Spinal Joint Pain

Mechanisms of Chiropractic Spinal Manipulative Therapy for Patients with Chronic Primary Low Back Pain: Protocol for a Mechanistic Randomized Placebo-controlled Trial

By Frank M. Painter|February 25, 2023|Chiropractic Management, Low Back Pain, Spinal Joint Pain|

Mechanisms of Chiropractic Spinal Manipulative Therapy for Patients with Chronic Primary Low Back Pain: Protocol for a Mechanistic Randomized Placebo-controlled Trial

SOURCE: BMJ Open 2023 (Feb 10); 13 (2): e065999

OPEN ACCESS

Carlos Gevers-Montoro, Arantxa Ortega-De Mues, Mathieu Piché

Real Centro Universitario Escorial Maria Cristina,
San Lorenzo de El Escorial, Spain.

Introduction: Chronic low back pain (CLBP) is a highly prevalent and disabling condition. Identifying subgroups of patients afflicted with CLBP is a current research priority, for which a classification system based on pain mechanisms was proposed. Spinal manipulative therapy (SMT) is recommended for the management of CLBP. Yet, little data are available regarding its mechanisms of action, making it difficult to match this intervention to the patients who may benefit the most. It was suggested that SMT may influence mechanisms associated with central sensitisation. Therefore, classifying patients with CLBP according to central sensitisation mechanisms may help predict their response to SMT.

Methods and analysis: This protocol describes a randomised placebo-controlled trial aiming to examine which variables linked to central sensitisation may help predict the clinical response to SMT in a cohort of patients with CLBP. One hundred patients with chronic primary low back pain will be randomised to receive 12 sessions of SMT or placebo SMT over a 4–week period. Pain intensity and disability will be assessed as primary outcomes after completing the 4–week treatment (primary endpoint), and at 4–week and 12–week follow-ups. Baseline values of two pain questionnaires, lumbar pressure pain thresholds, concentrations of an inflammatory cytokine and expectations of pain relief will be entered as predictors of the response to SMT in a multiple regression model. Changes in these variables after treatment will be used in a second multiple regression model. The reference values of these predictors will be measured from 50 age and sex-matched healthy controls to allow interpretation of values in patients. Mixed analyses of variance will also be conducted to compare the primary outcomes and the predictors between groups (SMT vs placebo) over time (baseline vs post-treatment).

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Elevated Production of Nociceptive CC-chemokines

By Frank M. Painter|April 22, 2017|Low Back Pain, Spinal Joint Pain|

Elevated Production of Nociceptive CC-chemokines and sE-selectin in Patients with Low Back Pain and the Effects of Spinal Manipulation: A Non-randomized Clinical Trial

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SOURCE: Clin J Pain. 2017 (Apr 19) [Epub]

Julita A. Teodorczyk-Injeyan, PhD,
Marion McGregor, PhD, DC,
John J. Triano, DC, PhD,
H. Stephen Injeyan, PhD, DC

Graduate Education and Research Programs,
Canadian Memorial Chiropractic College,
Toronto, Ontario, Canada

BACKGROUND: The involvement of inflammatory components in the pathophysiology of low back pain is poorly understood. It has been suggested that spinal manipulative therapy (SMT) may exert anti-inflammatory effects.

PURPOSE: To determine the involvement of inflammation-associated chemokines (CC series) in the pathogenesis of non-specific low back pain and to evaluate the effect of SMT on that process.

METHODS: Patients presenting with non-radicular, non-specific low back pain (minimum pain score 3 on 10 point visual analogue scale, VAS) were recruited according to stringent inclusion criteria. They were evaluated for appropriateness to treat using a high velocity low amplitude manipulative thrust (HVLT) in the lumbar-lumbosacral region. Blood samples were obtained at baseline and following the administration of a series of 6 HVLTs on alternate days over the period of two weeks. The in vitro levels of CC chemokines (CCL2, CCL3 and CCL4) production and plasma levels of an inflammatory biomarker, soluble E-selectin, were determined at baseline and at the termination of treatments two weeks later.

