Low Back Pain

Low Back Pain: The Potential Contribution of Supraspinal

By Frank M. Painter|November 8, 2018|Low Back Pain|

Low Back Pain: The Potential Contribution of Supraspinal Motor Control and Proprioception

SOURCE: Neuroscientist. 2018 (Nov 2) [Epub]

Michael Lukas Meier, Andrea Vrana1, and Petra Schweinhardt

Integrative Spinal Research,
Department of Chiropractic Medicine,
University Hospital Balgrist,
Zurich, Switzerland.

Motor control, which relies on constant communication between motor and sensory systems, is crucial for spine posture, stability and movement. Adaptions of motor control occur in low back pain (LBP) while different motor adaption strategies exist across individuals, probably to reduce LBP and risk of injury. However, in some individuals with LBP, adapted motor control strategies might have long-term consequences, such as increased spinal loading that has been linked with degeneration of intervertebral discs and other tissues, potentially maintaining recurrent or chronic LBP. Factors contributing to motor control adaptations in LBP have been extensively studied on the motor output side, but less attention has been paid to changes in sensory input, specifically proprioception.

Furthermore, motor cortex reorganization has been linked with chronic and recurrent LBP, but underlying factors are poorly understood. Here, we review current research on behavioral and neural effects of motor control adaptions in LBP. We conclude that back pain-induced disrupted or reduced proprioceptive signaling likely plays a pivotal role in driving long-term changes in the top-down control of the motor system via motor and sensory cortical reorganization. In the outlook of this review, we explore whether motor control adaptations are also important for other (musculoskeletal) pain conditions.

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Group and Individual-level Change on Health

By Frank M. Painter|October 13, 2018|Chronic Neck Pain, Low Back Pain|

Group and Individual-level Change on Health-related Quality of Life in Chiropractic Patients with Chronic Low Back or Neck Pain

The Chiro.Org Blog

SOURCE: Spine (Phila Pa 1976). 2018 (Oct 11) [Epub]

Ron D. Hays, Ph.D., Karen L. Spritzer, B.S., Cathy D. Sherbourne, Ph.D., Gery W. Ryan, Ph.D., Ian D. Coulter, Ph.D.

Division of General Internal Medicine & Health Services Research
UCLA Department of Medicine
911 Broxton Avenue
Los Angeles, CA

STUDY DESIGN: Prospective observational study.

OBJECTIVE: To evaluate group-level and individual-level change in health-related quality of life among persons with chronic low back pain or neck pain receiving chiropractic care in the United States.

SUMMARY OF BACKGROUND DATA: Chiropractors treat chronic low back and neck pain, but there is limited evidence of the effectiveness of their treatment

METHODS: A 3–month longitudinal study of 2,024 patients with chronic low back pain or neck pain receiving care from 125 chiropractic clinics at 6 locations throughout the United States was conducted. Ninety-one percent of the sample completed the baseline and 3–month follow-up survey (n = 1,835). Average age was 49, 74% females, and most of the sample had a college degree, were non-Hispanic White, worked full-time, and had an annual income of $60,000 or more. Group-level (within group t-tests) and individual-level (coefficient of repeatability) changes on the Patient-Reported Outcomes Measurement Information System (PROMIS) v2.0 profile measure was evaluated: 6 multi-item scales (physical functioning, pain, fatigue, sleep disturbance, social health, emotional distress) and physical and mental health summary scores.

RESULTS: Within group t-tests indicated significant group-level change (p < 0.05) for all scores except for emotional distress, and these changes represented small improvements in health (absolute value of effect sizes ranged from 0.08 for physical functioning to 0.20 for pain). From 13% (physical functioning) to 30% (PROMIS-29 Mental Health Summary Score) got better from baseline to 3 months later according to the coefficient of repeatability.

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Characteristics of Chiropractic Patients Being Treated

By Frank M. Painter|September 1, 2018|Chronic Neck Pain, Low Back Pain|

Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2018 (Aug 15) [Epub]

Scott Haldeman, Claire D. Johnson, Roger Chou, Margareta Nordin, Pierre Côté, Eric L. Hurwitz, Bart N. Green, Christine Cedraschi et. al.

RAND Corporation,
Santa Monica, California.

OBJECTIVES: Chronic low back pain (CLBP) and chronic neck pain (CNP) are the most common types of chronic pain, and chiropractic spinal manipulation is a common nonpharmacologic treatment. This study presents the characteristics of a large United States sample of chiropractic patients with CLBP and CNP.

METHODS: Data were collected from chiropractic patients using multistage systematic stratified sampling with 4 sampling levels: regions and states, sites (ie, metropolitan areas), providers and clinics, and patients. The sites and regions were San Diego, California; Tampa, Florida; Minneapolis, Minnesota; Seneca Falls and Upstate New York; Portland, Oregon; and Dallas, Texas. Data were collected from patients through an iPad-based prescreening questionnaire in the clinic and emailed links to full screening and baseline online questionnaires. The goal was 20 providers or clinics and 7 patients with CLBP and 7 with CNP from each clinic.

RESULTS: We had 6342 patients at 125 clinics complete the prescreening questionnaire, 3333 patients start the full screening questionnaire, and 2024 eligible patients completed the baseline questionnaire: 518 with CLBP only, 347 with CNP only, and 1159 with both. In general, most of this sample were highly-educated, non-Hispanic, white females with at least partial insurance coverage for chiropractic care who have been in pain and using chiropractic care for years. Over 90% reported high satisfaction with their care, few used narcotics, and avoiding surgery was the most important reason they chose chiropractic care.

