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Doctors Ignoring Evidence for Back Pain Treatment

Medical doctors are increasingly ignoring the recommended guidelines for treating back pain, a new study from the Journal of American Medical Association finds.

Researchers from the Beth Israel Deaconess Medical Center in Boston examined records for 23,918 doctor visits related to back pain between 1999 and 2000. They discovered that medical doctors are actually getting worse at employing evidence-based treatments.

Current guidelines from the American Medical Association recommend that acute back pain be treated first with conservative, active treatments like chiropractic care and exercise rehabilitation. Over-the-counter non-steroidal anti-inflammatory drugs can be used to ease short-term pain, rather than narcotics like Oxycontin which can actually make matters worse, according to recent research.

However researchers found that physicians are overprescribing narcotics and overusing expensive testing.

During the study period, prescriptions for narcotics grew from 19.3% to 29.1%, reflecting a national trend of growing opioid use. Lead researcher, Dr. John Mafi, explained that during the 1990s medical doctors were widely accused of ignoring patients' pain. While some of the criticism was valid, many physicians overreacted by doling out more serious painkillers. Now around 43% of patients with back pain show signs of substance abuse disorders, Mafi and his colleagues found.

Doctors are also relying too heavily on imaging techniques no longer deemed necessary for every type of spinal pain. Use of MRI and CT scans grew from 7.2% to 11.3% during the study period, despite research demonstrating such scans are not always useful for many cases of back and neck pain. Although these scans do not harm the patient, they typically don't find anything wrong, and can cost around $1,000 per a scan.

That may be why patients under standard medical care tend have more medical costs associated with their back pain treatment compared to chiropractic patients, according to a recent study. Chiropractic patients can also expect to receive evidence-based treatments like exercise therapy and spinal adjustments. A study of military personnel with back pain earlier this year  found that those treated by a chiropractor had better results compared to patients treated with standard medical care alone.

Reference

Mafi JN, et al. Worsening trends in the management and treatment of back pain. JAMA 2013; doi:10.1001/jamainternmed.2013.8992.

 

 

Safety of Chiropractic Neck Adjustments Confirmed

Spinal manipulation therapy is a widely-accepted method for treating back pain, neck pain, and headaches. Although previous studies have pointed to the safety of chiropractic neck adjustments, there has been some concern about the effect of the forces applied during spinal manipulation of the neck. It has been argued that there is the possibility of damaging the internal carotid artery (ICA) by such force. Previously, little was known about the strains sustained by the ICA during spinal manipulation therapy. In a recent study, researchers sought to examine the mechanics of the ICA during neck manipulation to determine whether spinal manipulation causes strains in excess of those experienced during normal everyday movements.

The researchers measured strains applied to the internal carotid artery (ICA) during neck spinal manipulation treatments. Peak and average ICA strains were measured in 6 cadaver spines during cervical spinal manipulation performed by chiropractic doctors. These number were compared with the corresponding strain experienced during diagnostic testing of the head and neck to simulate normal everyday movements.

The researchers found that ICA strains were no different during chiropractic manipulation of the neck than during normal everyday movements. Therefore, cervical spinal manipulation performed by trained chiropractors does not appear to place undue strain on the ICA.

Earlier research has also demonstrated the safety of chiropractic neck adjustments. In an extensive literature review from the medical journal Spine, researchers analyzed data from 28,807 chiropractic patients receiving a total of 50, 276 adjustments of the cervical spine.  Among the thousands of adjustments made, the only negative side effect reported was temporary, mild dizziness; no serious side effects were reported.

Studies show that chiropractic neck adjustments can reduce pain in patients with neck disorders,whiplash, dizziness, and headaches.

References

Herzog W, Tang C, Leonard T. Internal Carotid Artery Strains During High-Speed, Low-Amplitude Spinal Manipulations of the Neck. Journal of Manipulative and Physiological Therapeutics 2012; pii: S0161-4754(12)00156-X. doi: 10.1016/j.jmpt.2012.09.005.

 

Preventing Whiplash With Head Restraints

Whiplash injuries are an expensive and painful problem in the US. Experts estimate that we spend $29 billion per year in treating the pain and disability that can result from a rear-end collision.


But there are steps you can take to protect yourself from whiplash injury. The key to good whiplash protection is your head restraint. Numerous studies have shown that most people have an improperly adjusted head restraint, commonly called a head rest.

Whiplash injury occurs when your torso moves in one direction while your head moves in another direction. This can put hundreds of pounds of force on the delicate ligaments of your neck.

The key to good head restraint positioning is to eliminate or reduce the amount of space that your head can move. By doing that, it reduces the strain put on your neck. Your head restraint needs to be placed so that the back of your head is level with the middle of the restraint, and your seat needs to be positioned so that your head is very close. You want to have a maximum of 2.5 inches between your head and the restraint.