RESULTS: Compared with asymptomatic controls baseline production of all chemokines was significantly elevated in acute (P=0.004 – <0.0001), and that of CCL2 and CCL4 in chronic LBP patients (P<0.0001). Furthermore, CCL4 production was significantly higher (P<0.0001) in the acute versus chronic LBP group. sE-selectin levels were significantly higher (P=0.003) in chronic but not in acute LBP patients. Following SMT, patient reported outcomes showed significant (P<0.0001) improvements in VAS and ODI scores. This was accompanied by a significant decline in CCL 3 production (P<0.0001) in both groups of patients. Change scores for CCL4 production differed significantly (P<0.0001) only for the acute LBP cohort, and no effect on the production of CCL2 or plasma sE-selectin levels was noted in either group.

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Spinal Pain in Danish School Children

By Frank M. Painter|April 7, 2017|Pediatrics, Spinal Joint Pain|

Spinal Pain in Danish School Children – How Often and How Long? The CHAMPS Study-DK

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SOURCE: BMC Musculoskelet Disord. 2017 (Mar 27); 18 (1): 67

Kristina Boe Dissing, Lise Hestbæk, Jan Hartvigsen,
Christopher Williams, Steven Kamper, Eleanor Boyle,
and Niels Wedderkopp

Department of Sports Science and Clinical Biomechanics,
Faculty of Health Sciences,
University of Southern Denmark,
Campusvej 55, DK-5230, Odense M, Denmark.

BACKGROUND: Spinal pain in children and adolescents is a common condition, usually transitory, but the picture of spinal pain still needs elucidation, mainly due to variation in measurement methods. The aim of this study was to describe the occurrence of spinal pain in 8-15 year-old Danish school children, over a 3-year period. Specifically determining the characteristics of spinal pain in terms of frequency and duration.

METHODS: The study was a 3-year prospective longitudinal cohort study including 1,400 school children. The outcomes were based on weekly text messages (SMS) to the parents inquiring about the child’s musculoskeletal pain, and on clinical data from examinations of the children.

RESULTS: The 3-year prevalence was 55%. The prevalence was 29%, 33% and 31% for each of the three study years respectively, and increased statistically significantly with age, especially for lumbopelvic pain. Most children had few and short-lasting episodes with spinal pain, but more than one out of five children had three or more episodes during a study year and 17% of all episodes lasted for more than 4 weeks.

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Complementary and Alternative Medicine Use by Children with Pain in the United States

By Frank M. Painter|March 28, 2017|Pediatrics, Spinal Joint Pain|

Complementary and Alternative Medicine Use by Children with Pain in the United States

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SOURCE: Acad Pediatr. 2017 (Feb 20). pii: S1876-2859(17)30063-3

Cornelius B. Groenewald, MBChB, Sarah E. Beals-Erickson, PhD, Jaime Ralston-Wilson, DAOM, LAc, Jennifer A. Rabbitts, MB, ChB, Tonya M. Palermo, PhD

Department of Anesthesiology and Pain Medicine,
University of Washington School of Medicine and Seattle Children’s Hospital.
M/S MB.11.500, 4800 Sand Point Way NE,
Seattle, WA 98105, USA.

OBJECTIVE: Chronic pain is reported by 15-25% of children. Growing evidence from clinical samples suggests that complementary and alternative medicine (CAM) therapies are desired by families and may benefit some children with pain conditions. The objective of this study is to provide estimates of CAM use by children with pain in the United States.

METHODS: We analyzed data from the 2012 National Health Interview Survey (NHIS) to estimate patterns, predictors, and perceived benefits of CAM use among children 4-17 years of age with and without painful conditions in the US. We used χ² tests to compare the prevalence rates of CAM use among children with pain to CAM use among children without pain. Multivariable logistic regression was used to examine factors associated with CAM use within the group of children with pain conditions.

