Pregnancy

A Randomized Controlled Trial Comparing a Multimodal Intervention and Standard Obstetrics Care for Low Back and Pelvic Pain in Pregnancy

By Frank M. Painter|February 1, 2015|Low Back Pain, Pregnancy|

A Randomized Controlled Trial Comparing a Multimodal Intervention and Standard Obstetrics Care for Low Back and Pelvic Pain in Pregnancy

SOURCE: Am J Obstet Gynecol. 2013 (Apr); 208 (4): 295.e1-7 ~ FULL TEXT

James W. George, DC, Clayton D. Skaggs, DC,
Paul A. Thompson, PhD, D. Michael Nelson, MD, PhD,
Jeffrey A. Gavard, PhD, Gilad A. Gross, MD

Chiropractic Science Division,
College of Chiropractic,
Logan University,
Chesterfield, MO, USA.

OBJECTIVE: Women commonly experience low back pain during pregnancy. We examined whether a multimodal approach of musculoskeletal and obstetric management (MOM) was superior to standard obstetric care to reduce pain, impairment, and disability in the antepartum period.

STUDY DESIGN: A prospective, randomized trial of 169 women was conducted. Baseline evaluation occurred at 24-28 weeks’ gestation, with follow-up at 33 weeks’ gestation. Primary outcomes were the Numerical Rating Scale (NRS) for pain and the Quebec Disability Questionnaire (QDQ). Both groups received routine obstetric care. Chiropractic specialists provided manual therapy, stabilization exercises, and patient education to MOM participants.

RESULTS: The MOM group demonstrated significant mean reductions in Numerical Rating Scale scores (5.8 ± 2.2 vs 2.9 ± 2.5; P < .001) and Quebec Disability Questionnaire scores (4.9 ± 2.2 vs 3.9 ± 2.4; P < .001) from baseline to follow-up evaluation. The group that received standard obstetric care demonstrated no significant improvements.

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Pre-Eclampsia and the Impact on Chiropractic Management of the Pregnant Patient

By Frank M. Painter|August 3, 2014|Chiropractic Management, Pre-Eclampsia, Pregnancy|

Pre-Eclampsia and the Impact on Chiropractic Management of the Pregnant Patient

The Chiro.Org Blog

SOURCE: J Clinical Chiropractic Pediatrics 2012 (Dec)

Sharon Gordon, BAppSc(Chiro), DICCP and Sherryn Silverthorne, M Clinical Chiro, RN, RM

Sharon Gordon, BAppSc(Chiro), DICCP
Private Practice, Gippsland, Victoria, Australia

Sherryn Silverthorne, M Clinical Chiro, RN, RM
Private Practice, Melbourne, Victoria, Australia

Up to 10% of women develop pre-eclampsia during pregnancy. It is a significant cause of mortality, responsible for 10-15% of maternal deaths. Its diagnosis is based on the presence of hypertension, with or without proteinuria and edema. As primary contact health care providers, chiropractors must be aware of the risk factors, clinical signs of pre-eclampsia, and the need to modify their management appropriately. An open internet search was conducted for current guidelines in scientific journal databases, in the diagnosis and management of pre-eclampsia. Although there is little literature outlining the role of the chiropractor in patient management, it is clear that specific history and examination procedures must be performed for appropriate co-management and referral.

Key Words: pre-eclampsia, eclampsia, toxemia, hypertension, pregnancy, chiropractic

From the Full-Text Article:

Introduction

Pre-eclampsia (also known as toxemia of pregnancy) is one of the major causes of maternal mortality and morbidity. 10%-15% of maternal deaths are directly associated with pre-eclampsia and eclampsia. [1] Up to 10% of pregnant women develop pre-eclampsia. [2] The incidence of pre-eclampsia in the nulliparous woman is cited as being between 3%-7% and for the multiparous woman 1%-3%. [1, 3] This diagnosis is based on the presence of hypertension, proteinuria, with or without edema. As primary contact health care providers, chiropractors must be aware of the risk factors, clinical signs of pre-eclampsia, and the need to modify their management appropriately.