While car crashes are often out of your control, you can properly adjust your head restraint to reduce the chance of neck injury during a rear-end collision.

If you've already been injured in a crash, it's important to get treatment right away. Research suggests that chiropractors can provide effective treatments for many patients with whiplash-associated disorders.

References

Freeman MD, et al. A review and methodologic critique of the literature refuting whiplash syndrome. Spine 1999; 24 (1): 86-96.

Prevent Injury, Adjust your Headrest. CAA South Central Ontario.   http://www.caasco.com/insurance/auto-vehicle-insurance/adjust-your-headrest.jsp.

How to Adjust Your Head Restraint. The Royal Society for the Prevention of Accidents. http://www.rospa.com/roadsafety/info/adjust_head_restraints.pdf.

 

Chiropractic Plus Exercise Eases Cervicogenic Headache, Study Suggests

Many headaches arise from cervical musculoskeletal disorders. Often, conservative therapies are recommended as the first treatment for cervicogenic headache, but it was previously unclear which treatments were the most effective. Should patients be prescribed a set of exercises and physical therapy sessions, chiropractic adjustments, or both? Will one lead to better outcomes?

A 2002 study sought to answer these questions by examining the effectiveness of a combination treatment involving both chiropractic adjustments and an exercise program. Two-hundred participants with chronic, moderate intensity cervicogenic headaches were assigned to one of four groups: spinal adjustments, exercise therapy, combined therapy, and a control group. Over six weeks of treatment, they reported their headache frequency, intensity, duration, pain, medication intake, and satisfaction with treatment. Researchers also measured physical outcomes such as pain on neck movement and a photographic measure of posture.

The study showed that all three active treatments (chiropractic adjustments, exercise, and a combination of both) were effective for improving the symptoms of cervicogenic headache, with benefits maintained at least 12 months following treatment. There was no statistical evidence of an additive effect when both chiropractic manipulation and exercise therapy were used simultaneously. Despite patients receiving combined treatments experienced the same clinical benefits as patients in the stand-alone treatment groups, a greater proportion of participants in the combined treatment group experienced good or excellent outcomes. This supports the use of combined treatments for the management of cervicogenic headaches.

Combining chiropractic with exercise can also ease symptoms in patients with neck and back pain.

Reference

Jull G, Trott P, Potter H, et al. A randomized controlled trail of exercise and manipulative therapy for cervicogenic headache. Spine 2002; 27(17):1835-1843.

 

 

Chiropractic Relieves Radicular Pain for 85% of Patients

​Recent research suggests that a multimodal chiropractic treatment can effectively ease radicular pain.

Radiculopathy, or radicular pain, is a condition related to compression of the spinal nerve roots. This nerve impingement can lead to  pain, numbness, tingling, or weakness in parts of the body far from the original source. Radiculopathy is often disabling, and there is little information regarding the most effective course of treatment, though both surgical and non-surgical approaches are common.

A recent review examined the outcomes of conservative, non-surgical treatment of patients with radiculopathy. This review involved 162 patients with a diagnosis of radiculopathy who were treated with chiropractic spinal adjustments, neuromobilization, and exercise stabilization. The frequency and duration of care were determined on an individual patient, though most patients underwent treatment 2 to 3 times per week.

85.5% of the patients experienced resolution of their radicular complaints, after undergoing an average of 9 treatment sessions. Patients experienced an average change in numeric pain scale of 4.2 between the initial and final visit. 23 cases were considered unresolved; those patients were referred for steroid injection, further medication management, or surgery. The researchers concluded that the conservative management strategy explored here produced favorable outcomes for most radiculopathy patients.

This study adds to the knowledge surrounding radiculopathy treatments by demonstrating that a conservative approach utilizing spinal adjustments, in combination with neuromobilization and stabilization exercise, may be effective for the majority of patients with radicular pain.

Reference

Christensen KD, Buswell K. Chiropractic outcomes managing radiculopathy in a hospital setting: a retrospective review of 162 patients. Journal of Chiropractic Medicine 2008; 7 (3): 115-25.

 

Chiropractic Eases Infant Colic, Study Suggests

As if sleepless nights and endless crying weren't enough, parents of infants with colic often endure a string of unsuccessful treatments and frustrating doctors visits as they struggle to fight the elusive condition. But new research offers hope to parents searching for natural treatment of infant colic: chiropractic therapies produced clinically and statistically significant reductions in crying time in colicky babies in a recent study.