RESULTS: Parents reported that 26.6% of children had pain conditions (e.g. headache, abdominal, musculoskeletal pain) in the past year; of these children, 21.3% used CAM. In contrast only 8.1% of children without pain conditions used CAM (χ²: p<.001). CAM use among children with pain was associated with female sex (adjusted odds ratio (aOR)=1.49, p=0.005), higher income (aOR=1.61, p=0.027), and presence of 4+ comorbidities (aOR=2.01, p=0.013). Among children with pain who used CAM the 2 most commonly used CAM modalities were biologically-based therapies (47.3%) (e.g., special diets and herbal supplements) and manipulative or body-based therapies (46.3%) (e.g., chiropractic and massage).

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Prevalence and Tracking of Back Pain From Childhood to Adolescence

By Frank M. Painter|May 17, 2016|Pediatrics, Spinal Joint Pain|

Prevalence and Tracking of Back Pain From Childhood to Adolescence

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SOURCE: BMC Musculoskelet Disord. 2011 (May 16); 12: 98

Per Kjaer, Niels Wedderkopp, Lars Korsholm
and Charlotte Leboeuf-Yde

Institute of Sports Science and Clinical Biomechanics,
Part of Clinical Locomotion Network,
University of Southern Denmark,
Campusvej 55, DK-5230, Odense, Denmark.

BACKGROUND: It is generally acknowledged that back pain (BP) is a common condition already in childhood. However, the development until early adulthood is not well understood and, in particular, not the individual tracking pattern. The objectives of this paper are to show the prevalence estimates of BP, low back pain (LBP), mid back pain (MBP), neck pain (NP), and care-seeking because of BP at three different ages (9, 13 and 15 years) and how the BP reporting tracks over these age groups over three consecutive surveys.

METHODS: A longitudinal cohort study was carried out from the years of 1997 till 2005, collecting interview data from children who were sampled to be representative of Danish schoolchildren. BP was defined overall and specifically in the three spinal regions as having reported pain within the past month. The prevalence estimates and the various patterns of BP reporting over time are presented as percentages.

RESULTS: Of the 771 children sampled, 62%, 57%, and 58% participated in the three back surveys and 34% participated in all three. The prevalence estimates for children at the ages of 9, 13, and 15, respectively, were for BP 33%, 28%, and 48%; for LBP 4%, 22%, and 36%; for MBP 20%, 13%, and 35%; and for NP 10%, 7%, and 15%. Seeking care for BP increased from 6% and 8% at the two youngest ages to 34% at the oldest. Only 7% of the children who participated in all three surveys reported BP each time and 30% of these always reported no pain. The patterns of development differed for the three spinal regions and between genders. Status at the previous survey predicted status at the next survey, so that those who had pain before were more likely to report pain again and vice versa. This was most pronounced for care-seeking.

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Pain Characteristics of Adolescent Spinal Pain

By Frank M. Painter|December 4, 2015|Pediatrics, Spinal Joint Pain|

Pain Characteristics of Adolescent Spinal Pain

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SOURCE: BMC Pediatr. 2015 (Apr 17); 15 (1): 42 ~ FULL TEXT

Brigitte Wirth and B Kim Humphreys

Institute of Human Movement Sciences and Sport,
ETH Zurich, Wolfgang Pauli Str. 27,
Zurich, 8093, Switzerland

BACKGROUND: Although adolescent spinal pain increases the risk for chronic back pain in adulthood, most adolescents can be regarded as healthy. The aim of the present study was to provide data on localization, intensity and frequency of adolescent spinal pain and to investigate which physical and psycho-social parameters predict these pain characteristics.

METHOD: On the occasion of Spine Day, an annual event where children and adolescents are examined by chiropractors on a voluntary basis for back problems, 412 adolescents (10 to 16 years) were tested (by questionnaire and physical examination). Pain characteristics (localization, intensity, and frequency) were identified and evaluated using descriptive statistics. Regression analyses were performed to investigate possible influencing psycho-social and physical influence factors.

RESULTS: Adolescents who suffered from pain in more than one spinal area reported higher pain intensity and frequency than those with pain in only one spinal area. Sleep disorders were a significant predictor for pain in more than one spinal area (p < 0.01) as well as a trend for frequent pain (p = 0.06). Adolescents with frequent pain showed impaired balance on one leg standing with closed eyes (p = 0.02).

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