Objective

To review the diagnostic criteria, risk factors and complications of pre-eclampsia, and discuss how this may affect chiropractic management of the pregnant patient.

Methods

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A Randomized Controlled Trial Comparing A Multimodal Intervention and Standard Obstetrics Care For Low Back and Pelvic Pain In Pregnancy

By Frank M. Painter|April 5, 2014|Chiropractic Care, Low Back Pain, Pregnancy|

A Randomized Controlled Trial Comparing A Multimodal Intervention and Standard Obstetrics Care For Low Back and Pelvic Pain In Pregnancy

The Chiro.Org Blog

SOURCE: Am J Obstet Gynecol. 2013 (Apr); 208 (4): 295. e1-7

James W. George, DC; Clayton D. Skaggs, DC;
Paul A. Thompson, PhD; D. Michael Nelson, MD, PhD;
Jeffrey A. Gavard, PhD; Gilad A. Gross, MD

Chiropractic Science Division,
College of Chiropractic,
Logan University, Chesterfield, MO, USA

OBJECTIVE: Women commonly experience low back pain during pregnancy. We examined whether a multimodal approach of musculoskeletal and obstetric management (MOM) was superior to standard obstetric care to reduce pain, impairment, and disability in the antepartum period.

STUDY DESIGN: A prospective, randomized trial of 169 women was conducted. Baseline evaluation occurred at 24-28 weeks’ gestation, with follow-up at 33 weeks’ gestation. Primary outcomes were the Numerical Rating Scale (NRS) for pain and the Quebec Disability Questionnaire (QDQ). Both groups received routine obstetric care. Chiropractic specialists provided manual therapy, stabilization exercises, and patient education to MOM participants.

RESULTS: The MOM group demonstrated significant mean reductions in Numerical Rating Scale scores (5.8 ± 2.2 vs 2.9 ± 2.5; P < .001) and Quebec Disability Questionnaire scores (4.9 ± 2.2 vs 3.9 ± 2.4; P < .001) from baseline to follow-up evaluation. The group that received standard obstetric care demonstrated no significant improvements.

CONCLUSION: A multimodal approach to low back and pelvic pain in mid pregnancy benefits patients more than standard obstetric care.

From the Full-Text Article:

Introduction

Musculoskeletal pain in pregnant women commonly is viewed as transient, physiologic, and self-limited. However, most women report either low back pain (LBP) or pelvic pain (PP) during pregnancy [1-6] and the morbidity that is associated with such complaints. [7, 8] Moreover, up to 40% of patients report musculoskeletal pain during the 18 months after delivery, [2, 7, 9, 10] and one-fifth of these women have severe LBP that leads to major personal, social, or economic problems. [7, 9, 11] Pregnancy-related LBP contributes substantially to health care costs. For example, one-fifth of pregnant women in Scandinavian countries experience back pain as an indication for up to 7 weeks of sick leave in the perinatal period. [7, 9] Ninety-four percent of women who experienced LBP in an index pregnancy have recurrent symptoms with subsequent pregnancy, and two-thirds of these patients experience disability and require sick leave during pregnancy. Notably, 19% of women with pain in an initial pregnancy report avoidance of a future pregnancy out of fear of recurrence of the musculoskeletal symptoms. [11]

Most past investigations that have evaluated interventions to reduce morbidity in women with LBP/PP during pregnancy have used modalities that have included prescription exercise, [12] manual manipulation, [13] education, [14] acupuncture, [15] or pelvic belts. [16] Recently, a multimodal randomized trial compared osteopathic manipulation to usual obstetric care and sham ultrasonic therapy on 144 participants. [13] Importantly, this trial did not include behavioral and exercise therapies. We conducted a prospective, randomized, masked clinical trial to test the hypothesis that a multimodal approach of manual therapy, exercise, and education for LBP/PP in pregnant women is superior to standard obstetric care (STOB) for the reduction of pain, impairment, and disability in the ante-partum period.