Previous research has examined the effects of chiropractic therapies on colic with inconclusive results. In a 2006 study from Britain and in a 1999 Danish study, manual therapy was associated with significant reductions in crying time. In both studies however, parents were not blinded to the treatment infants received, leading critics to worry that parents' knowledge of the treatment biased their reporting on infant crying time. In a 2002 Norwegian study that did blind parents to the treatment, no significant differences were found between a manual therapy and a placebo treatment. In still another study, two different manual therapies reduced crying time but there were no placebos for comparison. These varying results meant that although some evidence pointed to the benefits of chiropractic care for colic, questions lingered about parental bias and treatment efficacy.

Researchers from the Anglo-European College of Chiropractic sought to investigate these questions in a study of 104 infants with colic. They divided the patients into three groups: in the first group, the infants were treated and the parents were aware of treatment; in the second group the infants were treated and the parents were blinded to treatment; and in the third group the infants were not treated and the parents were blinded to the lack of treatment.

After ten days, all three groups had significant reductions in crying time but the infants in the treatment groups saw greater improvements. Babies who received chiropractic therapies cried for an average of 1.5 hours less than untreated infants. Treated infants with blinded parents had a 44% reduction in crying time, compared to a 51% reduction in crying time for infants with parents who were aware of treatment. Those who received no treatment had just an 18% reduction in crying time. The slight differences between treatment groups were not statistically significant, suggesting that parental bias did not substantially alter reporting of crying time. The improvements were considered clinically significant by two cutoffs: a reduction in crying time by 30% and crying for 2 hours or less a day.

Researchers pointed to studies showing that moderate finger pressure can induce a relaxation response in adults, decreasing heart rate and increasing alpha and beta brainwave activity. Other studies have found that manual impulse can similarly result in reduced heart rate in infants. This relaxation response could be a potential mechanism behind the reduced crying time. If colic is indeed related to musculoskeletal conditions as hypothesized by some authors, manual therapies could also address underlying musculoskeletal disorders.

While larger studies are needed to confirm these results, the study suggests that chiropractic therapies could be beneficial for infants with colic. Previous research suggests that chiropractors can play a role in treating colic related to infant headache. Doctors of chiropractic can also advise you in making nutritional and dietary changes to minimize allergic reactions that may also be an underlying cause of colic.

References

Miller J, Newell D, and Bolton J. Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic, Single-Blind, Randomized Controlled Trial. Journal of Manipulative and Physiological Therapeutics 2012; 35 (8): 600-607.

Marchland AM, Miller JE, Mitchell C. Diagnosis and Chiropractic Treatment of Infant Headache Based on Behavioral Presentation and Physical Findings: A Retrospective Series of 13 Cases.  Journal of Manipulative and Physiological Therapeutics 2009; 32 (8): 682-686.

 

 

 

Chiropractic Offers Holistic Approach to Carpal Tunnel Syndrome

Many patients with chronic carpal tunnel syndrome are told they need surgery to relieve the pain. While surgical interventions aim to relieve pressure on the irritated median nerve, the treatment may be too narrow in scope for some patients. Case in point: nearly a third of patients who receive surgery for carpal tunnel report a return in symptoms within two years of surgery.1

Recent research suggests there's more to carpal tunnel than wrist and arm pain: CTS could be related to problems in the neck.

A recent study from Journal of Orthopaedic and Physical Therapy assessed the cervical range of motion in 71 women with carpal tunnel syndrome. Compared to women without CTS, women with carpal tunnel had significantly restricted range of motion. The greater the pain intensity women experienced, the less able they were to perform lateral flexion away from the affected side. There were no major difference among women with minimal, moderate, or severe CTS.

This study confirms what chiropractors have known for years: that wrist pain can often be related to problems in the cervical spine. In fact, the cervical spine may be the source of wrist and arm pain for patients with cervical radiculopathy. That's why chiropractors use a more holistic approach to treating carpal tunnel syndrome, one that involves relieving irritation of the median nerve in addition to addressing any underlying concerns in the neck. Chiropractors can draw on a combination of spinal adjustments, trigger point therapy, exercises, and advice on ways to prevent overuse injuries.

Research shows that this holistic approach is successful for many patients with carpal tunnel. A 2010 study found that trigger point therapy administered by chiropractors resulted in 67% improvement in symptoms.2

In another study published earlier, CTS patients who received soft tissue mobilization and other chiropractic treatments had significantly reduced hand pain intensity after just a week of treatment. They also showed signs of reduced pain sensitivity in certain joints of the cervical spine.3

Case studies also suggest that chiropractic can be effective for chronic CTS patients who failed to improve with other methods like surgery, wrist splints, and drugs.4

If you suffer from ongoing wrist pain and CTS, remember that surgery is not your only option for relief. Chiropractic care could address the multifaceted nature of your pain to provide lasting relief of carpal tunnel syndrome.

