Low Back Pain

Chiropractic Management of Pregnancy-Related Lumbopelvic Pain

By Frank M. Painter|August 7, 2016|Low Back Pain, Pregnancy|

Chiropractic Management of Pregnancy-Related Lumbopelvic Pain: A Case Study

SOURCE: J Chiropractic Medicine 2016 (Jun); 15 (2): 129–133

Maria Bernard, BSc, GradDipChiro, GradCertChiroPaediatrics,
Peter Tuchin, BSc, GredDipChiro, OHS, PhD

Private Practice,
Sydney, Australia.

Associate Professor,
Department of Chiropractic Faculty Science,
Macquarie University,
Sydney, NSW, Australia.

OBJECTIVE: The purpose of this case report is to describe chiropractic management of a patient with pregnancy-related lumbopelvic pain.

CLINICAL FEATURES: A pregnant 35-year-old woman experienced insidious moderate to severe pregnancy-related lumbopelvic pain and leg pain at 32 weeks’ gestation. Pain limited her endurance capacity for walking and sitting. Clinical testing revealed a left sacroiliac joint functional disturbance and myofascial trigger points reproducing back and leg pain.

INTERVENTION AND OUTCOME: A diagnosis of pregnancy-related low back pain and pregnancy-related pelvic girdle pain was made. The patient was treated with chiropractic spinal manipulation, soft tissue therapy, exercises, and ergonomic advice in 13 visits over 6 weeks. She consulted her obstetrician for her weekly obstetric visits. At the end of treatment, her low back pain reduced from 7 to 2 on a 0-10 numeric pain scale rating. Functional activities reported such as walking, sitting, and traveling comfortably in a car had improved.

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Aging Baby Boomers and the Rising Cost of Chronic Back Pain

By Frank M. Painter|June 1, 2016|Low Back Pain|

Aging Baby Boomers and the Rising Cost of Chronic Back Pain: Secular Trend Analysis of Longitudinal Medical Expenditures Panel Survey Data for Years 2000 to 2007

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2013 (Jan); 36 (1): 2–11

Monica Smith, DC, PhD, Matthew A. Davis, DC, MPH,
Miron Stano, PhD, James M. Whedon, DC, MS

Adjunct Faculty (Off-Site),
National University Health Sciences,
Lombard, IL, USA.

OBJECTIVES: The purposes of this study were to analyze data from the longitudinal Medical Expenditures Panel Survey (MEPS) to evaluate the impact of an aging population on secular trends in back pain and chronicity and to provide estimates of treatment costs for patients who used only ambulatory services.

METHODS: Using the MEPS 2-year longitudinal data for years 2000 to 2007, we analyzed data from all adult respondents. Of the total number of MEPS respondent records analyzed (N = 71,838), we identified 12,104 respondents with back pain and further categorized 3842 as chronic cases and 8262 as nonchronic cases.

RESULTS: Secular trends from the MEPS data indicate that the prevalence of back pain has increased by 29%, whereas chronic back pain increased by 64%. The average age among all adults with back pain increased from 45.9 to 48.2 years; the average age among adults with chronic back pain increased from 48.5 to 52.2 years. Inflation-adjusted (to 2010 dollars) biennial expenditures on ambulatory services for chronic back pain increased by 129% over the same period, from $15.6 billion in 2000 to 2001 to $35.7 billion in 2006 to 2007.

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Long-term Trajectories of Back Pain: Cohort Study With 7-year Follow-up

By Frank M. Painter|May 30, 2016|Low Back Pain|

Long-term Trajectories of Back Pain: Cohort Study With 7-year Follow-up

The Chiro.Org Blog

SOURCE: BMJ Open. 2013 (Dec 11); 3 (12): e003838

Kate M Dunn, Paul Campbell, and Kelvin P Jordan

Arthritis Research UK Primary Care Centre,
Institute of Primary Care and Health Sciences,
Keele University,
Newcastle, Staffordshire, UK.

OBJECTIVE: To describe long-term trajectories of back pain.

DESIGN: Monthly data collection for 6 months at 7-year follow-up of participants in a prospective cohort study.

SETTING: Primary care practices in Staffordshire, UK.

PARTICIPANTS: 228 people consulting their general practitioners with back pain, on whom information on 6-month back pain trajectories had been collected during 2001-2003, and who had valid consent and contact details in 2009-2010, were contacted. 155 participants (68% of those contacted) responded and provided sufficient data for primary analyses.

OUTCOME MEASURES: Trajectories based on patients’ self-reports of back pain were identified using longitudinal latent class analysis. Trajectories were characterised using information on disability, psychological status and presence of other symptoms.

RESULTS: Four clusters with different back pain trajectories at follow-up were identified:

(1) no or occasional pain
(2) persistent mild pain
(3) fluctuating pain and
(4) persistent severe pain.

Trajectory clusters differed significantly from each other in terms of disability, psychological status and other symptoms. Most participants remained in a similar trajectory as 7 years previously (weighted κ 0.54; 95% CI 0.42 to 0.65).

