Nonpharmacologic Therapies

Effect of Chiropractic Care on Low Back Pain for Active-duty Military Members: Mediation Through Biopsychosocial Factors

By Frank M. Painter|October 16, 2024|Acute Low Back Pain, Chiropractic Care, Nonpharmacologic Therapies|

Effect of Chiropractic Care on Low Back Pain for Active-duty Military Members: Mediation Through Biopsychosocial Factors

SOURCE: PLoS One 2024 (Oct 1); 19 (10): e0310642

Zacariah K. Shannon • Cynthia R. Long • Elizabeth A. Chrischilles • Christine M. Goertz • Robert B. Wallace • Carri Casteel • Ryan M. Carnahan

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, IA, USA.

FROM: Schneider, Spine 2015

This study evaluates biopsychosocial factors as mediators of the effect of chiropractic care on low back pain (LBP) intensity and interference for active-duty military members. Data from a multi-site, pragmatic clinical trial comparing six weeks of chiropractic care plus usual medical care to usual medical care alone for 750 US active-duty military members with LBP were analyzed using natural-effect, multiple-mediator modeling. Mediation of the adjusted mean effect difference on 12-week outcomes of PROMIS-29 pain interference and intensity by 6-week mediators of other PROMIS-29 physical, mental, and social health subdomains was evaluated. The effect difference on pain interference occurring through PROMIS-29 biopsychosocial factors (natural indirect effect = -1.59, 95% CI = -2.28 to -0.88) was 56% (95% CI = 35 to 96) of the total effect (-2.82, 95% CI = -3.98 to -1.53). The difference in effect on pain intensity occurring through biopsychosocial factors was smaller (natural indirect effect = -0.32, 95% CI = -0.50 to -0.18), equaling 26% (95% CI = 15 to 42) of the total effect (-1.23, 95% CI = -1.52 to -0.88). When considered individually, all physical, mental, and social health factors appeared to mediate the effect difference on pain interference and pain intensity with mental health factors having smaller effect estimates. In contrast with effects on pain interference, much of the effect of adding chiropractic care to usual medical care for US military members on pain intensity did not appear to occur through the PROMIS-29 biopsychosocial factors. Physical and social factors appear to be important intermediate measures for patients receiving chiropractic care for low back pain in military settings. Further study is needed to determine if the effect of chiropractic care on pain intensity for active-duty military occurs through other unmeasured factors, such as patient beliefs, or if the effect occurs directly.

Trial registration registered on clinical trials.gov (NCT01692275)

From the FULL TEXT Article:

Introduction

There is more like this @ our

LOW BACK PAIN Section and the

INITIAL PROVIDER/FIRST CONTACT Section

(more…)

0

Chiropractic Clinical Outcomes Among Older Adult Male Veterans With Chronic Lower Back Pain: A Retrospective Review of Quality-Assurance Data

By Frank M. Painter|December 14, 2022|Nonpharmacologic Therapies, Veterans|

Chiropractic Clinical Outcomes Among Older Adult Male Veterans With Chronic Lower Back Pain: A Retrospective Review of Quality-Assurance Data

The Chiro.Org Blog

SOURCE: J Chiropractic Medicine 2022 (Jun); 21 (2): 77–82

OPEN ACCESS

Brian A. Davis, DC, Andrew S.Dunn, DC, MS, MEd, Derek J. Golley, DC, MS, Dave R. Chicoine, DC, MS

Chiropractic Department,
VA Western New York Healthcare System,
Buffalo, New York.

FROM: Nahin ~ Pain 2017

Objective: The purpose of this study was to determine whether a sample of older adult male U.S. veterans demonstrated clinically and statistically significant improvement in chronic lower back pain on validated outcome measures after a short course of chiropractic care.

Methods: We performed a retrospective review of a quality-assurance data set of outcome metrics for male veterans, aged 65 to 89 years, who had chronic low back pain, defined as pain in the lower back region present for at least 3 months before evaluation. We included those who received chiropractic management from January 1, 2010, to December 31, 2018. Paired t tests were used to compare outcomes after 4 treatments on both a numeric rating scale (NRS) and the Back Bournemouth Questionnaire (BBQ). The minimum clinically important difference (MCID) was set at 30% change from baseline.