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Outcomes Of Pregnant Patients With Low Back Pain Undergoing Chiropractic Treatment: A Prospective Cohort Study With Short Term, Medium Term and 1 Year Follow-up

By Frank M. Painter|April 4, 2014|Chiropractic Care, Low Back Pain, Pregnancy|

Outcomes Of Pregnant Patients With Low Back Pain Undergoing Chiropractic Treatment: A Prospective Cohort Study With Short Term, Medium Term and 1 Year Follow-up

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2014 (Apr 1); 22 (1): 15 ~ FULL TEXT

Cynthia K Peterson, Daniel Mühlemann,
Barry Kim Humphreys

Department of Chiropractic Medicine,
Orthopaedic University Hospital Balgrist,
University of Zürich,
Forchstrasse 340, Zürich, Switzerland

BACKGROUND: Low back pain in pregnancy is common and research evidence on the response to chiropractic treatment is limited. The purposes of this study are 1) to report outcomes in pregnant patients receiving chiropractic treatment; 2) to compare outcomes from subgroups; 3) to assess predictors of outcome.

METHODS: Pregnant patients with low back or pelvic pain, no contraindications to manipulative therapy and no manual therapy in the prior 3 months were recruited.Baseline numerical rating scale (NRS) and Oswestry questionnaire data were collected. Duration of complaint, number of previous LBP episodes, LBP during a previous pregnancy, and category of pain location were recorded.The patient’s global impression of change (PGIC) (primary outcome), NRS, and Oswestry data (secondary outcomes) were collected at 1 week, 1 and 3 months after the first treatment. At 6 months and 1 year the PGIC and NRS scores were collected. PGIC responses of ‘better or ‘much better’ were categorized as ‘improved’.The proportion of patients ‘improved’ at each time point was calculated. Chi-squared test compared subgroups with ‘improvement’. Baseline and follow-up NRS and Oswestry scores were compared using the paired t-test. The unpaired t-test compared NRS and Oswestry scores in patients with and without a history of LBP and with and without LBP during a previous pregnancy. Anova compared baseline and follow-up NRS and Oswestry scores by pain location category and category of number of previous LBP episodes. Logistic regression analysis also was also performed.

RESULTS: 52% of 115 recruited patients ‘improved’ at 1 week, 70% at 1 month, 85% at 3 months, 90% at 6 months and 88% at 1 year. There were significant reductions in NRS and Oswestry scores (p < 0.0005). Category of previous LBP episodes number at one year (p = 0.02) was related to ‘improvement’ when analyzed alone, but was not strongly predictive in logistic regression. Patients with more prior LBP episodes had higher 1 year NRS scores (p = 0.013).

CONCLUSIONS: Most pregnant patients undergoing chiropractic treatment reported clinically relevant improvement at all time points. No single variable was strongly predictive of ‘improvement’ in the logistic regression model.

From the Full-Text Article:

Background

Low back and pelvic pain in pregnant women is such a common phenomenon that it is often considered a normal part of the pregnancy [1-3]. However, the high prevalence of this problem (50-80% of women) and the impact that this may have on their quality of life, as well as the fact that back pain during pregnancy is commonly linked to low back pain persisting after pregnancy, mandates that it be taken seriously by health care practitioners [1-6]. Many of these patients rate their back pain as moderate to severe with a small percentage claiming to be significantly disabled by the pain [6-8].

Pregnancy-related low back pain is most often divided into 3 categories based on location. These are: lumbar spine pain (LP), posterior pelvic pain (PPP), or a combination of these two [1, 2, 9], with posterior pelvic pain reported to be the most common presentation [1, 10] and the location most specific for pregnant patients [9]. However, other authors have used 4 categories for pelvic only pain, including anterior pain at the pubic symphysis (symphysiolysis) but excluding lumbar spine pain [11].