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Trajectories of Low Back Pain

By Frank M. Painter|May 26, 2016|Low Back Pain|

Trajectories of Low Back Pain

The Chiro.Org Blog

SOURCE: Best Pract Res Clin Rheumatol. 2013 (Oct); 27 (5): 601–612

Iben Axén, Charlotte Leboeuf-Yde

Unit of Intervention & Implementation Research,
Institute of Environmental Medicine,
Karolinska Institutet,
Nobels väg 13, S-171 77 Stockholm, Sweden

Low back pain is not a self-limiting problem, but rather a recurrent and sometimes persistent disorder. To understand the course over time, detailed investigation, preferably using repeated measurements over extended periods of time, is needed. New knowledge concerning short-term trajectories indicates that the low back pain ‘episode’ is short lived, at least in the primary care setting, with most patients improving. Nevertheless, in the long term, low back pain often runs a persistent course with around two-thirds of patients estimated to be in pain after 12 months. Some individuals never have low back pain, but most have it on and off or persistently. Thus, the low back pain ‘condition’ is usually a lifelong experience. However, subgroups of patients with different back pain trajectories have been identified and linked to clinical parameters. Further investigation is warranted to understand causality, treatment effect and prognostic factors and to study the possible association of trajectories with pathologies.

From the FULL TEXT Article:

Introduction

Until recently, low back pain (LBP) was believed to be a self-limiting condition, much like the common cold. The European guidelines for the management of acute LBP state that 90% of patients will recover within 6 weeks. [1]

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What Have We Learned From Ten Years of Trajectory Research in Low Back Pain?

By Frank M. Painter|May 25, 2016|Low Back Pain, Research|

What Have We Learned From Ten Years of Trajectory Research in Low Back Pain?

The Chiro.Org Blog

SOURCE: BMC Musculoskelet Disord. 2016 (May 21); 17 (1): 220

Alice Kongsted, Peter Kent, Iben Axen, Aron S. Downie, and Kate M. Dunn

The Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark.
a.kongsted@nikkb.dk

BACKGROUND: Non-specific low back pain (LBP) is often categorised as acute, subacute or chronic by focusing on the duration of the current episode. However, more than twenty years ago this concept was challenged by a recognition that LBP is often an episodic condition. This episodic nature also means that the course of LBP is not well described by an overall population mean. Therefore, studies have investigated if specific LBP trajectories could be identified which better reflect individuals’ course patterns. Following a pioneering study into LBP trajectories published by Dunn et al. in 2006, a number of subsequent studies have also identified LBP trajectories and it is timely to provide an overview of their findings and discuss how insights into these trajectories may be helpful for improving our understanding of LBP and its clinical management.

DISCUSSION: LBP trajectories in adults have been identified by data driven approaches in ten cohorts, and these have consistently demonstrated that different trajectory patterns exist. Despite some differences between studies, common trajectories have been identified across settings and countries, which have associations with a number of patient characteristics from different health domains. One study has demonstrated that in many people such trajectories are stable over several years. LBP trajectories seem to be recognisable by patients, and appealing to clinicians, and we discuss their potential usefulness as prognostic factors, effect moderators, and as a tool to support communication with patients.

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Variations in Patterns of Utilization and Charges for the Care of Low Back Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis

By Frank M. Painter|May 18, 2016|Cost-Effectiveness, Low Back Pain|

Variations in Patterns of Utilization and Charges for the Care of Low Back Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis

The Chiro.Org Blog

SOURCE: J Manip Physiol Ther. 2016 (May); 39 (4): 252–262

Eric L. Hurwitz, DC, PhD, Dongmei Li, PhD,
Jenni Guillen, MS, Michael J. Schneider, DC, PhD,
Joel M. Stevans, DC, Reed B. Phillips, DC, PhD,
Shawn P. Phelan, DC, Eugene A. Lewis, DC, MPH,
Richard C. Armstrong, MS, DC,
Maria Vassilaki, MD, MPH, PhD

Office of Public Health Studies,
University of Hawai`i at M?noa,
Honolulu, HI.

OBJECTIVES: The purpose of the study was to compare utilization and charges generated by medical doctors (MD), doctors of chiropractic (DC) and physical therapists (PT) by patterns of care for the treatment of low back pain in North Carolina.

METHODS: This was an analysis of low-back-pain-related closed claim data from the North Carolina State Health Plan for Teachers and State Employees from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the North Carolina State Health Plan using International Classification of Diseases, 9th Revision diagnostic codes for:

uncomplicated low back pain (ULBP) and
complicated low back pain (CLBP).

RESULTS: Care patterns with single-provider types and no referrals incurred the least charges on average for both ULBP and CLBP. When care did not include referral providers or services, for ULBP, MD and DC care was on average $465 less than MD and PT care. For CLBP, MD and DC care averaged $965 more than MD and PT care. However, when care involved referral providers or services, MD and DC care was on average $1600 less when compared to MD and PT care for ULBP and $1885 less for CLBP. Risk-adjusted charges (available 2006-2009) for patients in the middle quintile of risk were significantly less for DC care patterns.

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