Low Back Pain

Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients with Acute Low Back Pain:

By Frank M. Painter|January 28, 2015|Low Back Pain|

Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients with Acute Low Back Pain: Results of a Pragmatic Randomized Comparative Effectiveness Study

SOURCE: Spine (Phila Pa 1976). 2013 (Apr 15); 38 (8): 627–634

Goertz, Christine M. DC, PhD; Long, Cynthia R. PhD;
Hondras, Maria A. DC, MPH; Petri, Richard MD;
Delgado, Roxana MS; Lawrence, Dana J. DC, MMedEd, MA;
Owens, Edward F. MS, DC; Meeker, William C. DC, MPH

Palmer Center for Chiropractic Research,
Davenport, IA 52803, USA.
christine.goertz@palmer.edu

STUDY DESIGN: Randomized controlled trial.

OBJECTIVE: To assess changes in pain levels and physical functioning in response to standard medical care (SMC) versus SMC plus chiropractic manipulative therapy (CMT) for the treatment of low back pain (LBP) among 18 to 35-year-old active-duty military personnel.

SUMMARY OF BACKGROUND DATA: LBP is common, costly, and a significant cause of long-term sick leave and work loss. Many different interventions are available, but there exists no consensus on the best approach. One intervention often used is manipulative therapy. Current evidence from randomized controlled trials demonstrates that manipulative therapy may be as effective as other conservative treatments of LBP, but its appropriate role in the healthcare delivery system has not been established.

METHODS: Prospective, 2-arm randomized controlled trial pilot study comparing SMC plus CMT with only SMC. The primary outcome measures were changes in back-related pain on the numerical rating scale and physical functioning at 4 weeks on the Roland-Morris Disability Questionnaire and back pain functional scale (BPFS).

RESULTS: Mean Roland-Morris Disability Questionnaire scores decreased in both groups during the course of the study, but adjusted mean scores were significantly better in the SMC plus CMT group than in the SMC group at both week 2 (P < 0.001) and week 4 (P = 0.004). Mean numerical rating scale pain scores were also significantly better in the group that received CMT. Adjusted mean back pain functional scale scores were significantly higher (improved) in the SMC plus CMT group than in the SMC group at both week 2 (P < 0.001) and week 4 (P = 0.004).

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Occupational Low Back Pain in Primary and High School Teachers

By Frank M. Painter|November 29, 2014|Low Back Pain|

Occupational Low Back Pain in Primary and High School Teachers: Prevalence and Associated Factors

The Chiro.Org Blog

SOURCE: J Manip Physiol Ther. 2014 (Nov); 37 (9): 702–708

Mohammad A. Mohseni Bandpei, PhD, Fatemeh Ehsani, MSc,
Hamid Behtash, MD, Marziyeh Ghanipour, BSc

Professor, Iranian Research Centre on Aging,
Department of Physiotherapy,
University of Social Welfare and Rehabilitation Sciences,
Evin, Tehran, Iran.
Fatemehehsani59@yahoo.com

OBJECTIVE: The purposes of this study were to investigate the prevalence of and risk factors for low back pain (LBP) in teachers and to evaluate the association of individual and occupational characteristics with the prevalence of LBP.

METHODS: In this cross-sectional study, 586 asymptomatic teachers were randomly selected from 22 primary and high schools in Semnan city of Iran. Data on the personal, occupational characteristics, pain intensity, and functional disability as well as the prevalence and risk factors of LBP were collected using different questionnaires.

RESULTS: Point, last month, last 6 months, annual, and lifetime prevalence rates of LBP were 21.8%, 26.3%, 29.6%, 31.1%, and 36.5%, respectively. The highest prevalence was obtained for the high school teachers. The prevalence of LBP was significantly associated with age, body mass index, job satisfaction, and length of employment (P < .05 in all instances). Prolonged sitting and standing, working hours with computer, and correcting examination papers were the most aggravating factors, respectively. Rest and participation in physical activity were found to be the most relieving factors.

