Low Back Pain

Inappropriate Use of Skeletal Muscle Relaxants in Geriatric Patients

By Frank M. Painter|January 20, 2020|Low Back Pain, Muscle Relaxants|

Inappropriate Use of Skeletal Muscle Relaxants in Geriatric Patients

SOURCE: U. S. Pharmacist 2020 (Jan 21); 45 (1): 25–29

Caressa Trueman, PharmD, RPh, Shana Castillo, PharmD, RPh
Karen K. O’Brien, BS Pharm, PharmD, RPh, Eric Hoie, PharmD, RPh

Creighton University School of Pharmacy and Health Professions
Omaha, Nebraska

Falls in geriatric patients cost the United States billions of dollars each year and contribute to morbidity and mortality in this population. Polypharmacy can significantly contribute to the fall risk, especially those medications that are on the Beers Criteria list. Skeletal muscle relaxants are on this list, and an increased risk of falls is associated with their use. These medications are inappropriately used as an alternative to conventional pain medications and can be as harmful as opioids in the geriatric population. Education of patients and prescribers is necessary in order to prevent inappropriate muscle-relaxant use and to lessen the risk of falls.

In the United States, an estimated 29 million falls occurred in 46 million people older than age 65 years in 2014, and 7 million of those falls resulted in injuries. [1] In 2015, estimated medical costs related to fatal and nonfatal falls totaled more than $49 billion. [2]

There are more articles like this @ our:

LOW BACK PAIN Page and the:

IATROGENIC INJURY Page

(more…)

0

The Effect of Spinal Manipulation on Brain Neurometabolites

By Frank M. Painter|December 3, 2019|Low Back Pain, Neurology|

The Effect of Spinal Manipulation on Brain Neurometabolites in Chronic Nonspecific Low Back Pain Patients: A Randomized Clinical Trial

The Chiro.Org Blog

SOURCE: Irish Journal of Medical Science 2019 (Nov 26) [Epub]

Daryoush Didehdar, Fahimeh Kamali, Amin Kordi Yoosefinejad, Mehrzad Lotfi

Department of Physical Therapy,
School of Rehabilitation Sciences,
Shiraz University of Medical Sciences,
Shiraz, Iran.

BACKGROUND: In patients with chronic nonspecific low back pain (NCLBP), brain function changes due to the neuroplastic changes in different regions.

AIM: The current study aimed to evaluate the brain metabolite changes after spinal manipulation, using proton magnetic resonance spectroscopy (1H-MRS).

METHODS: In the current study, 25 patients with NCLBP aged 20-50 years were enrolled. Patients were randomly assigned to lumbopelvic manipulation or sham. Patients were evaluated before and 5 weeks after treatment by the Numerical Rating Scale (NRS), the Oswestry Disability Index (ODI), and 1H-MRS.

RESULTS: After treatment, severity of pain and functional disability were significantly reduced in the treatment group vs. sham group (p < 0.05). After treatment, N-acetyl aspartate (NAA) in thalamus, insula, dorsolateral prefrontal cortex (DLPFC) regions, as well as choline (Cho) in the thalamus, insula, and somatosensory cortex (SSC) regions, had increased significantly in the treatment group compared with the sham group (p < 0.05). A significant increase was further observed in NAA in thalamus, anterior cingulate cortex (ACC), and SCC regions along with Cho metabolite in thalamus and SCC regions after treatment in the treatment group compared with the baseline measures (p < 0.05).

There are more articles like this @ our:

LOW BACK Section

(more…)

0

Nonpharmacological Treatment of Army Service Members

By Frank M. Painter|November 12, 2019|Low Back Pain, Veterans|

Nonpharmacological Treatment of Army Service Members with Chronic Pain Is Associated with Fewer Adverse Outcomes After Transition to the Veterans Health Administration

The Chiro.Org Blog

SOURCE: J Gen Intern Med. 2019 (Oct 28) [Epub]

Esther L. Meerwijk, PhD, MSN , Mary Jo Larson, PhD, MPA, Eric M. Schmidt, PhD, Rachel Sayko Adams, PhD, MPH, Mark R. Bauer, MD, Grant A. Ritter, PhD, Chester Buckenmaier III, MD, and Alex H. S. Harris, PhD, MS

VA Health Services Research & Development,
Center for Innovation to Implementation (Ci2i),
VA Palo Alto Health Care System,
Menlo Park, CA, USA.

BACKGROUND: Potential protective effects of nonpharmacological treatments (NPT) against long-term pain-related adverse outcomes have not been examined.

OBJECTIVE: To compare active duty U.S. Army service members with chronic pain who did/did not receive NPT in the Military Health System (MHS) and describe the association between receiving NPT and adverse outcomes after transitioning to the Veterans Health Administration (VHA).

DESIGN AND PARTICIPANTS: A longitudinal cohort study of active duty Army service members whose MHS healthcare records indicated presence of chronic pain after an index deployment to Iraq or Afghanistan in the years 2008-2014 (N = 142,539). Propensity score-weighted multivariable Cox proportional hazard models tested for differences in adverse outcomes between the NPT group and No-NPT group.

EXPOSURES: NPT received in the MHS included acupuncture/dry needling, biofeedback, chiropractic care, massage, exercise therapy, cold laser therapy, osteopathic spinal manipulation, transcutaneous electrical nerve stimulation and other electrical manipulation, ultrasonography, superficial heat treatment, traction, and lumbar supports.

