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Complementary and Integrated Health Approaches

By |May 3, 2019|Alternative Medicine, Veterans|

Complementary and Integrated Health Approaches: What Do Veterans Use and Want

The Chiro.Org Blog


SOURCE:   J Gen Intern Med. 2019 (Apr 22) [Epub]

Stephanie L. Taylor, PhD, Katherine J. Hoggatt, MPH, and Benjamin Kligler, MD, MPH

Center for the Study of Healthcare Innovation,
Implementation and Policy,
Greater Los Angeles VA Healthcare System,
Los Angeles, CA, USA.


OBJECTIVES:   Non-pharmacological treatment options for common conditions such as chronic pain, anxiety, and depression are being given increased consideration in healthcare, especially given the recent emphasis to address the opioid crisis. One set of non-pharmacological treatment options are evidence-based complementary and integrative health (CIH) approaches, such as yoga, acupuncture, and meditation. The Veterans Health Administration (VHA), the nation’s largest healthcare system, has been at the forefront of implementing CIH approaches, given their patients’ high prevalence of pain, anxiety, and depression. We aimed to conduct the first national survey of veterans’ interest in and use of CIH approaches.

METHODS:   Using a large national convenience sample of veterans who regularly use the VHA, we conducted the first national survey of veterans’ interest in, frequency of and reasons for use of, and satisfaction with 26 CIH approaches (n = 3346, 37% response rate) in July 2017.

RESULTS:   In the past year, 52% used any CIH approach, with 44% using massage therapy, 37% using chiropractic, 34% using mindfulness, 24% using other meditation, and 25% using yoga. For nine CIH approaches, pain and stress reduction/relaxation were the two most frequent reasons veterans gave for using them. Overall, 84% said they were interested in trying/learning more about at least one CIH approach, with about half being interested in six individual CIH approaches (e.g., massage therapy, chiropractic, acupuncture, acupressure, reflexology, and progressive relaxation). Veterans appeared to be much more likely to use each CIH approach outside the VHA vs. within the VHA.

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Differences in Pain-related Characteristics Among Younger

By |July 15, 2018|Veterans|

Differences in Pain-related Characteristics Among Younger and Older Veterans Receiving Primary Care

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SOURCE:   Pain Med. 2002 (Jun);   3 (2):   102–107

M. Carrington Reid, PhD, MD Kimberly T. Crone, PhD John Otis, PhD Robert D. Kerns, PhD

Clinical Epidemiology Unit,
VA Connecticut Healthcare System,
West Haven, Connecticut 06516, USA.


Editorial Comment:

The most disturbing comment in this article was:

Furthermore, the vast majority of respondents reported that the pain causing them the most discomfort had been present for years:   Over 90% of all respondents reported a pain duration of greater than 6 months, suggesting that chronic (as opposed to acute) pain conditions are more concerning to veterans receiving primary care.

OBJECTIVES:   To characterize the nature of pain complaints among younger and older veterans receiving primary care, and to determine whether characteristics of pain vary as a function of age.

METHODS:   Primary care patients at a Veterans Affairs medical center were screened for pain prior to a routine office visit, and those who endorsed a concern about pain were given a self-administered questionnaire that inquired about specific characteristics of their pain including site, duration, frequency, and average intensity of the pain.

RESULTS:   Over a 7–month period, 1,290 patients were screened; 641 (50%) reported a concern about pain, and of these, 516 (82%) completed the pain survey. Among younger (age <65 years, N = 191) and older (age > or =65 years, N = 325) respondents, the mean number of sites causing pain was similar (3.6 vs 3.3). Back pain was the most frequently reported site of pain causing the most discomfort among younger (vs older) respondents (31.9% vs 17.8%), whereas older (vs younger) respondents most often endorsed leg pain (32.3% vs 19.9%). The mean duration of pain was not significantly different between older and younger (10.7 vs 10.1 years) respondents; but older (vs younger) respondents were more likely to report constant pain (63.7% vs 46.9%). Using a 0 to 10 numeric rating scale, pain intensity scores were higher among younger (vs older) respondents (5.3 vs 4.3). Rates of prescription pain medication use were not significantly different (52.4% vs 48.0%). Compensation for pain-related disability was more common among younger (vs older) respondents (40.4% vs 19.4%).