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Chiropractic Treatment Helps Back-Related Leg Pain

By Frank M. Painter|September 16, 2014|Chiropractic Care, Low Back Pain|

Chiropractic Treatment Helps Back-Related Leg Pain

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Spinal Manipulation and Home Exercise With Advice for Subacute and Chronic Back-Related Leg Pain: A Trial With Adaptive Allocation

SOURCE: Annals of Internal Medicine 2014 (Sep 16); 161 (6): 381—391

Gert Bronfort, DC, PhD; Maria A. Hondras, DC, MPH;
Craig A. Schulz, DC, MS; Roni L. Evans, DC, PhD;
Cynthia R. Long, PhD; and Richard Grimm, MD, PhD

University of Minnesota,
Northwestern Health Sciences University,
and Berman Center for Outcomes and Clinical Research
at the Minneapolis Medical Research Foundation,
Minneapolis, Minnesota, and
Palmer Center for Chiropractic Research,
Davenport, Iowa

Chiropractic Treatment Helps Back-Related Leg Pain
FROM: MedPage Today ~ September 16, 2014
By Shara Yurkiewicz , Staff Writer, MedPage Today

Patients with back-related leg pain who received spinal manipulative therapy (SMT) plus home exercise and advice (HEA) had less leg pain, lower back pain, and disability after 12 weeks than patients who received home exercise and advice alone, researchers reported.

At 1 year, those differences were no longer significant, wrote Gert Bronfort, DC, PhD, at Northwestern Health Sciences University in Bloomington, Minn., and colleagues in a study appearing in Annals of Internal Medicine. But patients experienced more global improvement, higher satisfaction, and lower medication use, the researchers reported.

The findings suggest that SMT in addition to HEA could be a safe and effective conservative, short-term treatment approach for back-related leg pain, the authors said.

“Prior to this study, SMT was considered a viable treatment option of what is known as ‘uncomplicated low back pain,’ which is low back pain without radiating pain to the leg,” authors Bronfort and Roni Evans, DC, PhD, at the University of Minnesota in Minneapolis, wrote in an email to MedPage Today.

“This study shows that for patients without progressive neurological deficits and serious identifiable causes (e.g., spinal fracture, etc.) SMT, coupled with home exercise and advice, may be helpful, and should be considered,” they added.

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What Happened To The ‘Bio’ In The Bio-psycho-social Model of Low Back Pain?

By Frank M. Painter|July 15, 2014|Chiropractic Research, Low Back Pain|

What Happened To The ‘Bio’ In The Bio-psycho-social Model of Low Back Pain?

The Chiro.Org Blog

SOURCE: Eur Spine J. 2011 (Dec); 20 (12): 2105-2110

Mark J. Hancock, Chris G. Maher, Mark Laslett, Elaine Hay, and Bart Koes

Faculty of Health Sciences,
University of Sydney,
PO Box 170,
Lidcombe 1825, NSW, Australia.
mark.hancock@sydney.edu.au

Purpose Over 20 years ago the term non-specific low back pain became popular to convey the limitations of our knowledge of the pathological source of most people’s low back pain. Knowledge of underlying pathology has advanced little since then, despite limited improvements in outcomes for patients with low back pain.

Methods This paper discusses potential misunderstandings related to diagnostic studies in the field of low back pain and argues that future diagnostic studies should include and investigate pathological sources of low back pain.

Results Six potential misunderstandings are discussed.

Until diagnosis is shown to improve outcomes it is not worth investigating;
without a gold standard it is not possible to investigate diagnosis of low back pain;
the presence of pathology in some people without low back pain means it is not important;
dismissal of the ability to diagnose low back pain in clinical guidelines is supported by the same level of evidence as recommendations for therapy;
suggesting use of a diagnostic test in research is misinterpreted as endorsing its use in current clinical practice;
we seem to have forgotten the ‘bio’ in biopsychosocial low back pain.

Conclusions We believe the misunderstandings presented in this paper partly explain the lack of investigation into pathology as an important component of the low back pain experience. A better understanding of the biological component of low back pain in relation, and in addition, to psychosocial factors is important for a more rational approach to management of low back pain.