 References

1. Bessette L, Keller RB, Liang MH, Simmons BP, Fossel AH, Katz JN. Patients’ preferences and their relationship with satisfaction following carpal tunnel release. Journal of Hand Surgery 1997;22:613–20. Quoted in Hains G, et al (2010).

2. Hains G, Descarreaux M, Lamy AM, Hains F. A randomized controlled (intervention) trial of ischemic compression therapy for chronic carpal tunnel syndrome. Journal of the Canadian Chiropractic Association 2010; 54(3): 155–163.

3. De-la-llave-Rincon, A. Response of pain intensity to soft tissue mobilization and neurodynamic technique: a series of 18 patients with chronic carpal tunnel syndrome. Journal of Manipulative and Physiological Therapeutics 2012; doi:10.1016/j.jmpt.2012.06.002.

4. Crafts GJ, et al. Chiropractic management of work-related upper limb disorder complicated by intraossesous ganglion cysts: a case report. Journal of Chiropractic Medicine 2011; 10(3): 166-172.

 

Chiropractic and Exercise is Perfect Combination for Back Pain Treatment

An estimated 60-80% of people will suffer from low-back pain at least once in their lifetime. However, the treatment of chronic lower back pain is complex, and the outcome remains unpredictable. Doctors are advised to recommend that patients follow a program of active exercise to alleviate their symptoms. However, patients may be reluctant to do so because of their pain.

A recent study compared the effects of chiropractic treatment followed by exercise versus a placebo or 'sham' treatment followed by the same exercise. The researchers hypothesize that chiropractic adjustments – which are believed to induce an immediate analgesic effect – may enhance the benefits of exercise for patients with lower back pain.

The study involved patients with chronic, non-specific lower back pain. The first group received spinal adjustments plus active exercise therapy. The second group received a detuned ultrasound 'sham' treatment followed by active exercise. Both groups underwent eight treatment sessions over 4 to 8 weeks.

The analgesic effect of spinal adjustments were measured by evaluating pain intensity both before and immediately after each therapeutic session. Periodically, researchers also evaluated participants' disability, fear-avoidance beliefs, and erector spinae and abdominal muscle endurance (measured with Sorensen and Shirado tests).

The participants who received spinal adjustments experienced a better immediate analgesic effect, along with lower disability and a trend toward lower pain levels. The researchers concluded that manual therapy, immediately followed by active exercise, tends to induce a more significant decrease in pain reduction in patients with chronic lower back pain. These results confirm that chiropractic is an appropriate treatment for chronic low-back pain.

While exercise has long been a crucial component of chiropractic care, this study provides further evidence of the efficacy of combining exercise with chiropractic adjustments for relieving chronic pain.

Reference

Balthazard P, et al. Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial. BMC Musculoskeletal Disorders 2012; 13: 162. doi:10.1186/1471-2474-13-162.

 

Chiropractic for Kids

More and more children are receiving chiropractic care and there's a good reason why: chiropractic provides safe, natural treatment for a number of conditions while promoting wellness.


 

 

Multiple studies point to the safety of chiropractic for kids. In a 2012 survey of European chiropractors, fewer than 1% of children experienced side effects from chiropractic treatments, and those side effects were all mild,1 This confirms the results of three other studies in which no serious side effects were reported in pediatric patients receiving chiropractic treatment.

Research suggests that chiropractic can safely relieve musculoskeletal pain in children. In a 2003 study, 62% of pediatric patients had substantial reductions in back pain after receiving chiropractic adjustments.3 Treatment of musculoskeletal conditions continues to be the number one reason why children receive chiropractic care.

But chiropractic does more than treat conditions, it can help children improve their health through wellness care. In a 2009 survey, one of the primary reasons why parents took their child to see a chiropractor was for wellness care.4

Current research shows that chiropractic can reduce blood pressure, heart rate, and stress hormones, release endorphins, and boost the immune system.

Whether you're hoping to ease your child's pain or improve their health, chiropractic can help.

 

References

1. Marchland A. Chiropractic care of children from birth to adolescence and classification of reported conditions: an Internet cross-sectional survey of 956 European chiropractors. Journal of Manipulative and Physiological Therapeutics 2012; 35 (5):372-380.

2. Humpheys BK. Possible adverse events in children treated by manual therapy: a review. Chiropr Osteopat. 2010;18: doi:  10.1186/1746-1340-18-12.

3. Hayden Ja, Mior SA, Verhoef MJ. Evaluation of chiropractic management of pediatric patients with low back pain: a prospective cohort study. J Manipulative Physiol Ther. 2003 ;26(1):1-8.

4. Alcantara J, Ohm J, Kunz D. The safety and effectiveness of pediatric chiropractic: a survey of chiropractors and parents in a practice-based research network. Explore NY 2009; 5(5): 290-5.