There are more articles like this @ our:

Low Back Pain Page

(more…)

0

Awareness of Axial Spondyloarthritis Among Chiropractors

By Frank M. Painter|October 20, 2019|Low Back Pain|

Awareness of Axial Spondyloarthritis Among Chiropractors and Osteopaths: Findings From a UK Web-based Survey

The Chiro.Org Blog

SOURCE: Rheumatol Adv Pract. 2019 (Sep 30)

Cee Y Yong, Jill Hamilton, Jatinder Benepal, Katie Griffiths, Zoë E Clark, Amanda Rush, Raj Sengupta, Jane Martindale, and Karl Gaffney

Department of Rheumatology,
North West Anglia NHS Foundation Trust,
Huntingdon.

OBJECTIVE: Chiropractors and osteopaths are important professional partners in the management of axial spondyloarthritis (axSpA). In view of recent advances in diagnosis and treatment, we sought to understand their current knowledge and working practices.

METHODS: A Web-based survey was advertised to chiropractors and osteopaths via the Royal College of Chiropractors and the Institute of Osteopathy.

RESULTS: Of 382 completed responses [237 chiropractors (62%) and 145 osteopaths (38%)], all were familiar with AS, but only 63 and 25% were familiar with the terms axSpA and non-radiographic axSpA, respectively. Seventy-seven per cent were confident with inflammatory back pain. Respondents routinely asked about IBD (91%), psoriasis (81%), acute anterior uveitis (49%), peripheral arthritis (71%), genitourinary/gut infection (56%), enthesitis (30%) and dactylitis (20%). Eighty-seven per cent were aware of the association between axSpA and HLA-B27. Only 29% recognized that axSpA was common in women. Forty per cent recommend an X-ray (pelvic in 80%) and, if normal, 27% would recommend MRI of the sacroiliac joints and whole spine. Forty-four per cent were aware of biologic therapies. Forty-three per cent were confident with the process of onward referral to rheumatology via the general practitioner (GP). The principal perceived barrier to onward referral was reluctance by the GP to accept their professional opinion.

There are more articles like this @ our:

Low Back Pain Page

(more…)

0

Observational Retrospective Study of the Association

By Frank M. Painter|September 26, 2019|Low Back Pain, Opioid Epidemic|

Observational Retrospective Study of the Association of Initial Healthcare Provider for New-onset Low Back Pain with Early and Long-term Opioid Use

The Chiro.Org Blog

SOURCE: BMJ Open. 2019 (Sep 20); 9 (9): e028633

Lewis E Kazis, Omid Ameli, James Rothendler, Brigid Garrity, Howard Cabral, Christine McDonough, et. al.

Department of Health Law,
Policy and Management,
Boston University School of Public Health,
Boston, Massachusetts, USA

OBJECTIVE: This study examined the association of initial provider treatment with early and long-term opioid use in a national sample of patients with new-onset low back pain (LBP).

DESIGN: A retrospective cohort study of patients with new-onset LBP from 2008 to 2013.

SETTING: The study evaluated outpatient and inpatient claims from patient visits, pharmacy claims and inpatient and outpatient procedures with initial providers seen for new-onset LBP.

PARTICIPANTS: 216,504 individuals aged 18 years or older across the USA who were diagnosed with new-onset LBP and were opioid-naïve were included. Participants had commercial or Medicare Advantage insurance.

EXPOSURES: The primary independent variable is type of initial healthcare provider including physicians and conservative therapists (physical therapists, chiropractors, acupuncturists).

MAIN OUTCOME MEASURES: Short-term opioid use (within 30 days of the index visit) following new LBP visit and long-term opioid use (starting within 60 days of the index date and either 120 or more days’ supply of opioids over 12 months, or 90 days or more supply of opioids and 10 or more opioid prescriptions over 12 months).

RESULTS: Short-term use of opioids was 22%. Patients who received initial treatment from chiropractors or physical therapists had decreased odds of short-term and long-term opioid use compared with those who received initial treatment from primary care physicians (PCPs) (adjusted OR (AOR) (95% CI) 0.10 (0.09 to 0.10) and 0.15 (0.13 to 0.17), respectively). Compared with PCP visits, initial chiropractic and physical therapy also were associated with decreased odds of long-term opioid use in a propensity score matched sample (AOR (95% CI) 0.21 (0.16 to 0.27) and 0.29 (0.12 to 0.69), respectively).

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

(more…)

0

The Global Spine Care Initiative

By Frank M. Painter|August 10, 2019|Chronic Neck Pain, Low Back Pain|

The Global Spine Care Initiative: Applying Evidence-based Guidelines on the Non-invasive Management of Back and Neck Pain to Low- and Middle-income Communities

The Chiro.Org Blog

SOURCE: European Spine Journal 2018 (Sep); 27 (Suppl 6): 851–860

Roger Chou, Pierre Côté, Kristi Randhawa, Paola Torres, Hainan Yu, Margareta Nordin, Eric L. Hurwitz, Scott Haldeman, Christine Cedraschi

Department of Medical Informatics and Clinical Epidemiology,
Oregon Health and Science University,
Portland, OR, USA.

PURPOSE: The purpose of this review was to develop recommendations for the management of spinal disorders in low-income communities, with a focus on non-invasive pharmacological and non-pharmacological therapies for non-specific low back and neck pain.

METHODS: We synthesized two evidence-based clinical practice guidelines for the management of low back and neck pain. Our recommendations considered benefits, harms, quality of evidence, and costs, with attention to feasibility in medically underserved areas and low- and middle-income countries.

RESULTS: Clinicians should provide education and reassurance, advise patients to remain active, and provide information about self-care options. For acute low back and neck pain without serious pathology, primary conservative treatment options are exercise, manual therapy, superficial heat, and nonsteroidal anti-inflammatory drugs (NSAIDs).

There are more articles like this @ our:

LOW BACK PAIN Page and the:

CHRONIC NECK PAIN Page

(more…)

0