Safety

The Evidence-based Rap, or What’s Wrong With My Pain Meds?

By Frank M. Painter|April 23, 2011|Low Back Pain, Research, Safety|

The Evidence-based Rap, or What’s Wrong With My Pain Meds?

Based on: A Systematic Review on the Effectiveness of Pharmacological Interventions for Chronic Non-specific Low-back Pain ~ FULL TEXT
Eur Spine J. 2011 (Jan); 20 (1): 40–50

OK, maybe this isn’t a genuine Rap, and I’m not rhyming-Simon, but somebody needs to bust-a-cap on the pain-med industry, because they hold themselves to a much lower standard than they expect my profession to maintain.

Fortunately (and, to the rescue) comes this study from the Dutch Institute for Health Care Improvement. They actually *busted a cap*, by deciding to explore “the effectiveness of pharmacological interventions [i.e., non-steroid anti-inflammatory drugs (NSAIDs), muscle relaxants, antidepressants, and opioids] for non-specific chronic low-back pain (LBP)”.

This article is a real eye-opener!

I say Bravo, because these drugs are medicine’s sole conservative approach for managing LBP. This Blog has previously published numerous (and recent) studies suggesting that chiropractic management for low back pain is orders of magnitude more effective for pain relief, and is also significantly more cost-effective than standard medical management. [1-8] (more…)

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WARNING: Conducting an Orchestra Can Cause Vertebral Artery Dissection and Stroke

By Frank M. Painter|March 29, 2011|Research, Safety, Stroke|

WARNING: Conducting an Orchestra Can Cause Vertebral Artery Dissection and Stroke

The Chiro.Org Blog

SOURCE: J Stroke and Cerebrovascular Diseases 2011 (Mar 24)

During the past decade, the issues of cerebrovascular accidents [CVAs] and spinal manipulation have become linked in a debate of ever-increasing intensity. A copious number of studies have investigated spinal manipulation as a putative causative factor of CVAs; however, a common theme among these is the failure to adequately explore the possibility that the majority of CVAs may be spontaneous, cumulative, or caused by factors other than spinal manipulation itself. The problem is only exacerbated by the sometimes hysterical reactions apparent in the mass media over the past three years in reaction to these flawed investigations. [1]

Previous studies have shown that vertebral artery dissections (VADs) have been “caused” by things as innocuous as:

Salon shampoos
Archery
Coughing
Dental procedure
Watching aircraft
Telephone call
Yawning
Bleeding nose
Overhead work (more…)

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Neck Pain Commentaries: Part 3

By Frank M. Painter|September 2, 2010|Editorial, Research, Safety|

Neck Pain Commentaries: Part 3

The Chiro.Org Blog

Today we will review a trial that Kaiser’s reviewers obviously ignored so that they could deny benefits for cervical adjusting.

Editorial Commentary:

First off, this article should have been very easy for their reviewers to find. Look at the title:

“The Benefits Outweigh the Risks for Patients Undergoing Chiropractic Care for Neck Pain”

This study was a prospective, multicenter, observational cohort study. Patients with neck pain of any duration, who fulfilled the inclusion criteria, were recruited in a practice-based study. Data were collected on the patients and from the chiropractors at baseline, the first 3 visits, and at 3 and 12 months.

Clinical outcome measures included

(1) neck pain in the 24 hours preceding the visit,
(2) neck disability,
(3) treatment satisfaction,
(4) global assessment, and
(5) adverse events. (more…)

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Painkiller Deaths Double In Ontario

By John Wiens DC|December 8, 2009|Safety|

Source The Globe and Mail
December 8th, 2009
ANNA MEHLER PAPERNY

Painkillers are causing twice the number of overdose deaths they were two decades ago, a new study has revealed. And most of those who died obtained the medications through a doctor’s prescription and had seen a physician within the last month of their life.

The increase mirrors a dramatic rise in prescriptions for oxycodone. The potent opiate, found in OxyContin and Percocet, has proliferated in an epidemic of chronic pain turning Canadians into a nation of pill-poppers – using more prescription opioids per capita than any country but the United States and Belgium.

It’s an indication that many doctors have underestimated the power and complexity of prescription opioids, and their ability to harm as well as help, said Irfan Dhalla, a doctor at St. Michael’s Hospital in Toronto and the report’s primary author.

Dr. Dhalla is one of many physicians and researchers who argue that prescribing physicians – from general practitioners to gynecologists – need to reconsider the treatment of patients suffering from chronic pain and addiction.