Keywords: Low back pain, Diagnosis, Back pain

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From the FULL TEXT Article

Introduction

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Epidural Corticosteroids for Sciatica

By Frank M. Painter|June 10, 2014|Epidural Steroid Injections, Low Back Pain, Sciatica|

Epidural Corticosteroids for Sciatica

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

By Deborah Pate, DC, DACBR

Use of epidural steroid injections has increased dramatically in recent years, despite the fact that studies have failed to demonstrate evidence this procedure is clinically helpful (while other studies suggest it may actually be dangerous).

Considering that lack of evidence – not to mention the terrible 2012 outbreak of fungal meningitis / infections [see sidebar] caused by contaminated vials used for epidural corticosteroid injections – it is prudent at least to take a critical look at this procedure, particularly as it relates to conditions doctors of chiropractic treat.

Steroid Injections for Sciatica: Small, Short-Term Relief Only

In a recent meta-analysis of 23 randomized trials involving more than 2,000 patients in which epidural steroid injections were compared with placebo for sciatica, epidural steroid injections produced small, statistically insignificant short-term improvements in leg pain and disability (but not less back pain) compared to placebo. This improvement also was only over a short period of time – two weeks to three months. Beyond 12 months, there was no significant difference between groups. [1]

Side Effects Including Skeletal Deterioration, Fracture Risk

Besides infection, there are other side effects associated with epidural steroid injections: bleeding, nerve damage and dural puncture. Then there are side effects associated with the steroid medication, which include the following: a transient decrease in immunity, high blood sugar, stomach ulcers, avascular necrosis (mainly in the hip joint), cataracts and increased risk of fracture.

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Prevention of Low Back Pain: Effect, Cost-effectiveness, and Cost-utility of Maintenance Care – Study Protocol for a Randomized Clinical Trial

By Frank M. Painter|June 8, 2014|Cost-Effectiveness, Low Back Pain, Maintenance Care, Randomized Controlled Trial|

Prevention of Low Back Pain: Effect, Cost-effectiveness, and Cost-utility of Maintenance Care – Study Protocol for a Randomized Clinical Trial

The Chiro.Org Blog

SOURCE: Trials. 2014 (Apr 2); 15: 102

Andreas Eklund, Iben Axén, Alice Kongsted, Malin Lohela-Karlsson,
Charlotte Leboeuf-Yde, and Irene Jensen

Institute of Environmental Medicine,
Unit of Intervention and Implementation Research,
Karolinska Institutet, Nobels v13, S-171 77
Stockholm, Sweden. andreas.eklund@ki.se.

BACKGROUND: Low back pain (LBP) is a prevalent condition and a socioeconomic problem in many countries. Due to its recurrent nature, the prevention of further episodes (secondary prevention), seems logical. Furthermore, when the condition is persistent, the minimization of symptoms and prevention of deterioration (tertiary prevention), is equally important. Research has largely focused on treatment methods for symptomatic episodes, and little is known about preventive treatment strategies.

METHODS/DESIGN: This study protocol describes a randomized controlled clinical trial in a multicenter setting investigating the effect and cost-effectiveness of preventive manual care (chiropractic maintenance care) in a population of patients with recurrent or persistent LBP.Four hundred consecutive study subjects with recurrent or persistent LBP will be recruited from chiropractic clinics in Sweden. The primary outcome is the number of days with bothersome pain over 12 months. Secondary measures are self-rated health (EQ-5D), function (the Roland Morris Disability Questionnaire), psychological profile (the Multidimensional Pain Inventory), pain intensity (the Numeric Rating Scale), and work absence.The primary utility measure of the study is quality-adjusted life years and will be calculated using the EQ-5D questionnaire. Direct medical costs as well as indirect costs will be considered.

Subjects are randomly allocated into two treatment arms:

1) Symptom-guided treatment (patient controlled), receiving care when patients feel a need.

2) Preventive treatment (clinician controlled), receiving care on a regular basis.

Eligibility screening takes place in two phases: first, when assessing the primary inclusion/exclusion criteria, and then to only include fast responders, i.e., subjects who respond well to initial treatment. Data are collected at baseline and at follow-up as well as weekly, using SMS text messages.

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