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Chiropractic Spinal Manipulation for Low Back Pain of Pregnancy

By Frank M. Painter|July 31, 2018|Low Back Pain, Pregnancy|

Chiropractic Spinal Manipulation for Low Back Pain of Pregnancy: A Retrospective Case Series

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SOURCE: J Midwifery Womens Health 2006 (Jan); 51 (1): e7-10

Anthony J. Lisi

University of Bridgeport College of Chiropractic.

Low back pain is a common complaint in pregnancy, with a reported prevalence of 57% to 69% and incidence of 61%. Although such pain can result in significant disability, it has been shown that as few as 32% of women report symptoms to their prenatal provider, and only 25% of providers recommend treatment. Chiropractors sometimes manage low back pain in pregnant women; however, scarce data exist regarding such treatment. This retrospective case series was undertaken to describe the results of a group of pregnant women with low back pain who underwent chiropractic treatment including spinal manipulation. Seventeen cases met all inclusion criteria.

The overall group average Numerical Rating Scale pain score decreased from 5.9 (range 2-10) at initial presentation to 1.5 (range 0-5) at termination of care. Sixteen of 17 (94.1%) cases demonstrated clinically important improvement. The average time to initial clinically important pain relief was 4.5 (range 0-13) days after initial presentation, and the average number of visits undergone up to that point was 1.8 (range 1-5). No adverse effects were reported in any of the 17 cases. The results suggest that chiropractic treatment was safe in these cases and support the hypothesis that it may be effective for reducing pain intensity.

From the FULL TEXT Article:

INTRODUCTION

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Can a Bothersome Course of Pelvic Pain From Mid-pregnancy

By Frank M. Painter|July 29, 2018|Low Back Pain, Pregnancy|

Can a Bothersome Course of Pelvic Pain From Mid-pregnancy to Birth be Predicted? A Norwegian Prospective Longitudinal SMS-Track Study

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SOURCE: BMJ Open. 2018 (Jul 25); 8 (7): e021378

Stefan Malmqvist, Inger Kjaermann, Knut Andersen, Anne Marie Gausel, Inger Økland, Jan Petter Larsen, Kolbjorn S Bronnick

The Norwegian Centre for Movement Disorders,
Stavanger University Hospital,
Stavanger, Norway.

OBJECTIVE: To explore if pregnant women with pelvic girdle pain (PGP), subgrouped following the results from two clinical tests with high validity and reliability, differ in demographic characteristics and weekly amount of days with bothersome symptoms through the second half of pregnancy.

DESIGN: A prospective longitudinal cohort study.

PARTICIPANTS: Pregnant women with pelvic and lumbopelvic pain due for their second-trimester routine ultrasound examination.

SETTING: Obstetric outpatient clinic at Stavanger University Hospital, Norway.

METHODS: Women reporting pelvic and lumbopelvic pain completed a questionnaire on demographic and clinical features. They were clinically examined following a test procedure recommended in the European guidelines for the diagnosis and treatment of PGP. Women without pain symptoms completed a questionnaire on demographic data. All women were followed weekly through an SMS-Track survey until delivery.

PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome measures were the results from clinical diagnostic tests for PGP and the number of days per week with bothersome pelvic pain.

RESULTS: 503 women participated. 42% (212/503) reported pain in the lumbopelvic region and 39% (196/503) fulfilled the criteria for a probable PGP diagnosis. 27% (137/503) reported both the posterior pelvic pain provocation (P4) and the active straight leg raise (ASLR) tests positive at baseline in week 18, revealing 7.55 (95% CI 5.54 to 10.29) times higher mean number of days with bothersome pelvic pain compared with women with both tests negative. They presented the highest scores for workload, depressed mood, pain level, body mass index, Oswestry Disability Index and the number of previous pregnancies. Exercising regularly before and during pregnancy was more common in women with negative tests.

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Low Back Pain: A Major Global Problem For Which

By Frank M. Painter|June 26, 2018|Low Back Pain|

Low Back Pain: A Major Global Problem For Which the Chiropractic Profession Needs to Take More Care

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SOURCE: Chiropractic & Manual Therapies 2018 (Jun 25); 26: 28

Simon D. French, Aron S. Downie and Bruce F. Walker

Department of Chiropractic,
Faculty of Science and Engineering,
Macquarie University,
Sydney, Australia

An important series of papers have been published in the Lancet. These papers provide a comprehensive update for the major global problem of low back pain, and the challenges that low back pain presents to healthcare practitioners and policy makers. Chiropractors are well placed to reduce the burden of low back pain, but not all that chiropractors do is supported by robust, contemporary evidence. This commentary summarises the Lancet articles. We also make suggestions for how the chiropractic profession should most effectively help people with low back pain by implementing practices supported by high quality evidence.

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The Lancet 2018 Series on Low Back Pain

From the Full-Text Article

Background

Low back pain is a major global problem and it is getting worse. [1] An important series of articles in the journal Lancet, authored by world leading authorities on low back pain evidence, has drawn international attention to how enormous the problem is. The Lancet authors also discussed how low back pain is being poorly managed by healthcare systems around the globe, including emerging issues in low and middle-income countries. [2–4] This commentary will summarise the main findings of these Lancet papers, and provide some suggestions for how the chiropractic profession should respond to the global challenge that is low back pain.

The Lancet papers

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