“Physicians will be very surprised to learn just how many deaths occur from prescription opioids each year,” Dr. Dhalla said. (more…)

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Medicine and the Overtreatment of Back Pain

By Frank M. Painter|November 3, 2009|Education, News, Politics, Safety|

Medicine and the Overtreatment of Back Pain

The Chiro.Org Blog

SOURCE: J Am Board Fam Med. 2009 (Jan); 22 (1): 62-68

Commentary by Dan Murphy, D.C.

I just read a fascinating article in the January edition of the Journal of the American Board of Family Medicine, as it documents the massive increase in costs for medical management of chronic back pain, with no comparable improvements in patient outcomes, or decreases in disability rates. Worse yet, significant increases in post-intervention complications (including death) also appear to be on the rise.

This article documents:

a 629% increase for epidural steroid injections
a 423% increase in expenditures for opioids for back pain
a 307% increase in the number of lumbar magnetic resonance images
a 231% increase in facet joint injections
a 220% increase in spinal fusion surgery rates
Manufacturers aggressively promote new drugs and devices for the treatment of back pain, yet there is evidence of misleading advertising, kickbacks to physicians, and major investments by surgeons in the products they are promoting.
Prescription opioid use is steadily increasing, especially for musculoskeletal conditions. Emergency department reports of opioid overdose parallel the numbers of prescriptions. Deaths related to prescription opioids are greater than the combined total involving cocaine and heroin. Ironically, “Opioid use may paradoxically increase sensitivity to pain.”
New and improved spinal fusion techniques and devices, such as implants, increase the risk of nerve injury, blood loss, overall complications, operative time, and repeat surgery, but do not result in improved disability or reoperation rates.
Increases in the rates of imaging, opioid prescriptions, injections, and fusion surgery might be justified if there were substantial improvements in patient outcomes; unfortunately, they are not. In fact, statistics indicate that disability from musculoskeletal disorders is rising, not falling. “Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain.”

At the same time that medicine has ramped up costs (gobbling up the Medicare pie), a long line of studies have shown the clear superiority of chiropractic management for low back pain. Please review the most in-depth study, published in May of 2007 which compared medical and chiropractic management for LBP in a managed care group:

Clinical and cost utilization, based on 70,274 member-months, over a 7-year period, demonstrated:

decreases of 60.2% in-hospital admissions
59.0% less hospital days
62.0% less outpatient surgeries and procedures, and
83% less pharmaceutical costs

when patients were seen by a chiropractor, instead of seeing a conventional medical IPA doctor.

It’s time to end the

Medical Mis-Management of Low Back Pain

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2 and 2 is? [Humor Alert!]

By Frank M. Painter|September 22, 2009|Education, Health Care, Media, News, Politics, Safety|

2 and 2 is? [Humor Alert!]

The Chiro.Org Blog

The news media has been having a LOT of fun reporting on the Congressional Health Care Overhaul lately, so I will too.

Chiropractic’s *scientific critics* state we don’t have the kind of statistics they (grin) rely on, so we shouldn’t toot our own horn like they do. Hmmm? Well, let’s take a closer look at them. Here’s some amazing scientific statistics about modern medicine:

1. The total number of iatrogenic deaths caused by conventional medicine is an astounding 783,936 deaths per year at a cost of $282 billion dollars. That is a mind-boggling 2147 people killed every day. That’s as if 7 jumbo jet planes crashed every day. That’s a 9-11 incident, happening every other day…FOREVER. God help us all. [1]

2. A report by the British Medical Journal correlated a strike by medical doctors with lower death rates during the strike. Hmmm?

3. Recent surveys suggest that “45% Of Doctors (MDs) Would Consider Quitting If Congress Passes Health Care Overhaul.” [3]

So, if we put that all those facts together, supporting Congress’s new Health Care Plan could reduce the medical population by up to 45%, thus significantly reducing the incidence of medically-induced iatrogenic illness and death, and all the money they would save ($126.9 billion dollars) would help to pay for the new Plan.

And, perhaps with some of those savings, they could even consider adding conservative chiropractic care as another cost-saving option. [4, 5]

REFERENCES

1. http://www.chiro.org/LINKS/FULL/Death_By_Medicine.html

2. http://tinyurl.com/lzdq7a

3. http://www.investors.com/NewsAndAnalysis/Article.aspx?id=506199

4. http://www.chiro.org/LINKS/Cost_Effectiveness.shtml

5. http://www.chiro.org/LINKS/Safety.shtml

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