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Characteristics of Veterans Health Administration Chiropractors

By |June 10, 2018|Veterans|

Characteristics of Veterans Health Administration Chiropractors and Chiropractic Clinics

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SOURCE:   J Rehabil Res Dev. 2009; 46 (8): 997–1002

Anthony J. Lisi, DC; Christine Goertz, DC, PhD; Dana J. Lawrence, DC, MMedEd; Preeti Satyanarayana, MD, MPH

Veterans Health Administration,
Office of Rehabilitation Services,
Washington, DC


Chiropractic services have been delivered on station at select Veterans Health Administration (VHA) medical facilities since late 2004. No published data describing the characteristics of VHA chiropractic physicians (chiropractors) and chiropractic clinics exist at a national level. This study was designed to examine elements of the structures of chiropractic services in VHA settings. Web-based survey methods were used to question all chiropractors in VHA facilities (N = 36). Data were obtained from 33 providers, yielding a 91.6% response rate. Most respondents were full-time VHA employees, while others were part-time employees or contractors. Differences were found in prior training, integrated practice, and academic or research experience. Of the respondents, 88% ranked low back pain as the most common patient complaint seen in practice and 79% ranked cervical pain the second most common complaint. Of the new patient consultations, 67.6% originated from primary care, 9.4% from pain management, and 6.2% from physiatry. Most respondents were similar in their reported use of diagnostic and therapeutic procedures, but their reported rates of participation in various facility activities were different. Further work is needed for researchers and policy makers to more fully understand the integration and delivery of chiropractic services in VHA settings.

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Spine-area Pain in Military Personnel

By |May 29, 2018|Veterans|

Spine-area Pain in Military Personnel: A Review of Epidemiology, Etiology, Diagnosis, and Treatment

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SOURCE:   Spine J. 2012 (Sep); 12 (9): 833-842

Steven P. Cohen, MD, Rollin M. Gallagher, MD, MPH, Shelton A. Davis, MD, Scott R. Griffith, MD, Eugene J. Carragee, MD

Pain Management Division, Department of Anesthesiology & Critical Care Medicine,
Johns Hopkins School of Medicine,
Baltimore, MD 21205, USA.


BACKGROUND CONTEXT:   non-battle illnesses and injuries are the major causes of unit attrition in modern warfare. Spine-area pain is a common disabling injury in service members associated with a very low return-to-duty (RTD) rate.

PURPOSE:   To provide an overview of the current understanding of epidemiology, possible causes, and relative prognosis of spine-area pain syndromes in military personnel, including a discussion of various treatment options available in theaters of operation.

STUDY DESIGN:   Literature review.

METHODS:   Search focusing on epidemiology, etiology and associative factors, and treatment of spinal pain using electronic databases, textbooks, bibliographic references, and personal accounts.

RESULTS:   Spine-area pain is the most common injury or complaint “in garrison” and appears to increase during training and combat deployments. Approximately three-quarters involve low back pain, followed by cervical and midback pain syndromes. Some predictive factors associated with spine-area pain are similar to those observed in civilian cohorts, such as psychosocial distress, heavy physical activity, and more sedentary lifestyle. Risk factors specific to military personnel include concomitant psychological trauma, g-force exposure in pilots and airmen, extreme shock and vibration exposure, heavy combat load requirements, and falls incurred during airborne, air assault, and urban dismounted ground operations. Effective forward-deployed treatment has been difficult to implement, but newer strategies may improve RTD rates.

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Effect of Usual Medical Care Plus Chiropractic Care vs Usual

By |May 23, 2018|Low Back Pain, Veterans|

Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone
on Pain and Disability Among US Service Members With Low Back Pain.
A Comparative Effectiveness Clinical Trial

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SOURCE:   JAMA Network Open. 2018 (May 18); 1 (1): e180105

Christine M. Goertz, DC, PhD 1; Cynthia R. Long, PhD 1; Robert D. Vining, DC 1; Katherine A. Pohlman, DC, MS 2; Joan Walter, JD, PA 3; Ian Coulter, PhD 4

(1) Palmer College of Chiropractic,
Palmer Center for Chiropractic Research,
Davenport, Iowa

(2) Parker University Research Institute,
Dallas, Texas

(3) Samueli Institute for Information Biology,
Silver Spring, Maryland

(4) RAND Corporation,
Santa Monica, California


Importance   It is critically important to evaluate the effect of nonpharmacological treatments on low back pain and associated disability.