There is more like this @ our:

NON-PHARMACOLOGIC THERAPY Section and the:

CHIROPRACTIC CARE FOR VETERANS Section

(more…)

0

Association Between Chiropractic Spinal Manipulative Therapy and Benzodiazepine Prescription in Patients with Radicular Low Back Pain: A Retrospective Cohort Study Using Real-world Data From the USA

By Frank M. Painter|July 7, 2022|Low Back Pain, Nonpharmacologic Therapies|

Association Between Chiropractic Spinal Manipulative Therapy and Benzodiazepine Prescription in Patients with Radicular Low Back Pain: A Retrospective Cohort Study Using Real-world Data From the USA

The Chiro.Org Blog

SOURCE: BMJ Open 2022 (Jun 13); 12 (6): e058769

OPEN ACCESS

Robert James Trager, Zachary A Cupler, Kayla J DeLano, Jaime A Perez, Jeffery A Dusek

Connor Whole Health, University Hospitals Cleveland Medical Center,
Cleveland, Ohio, USA

Objectives: Although chiropractic spinal manipulative therapy (CSMT) and prescription benzodiazepines are common treatments for radicular low back pain (rLBP), no research has examined the relationship between these interventions. We hypothesise that utilisation of CSMT for newly diagnosed rLBP is associated with reduced odds of benzodiazepine prescription through 12 months’ follow-up.

Design: Retrospective cohort study.

Setting: National, multicentre 73-million-patient electronic health records-based network (TriNetX) in the USA, queried on 30 July 2021, yielding data from 2003 to the date of query.

Participants: Adults aged 18-49 with an index diagnosis of rLBP were included. Serious aetiologies of low back pain, structural deformities, alternative neurological lesions and absolute benzodiazepine contraindications were excluded. Patients were assigned to cohorts according to CSMT receipt or absence. Propensity score matching was used to control for covariates that could influence the likelihood of benzodiazepine utilisation.

Outcome measures: The number, percentage and OR of patients receiving a benzodiazepine prescription over 3, 6 and 12 months’ follow-up prematching and postmatching.

Results: After matching, there were 9206 patients (mean (SD) age, 37.6 (8.3) years, 54% male) per cohort. Odds of receiving a benzodiazepine prescription were significantly lower in the CSMT cohort over all follow-up windows prematching and postmatching (p<0.0001). After matching, the OR (95% CI) of benzodiazepine prescription at 3 months was 0.56 (0.50 to 0.64), at 6 months 0.61 (0.55 to 0.68) and 12 months 0.67 (0.62 to 0.74). Sensitivity analysis suggested a patient preference to avoid prescription medications did not explain the study findings.

There are more articles like this @ our:

NON-PHARMACOLOGIC THERAPY Section

(more…)

0

Associations Between Early Chiropractic Care and Physical Therapy on Subsequent Opioid Use Among Persons With Low Back Pain in Arkansas

By Frank M. Painter|July 5, 2022|Chiropractic Management, Nonpharmacologic Therapies|

Associations Between Early Chiropractic Care and Physical Therapy on Subsequent Opioid Use Among Persons With Low Back Pain in Arkansas

The Chiro.Org Blog

SOURCE: J Chiropractic Medicine 2022 (Jun); 21 (2): 67–76
Mahip Acharya, BPharm, Dvyan Chopra, MS, Allen M. Smith, PharmD, Julie M. Fritz, PhD, PT, Bradley C. Martin, PharmD, PhD

Division of Pharmaceutical Evaluation and Policy,
University of Arkansas for Medical Sciences,
Little Rock, Arkansas.

Department of Physical Therapy and Athletic Training,
University of Utah,
Salt Lake City, Utah.

Editorial Comment: These authors are to be praised for publishing this paper. When you look at their pedigrees, it’s reasonable to imagine that they may have been looking to see that physical therapy was associated with reduced opioid use. Numerous studies have shown that chiropractic already has a well-established track record for low- to no-opioid use, so they would be the perfect comparison group for a study like this. We all know that third parties are looking for safe and cost-effective alternatives to “usual care”.

In the past, a study favorable to chiropractic care, particularly one that used physical therapy as a comparison group, would never have been published, because of the long-standing medical bias against chiropractic care. So, let’s tip our hats to this group of researchers for their hard work and honesty!

Objective: The objective of this study was to estimate the association between early use of physical therapy (PT) or chiropractic care and incident opioid use and long-term opioid use in individuals with a low back pain (LBP) diagnosis.

