient characteristics were compared between younger (< 65 years old) and older (≥65 years old) adults using ?2 tests or t-tests, accounting for the clustering of patients and encounters within chiropractors.

Results:   A total of 6,781 chiropractor-adult patient encounters were recorded. Of these, 1,067 encounters were for persons aged > 65 years (16%), from 897 unique older patients. The most common diagnosis within older adult encounters was a back problem (56%), followed by neck problems (10%). Soft tissue techniques were most frequently used for older patients (85 in every 100 encounters) and in 29 of every 100 encounters, chiropractors recommended exercise to older patients as a part of their treatment.

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MEDICARE Page

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