05.17.13

Once Again Another Study Shows Manipulation Helps Back Pain

Posted in Chiropractic, Manual Therapy Works at 3:58 PM by Dr. Greathouse

Hey it works! Study after study demonstrates this and it’s safe too.

So, if you have back or neck pain, give it a go.

Spine:

01 April 2013 – Volume 38 – Issue 7 – p 540–548

doi: 10.1097/BRS.0b013e318275d09c

Randomized Trial

Abstract

Study Design. A randomized, double-blinded, placebo-controlled, parallel trial with 3 arms.

Objective. To investigate in acute nonspecific low back pain (LBP) the effectiveness of spinal high-velocity low-amplitude (HVLA) manipulation compared with the nonsteroidal anti-inflammatory drug diclofenac (anti-inflammatory) and with placebo.

Summary of Background Data. Few studies have evaluated the effectiveness of spinal manipulation in comparison to nonsteroidal anti-inflammatory drugs or placebo regarding satisfaction and function of the patient, off-work time, and rescue medication.

Methods. The subjects were randomized to 3 groups:

(1) spinal manipulation and placebo-diclofenac;

(2) sham manipulation and diclofenac;

(3) sham manipulation and placebo-diclofenac.

Results. Comparing the 2 intervention groups, the manipulation group was significantly better than the diclofenac group (Mann-Whitney test: P = 0.0134). No adverse effects or harm was registered.

Conclusion. In a subgroup of patients with acute nonspecific LBP, spinal manipulation was significantly better than nonsteroidal anti-inflammatory drug diclofenac and clinically superior to placebo.

04.18.13

Chiropractic vs Drugs

Posted in Chiropractic, Manual Therapy Works, Pain Management, Truths About Back & Neck Pain at 12:08 PM by Dr. Greathouse

Organized medicine considers chiropractic as a “first-line” solution to the opioid epidemic.

Prominent among prescription drug related deaths and emergency department visits are opioid pain relievers (OPR), also known as narcotics or opioid analgesics, a class of drugs that includes Oxycodone, Methadone, and Hydrocodone, among others. OPR’s now account for more overdose deaths than heroin and cocaine combined!
DeBar et al. (2011) reports alarming recent data showing the significant increase in pain med prescription use and the need to seek viable alternatives.

In 2012, Dr. William Owens, a chiropractor from Buffalo, New York, was conferred as an adjunct associate clinical professor at the State University of New York at Buffalo School of Medicine and Biomedical Sciences, Family Medical Practice. He was invited to participate in the research department, to consider a formal study showing the benefits of family practitioners comanaging cases with chiropractors.

Ciffuentes et al., 2011 showed that care provided by physical therapists or physician services was associated with higher disability recurrence than with chiropractic services. Additionally, those cases treated with chiropractic consistently tended to have lower severity, less pain med use and less surgery. Also, the cases were less costly and the patients experienced shorter initial periods of disability.

Other outcome studies show that when chiropractic care was pursued, the cost of treatment was reduced by 28%, hospitalizations reduced by 41%, back surgery was reduced by 32%, and the cost of medical imaging, including x-rays and MRIs was reduced by 37%.

Hey, for what it’s worth, this is pretty much par for the course! Chiropractic outcome studies have always been good. Of course, some chiros abuse the system and give us all a black eye, but, for the most part we do well in managing acute, subacute and chronic spinal problems as well as extremity problems too, like shoulders and knees etc.
Got a back or neck problem? I can probably help. Plus, I can probably teach you to help yourself! If I can’t help, I’ll send you to someone who can. I promise you that.

Chiropractic is a good place to start!

06.12.12

Low Back Pain – Manual Therapy Cost Effective

Posted in Chiropractic, Manual Therapy Works, Truths About Back & Neck Pain at 8:40 AM by Dr. Greathouse

“Evidence to date indicates that guideline-endorsed treatments such as interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation and cognitive-behavioural therapy for sub-acute or chronic LBP are cost-effective.”  Therapeutic exercise in conjunction with manual therapy or more specific “directional preference exercise”, as with McKenzie, has proven very effective for good outcomes and and cost effectiveness (when managed ethically).