Methods: A retrospective cohort study was conducted using data from Arkansas All Payers’ Claims Database. Adults with incident LBP diagnosed in primary care or emergency departments between July 1, 2013, and June 30, 2017, were identified. Participants were required to be opioid naïve in the 6-month baseline period and without cancer, cauda equina syndrome, osteomyelitis, lumbar fracture, and paraplegia/quadriplegia in the entire study period. PT and chiropractic treatment were documented over the ensuing 30 days starting on the date of LBP. Any opioid use and long-term opioid use (LTOU) in 1-year follow-up were assessed. Multivariable logistic regressions controlling for covariates were estimated.

There are more articles like this @ our:

NON-PHARMACOLOGIC THERAPY Section

(more…)

0

Chiropractic in the United States Military Health System: A 25th-Anniversary Celebration of the Early Years

By Frank M. Painter|February 5, 2022|Nonpharmacologic Therapies, Veterans|

Chiropractic in the United States Military Health System: A 25th-Anniversary Celebration of the Early Years

The Chiro.Org Blog

SOURCE: J Chiropractic Humanities 2020 (Dec); 27: 37-58

Bart N.Green DC, MSEd, PhD, Scott R.Gilford DC, Richard F.Beacham DC

Employer Based Integrated Primary Care Health Centers,
Stanford Health Care,
San Diego, California

Objective The purpose of this report is to record noteworthy events that occurred during the early years of chiropractic in the United States Military Health System (MHS).

Methods We used mixed methods to create this historical account, including documents, artifacts, research papers, and reports from personal experiences.

Results Chiropractic care was first included in the MHS in 1995, after years of legislative activity. The initial program was a 3-year study of the feasibility and advisability of integrating chiropractic in the MHS. This period was called the Chiropractic Health Care Demonstration Project; 20 pioneering chiropractors began their MHS journeys at 10 military bases in fiscal year 1995. The Demonstration Project was extended for 2 more years to gather research data, and 3 additional military facilities were added during those years to accomplish that purpose. The Demonstration Project concluded in 1999. In 2000, Congress approved the development of permanent chiropractic services and benefits for members of the uniformed services. These new clinics opened in 2002.

There is more like this @ our:

NON-PHARMACOLOGIC THERAPY Section and the:

CHIROPRACTIC CARE FOR VETERANS Section

(more…)

0

Health-related Quality of Life Among United States Service Members with Low Back Pain Receiving Usual Care plus Chiropractic Care plus Usual Care vs Usual Care Alone

By Frank M. Painter|January 29, 2022|Nonpharmacologic Therapies, Veterans|

Health-related Quality of Life Among United States Service Members with Low Back Pain Receiving Usual Care plus Chiropractic Care plus Usual Care vs Usual Care Alone

The Chiro.Org Blog

SOURCE: Pain Medicine 2022 (Jan 21); pnac009 [EPUB]

UCLA Department of Medicine,
Los Angeles, CA.

Department of Epidemiology,
University of Iowa,
Iowa City, IA.

Objective: This study examines Patient-Reported Outcome Measurement Information System (PROMIS®)-29 v1.0 outcomes of chiropractic care in a multi-site, pragmatic clinical trial and compares the PROMIS measures to: 1) worst pain intensity from a numerical pain rating 0-10 scale, 2) 24-item Roland-Morris Disability Questionnaire (RMDQ); and 3) global improvement (modified visual analog scale).

Design: A pragmatic, prospective, multisite, parallel-group comparative effectiveness clinical trial comparing usual medical care (UMC) with UMC plus chiropractic care (UMC+CC).

Setting: 3 military treatment facilities.

Subjects: 750 active-duty military personnel with low back pain.

Methods: Linear mixed effects regression models estimated the treatment group differences. Coefficient of repeatability to estimate significant individual change.

Results: We found statistically significant mean group differences favoring UMC+CC for all PROMIS®-29 scales and the RMDQ score. Area under the curve estimates for global improvement for the PROMIS®-29 scales and the RMDQ, ranged from 0.79 to 0.83.

There is more like this @ our:

LOW BACK PAIN Section and the:

NON-PHARMACOLOGIC THERAPY Section and the:

CHIROPRACTIC CARE FOR VETERANS Section

(more…)

0