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Get the Lead Out!

By Frank M. Painter|May 13, 2013|Iatrogenic Injury, Pediatrics, Pregnancy, Supplementation|

Get the Lead Out!

The Chiro.Org Blog

SOURCE: MedPage Today ~ May 13, 2013

By Nancy Walsh, Staff Writer, MedPage Today

When the FDA finally got around to testing 324 multivitamin-mineral products that target children and pregnant women, they found that only 4 of them were lead-free. [1]

Now, new research published in the Pediatrics Journal suggests that even low levels of lead in a supplement can have adverse effects on your children. [2] Why not use a supplement made correctly, so you can protect your family?

Here’s the Bad news from MedPage Today:

Even Low Lead Exposure Hinders Kids’ Reading

Young children exposed to lead — even at low levels — are at risk for not meeting reading readiness benchmarks in kindergarten, a large study of urban children found.

On tests of reading readiness, children with blood lead levels between 5 and 9 µg/dL scored 4.5 points (95% CI −2.9 to −6.2) lower than those with levels below 5 µg/dL, according to Pat McLaine, DPH, of the University of Maryland in Baltimore, and colleagues.

And those with lead levels of 10 µg/dL and higher had scores 10.1 points (95% CI −7 to −13.3) lower, the researchers reported online in Pediatrics. [2] (more…)

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The Treatment Experience of Patients With Low Back Pain During Pregnancy

By Frank M. Painter|October 10, 2012|Chiropractic Care, Pregnancy, Safety|

The Treatment Experience of Patients With Low Back Pain During Pregnancy

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2012 (Oct 9)

Shabnam Sadr, Neda Pourkiani-Allah-Abad and Kent Jason Stuber

Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3 J1, Canada

Background Chiropractors regularly treat pregnant patients for low back pain during their pregnancy. An increasing amount of literature on this topic supports this form of treatment; however the experience of the pregnant patient with low back pain and their chiropractor has not yet been explored. The objective of this study is to explore the experience of chiropractic treatment for pregnant women with low back pain, and their chiropractors.

Methods This qualitative study employed semi-structured interviews of pregnant patients in their second or third trimester, with low back pain during their pregnancy, and their treating chiropractors in separate interviews. Participants consisted of 11 patients and 12 chiropractors. The interviews consisted of 10 open-ended questions for patients, and eight open-ended questions for chiropractors, asking about their treatment experience or impressions of treating pregnant patients with LBP, respectively. All interviews were audio-recorded, transcribed verbatim, and reviewed independently by the investigators to develop codes, super-codes and themes. Thematic saturation was reached after the eleventh chiropractor and ninth patient interviews. All interviews were analyzed using the qualitative analysis software N-Vivo 9.

Results Five themes emerged out of the chiropractor and patient interviews. The themes consisted of Treatment and Effectiveness; Chiropractor-Patient Communication; Pregnant Patient Presentation and the Chiropractic Approach to Pregnancy Care; Safety Considerations; and Self-Care.

Conclusions Chiropractors approach pregnant patients with low back pain from a patient-centered standpoint, and the pregnant patients interviewed in this study who sought chiropractic care appeared to find this approach helpful for managing their back pain symptoms.

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From the Full-Text Article:

Background:

Low back pain (LBP) during pregnancy is reported by approximately 50% to 80% of pregnant women [1-3]. The structural, postural, or hormonal changes that occur during pregnancy, or any combination thereof, may lead to LBP during pregnancy [3]. Treatment options include a range of therapies, such as exercise programs, massage therapy, acupuncture, and chiropractic [4, 5]. Chiropractic care may include spinal manipulative therapy (SMT), mobilizations and soft tissue therapy, as well as exercise prescription. [3] Previous studies and systematic reviews of the literature have indicated the relative safety and effectiveness of chiropractic treatment for LBP during pregnancy. [3, 5, 7]

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