Objective   To determine whether the addition of chiropractic care to usual medical care results in better pain relief and pain-related function when compared with usual medical care alone.

Design, Setting, and Participants   A 3–site pragmatic comparative effectiveness clinical trial using adaptive allocation was conducted from September 28, 2012, to February 13, 2016, at 2 large military medical centers in major metropolitan areas and 1 smaller hospital at a military training site. Eligible participants were active-duty US service members aged 18 to 50 years with low back pain from a musculoskeletal source.

Interventions   The intervention period was 6 weeks. Usual medical care included self-care, medications, physical therapy, and pain clinic referral. Chiropractic care included spinal manipulative therapy in the low back and adjacent regions and additional therapeutic procedures such as rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies.

Main Outcomes and Measures   Coprimary outcomes were low back pain intensity (Numerical Rating Scale; scores ranging from 0 [no low back pain] to 10 [worst possible low back pain]) and disability (Roland Morris Disability Questionnaire; scores ranging from 0–24, with higher scores indicating greater disability) at 6 weeks. Secondary outcomes included perceived improvement, satisfaction (Numerical Rating Scale; scores ranging from 0 [not at all satisfied] to 10 [extremely satisfied]), and medication use. The coprimary outcomes were modeled with linear mixed-effects regression over baseline and weeks 2, 4, 6, and 12.

Results   Of the 806 screened patients who were recruited through either clinician referrals or self-referrals, 750 were enrolled (250 at each site). The mean (SD) participant age was 30.9 (8.7) years, 175 participants (23.3%) were female, and 243 participants (32.4%) were nonwhite. Statistically significant site × time × group interactions were found in all models. Adjusted mean differences in scores at week 6 were statistically significant in favor of usual medical care plus chiropractic care compared with usual medical care alone overall for low back pain intensity (mean difference, –1.1; 95% CI, –1.4 to –0.7), disability (mean difference, –2.2; 95% CI, –3.1 to –1.2), and satisfaction (mean difference, 2.5; 95% CI, 2.1 to 2.8) as well as at each site. Adjusted odd ratios at week 6 were also statistically significant in favor of usual medical care plus chiropractic care overall for perceived improvement (odds ratio = 0.18; 95% CI, 0.13–0.25) and self-reported pain medication use (odds ratio = 0.73; 95% CI, 0.54–0.97). No serious related adverse events were reported.

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Chiropractic Care Improves Usual Management for Low Back Pain

By |May 22, 2018|Veterans|

Chiropractic Care Improves Usual Management for Low Back Pain

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SOURCE:   Medscape Medical News ~ May 21, 2018


Adding chiropractic care to standard medical management of low back pain (LBP) in a military population reduced patient-reported pain and disability and improved satisfaction scores compared with standard treatment alone, new data show.

The findings, reported by Christine M. Goertz, DC, PhD, from Palmer College of Chiropractic, Davenport, Iowa, and colleagues in an article published online May 18 in JAMA Network Open, confirm results from the team’s pilot study.

In addition, the new data align with recent guidelines from the American College of Physicians that recommend inclusion of spinal manipulation, among other nondrug treatments, as first-line therapy for acute and chronic low-back pain.

For the current study, Goertz and colleagues enrolled 750 active-duty US service members aged 18 to 50 years with LBP from three military facilities in a pragmatic comparative effectiveness trial.

Patients were screened between September 28, 2012, and November 20, 2015, and 250 patients from each of the study sites were allocated to receive usual medical care with chiropractic care (375 participants) or usual medical care alone (375 participants). Usual medical care was defined as any care recommended or prescribed by nonchiropractic military clinicians to treat LBP, including self-management advice, drug treatment, physical therapy, or referral to a pain clinic.

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