For the entire article see this link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3176706/?tool=pmcentrez

06.04.11

Headache / Chiropractic Treatment of Adults With Headache

Posted in Manual Therapy Works at 9:08 PM by Dr. Greathouse

Evidence-Based Guidelines for the Chiropractic Treatment of Adults With Headache

Journal of Manipulative and Physiological Therapeutics (JMPT)

Roland Bryans, DCa, Martin Descarreaux, DC, PhDb, Mireille Duranleau, DCc, Henri Marcoux, DCd, Brock Potter, DCe, Rick Ruegg, PhD, DCf, Lynn Shaw, PhDg, Robert Watkin, LLBh, Eleanor White, DCi

Received 22 December 2010; received in revised form 10 March 2011; accepted 3 April 2011. Volume 34, Issue 5, Pages 274-289 (June 2011)

Abstract

Objective

The purpose of this manuscript is to provide evidence-informed practice recommendations for the chiropractic treatment of headache in adults.

Methods

Systematic literature searches of controlled clinical trials published through August 2009 relevant to chiropractic practice were conducted using the databases MEDLINE; EMBASE; Allied and Complementary Medicine; the Cumulative Index to Nursing and Allied Health Literature; Manual, Alternative, and Natural Therapy Index System; Alt HealthWatch; Index to Chiropractic Literature; and the Cochrane Library. The number, quality, and consistency of findings were considered to assign an overall strength of evidence (strong, moderate, limited, or conflicting) and to formulate practice recommendations.

Results

Twenty-one articles met inclusion criteria and were used to develop recommendations. Evidence did not exceed a moderate level. For migraine, spinal manipulation and multimodal multidisciplinary interventions including massage are recommended for management of patients with episodic or chronic migraine. For tension-type headache, spinal manipulation cannot be recommended for the management of episodic tension-type headache. A recommendation cannot be made for or against the use of spinal manipulation for patients with chronic tension-type headache. Low-load craniocervical mobilization may be beneficial for longer term management of patients with episodic or chronic tension-type headaches. For cervicogenic headache, spinal manipulation is recommended. Joint mobilization or deep neck flexor exercises may improve symptoms. There is no consistently additive benefit of combining joint mobilization and deep neck flexor exercises for patients with cervicogenic headache. Adverse events were not addressed in most clinical trials; and if they were, there were none or they were minor.

Conclusions

Evidence suggests that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches. The type, frequency, dosage, and duration of treatment(s) should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal.

03.07.11

Effectiveness of manual therapies: the UK evidence report

Posted in Manual Therapy Works at 11:22 AM by Dr. Greathouse

Effectiveness of manual therapies: the UK evidence report

Chiropractic & Osteopathy 2010, 18:3 doi:10.1186/1746-1340-18-3

Conclusions

Spinal manipulation/mobilization is effective in adults for:

Ø    Acute, subacute, and chronic low back pain.

Ø    Migraine and cervicogenic headache; cervicogenic dizziness.

Manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain.

The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media (ear aches) and enuresis (bedwetting), and it is not effective for infantile colic and asthma when compared to sham manipulation.

Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic.

01.10.11

Manipulation Significantly Greater Improvement Back Pain & Function

Posted in Manual Therapy Works at 9:23 AM by Dr. Greathouse

Spine J. 2010 Oct 2. [Epub ahead of print]

The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain.

Bishop PB, Quon JA, Fisher CG, Dvorak MF.

International Collaboration on Repair Discoveries (ICORD), 6110-818 West 10th Ave., University of British Columbia, Vancouver, British Columbia, Canada V5Z 1M9; Combined Neurosurgical and Orthopaedic Spine Program, Division of Spine, Department of Orthopaedics, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Vancouver, British Columbia, Canada V5Z 1M9.

Abstract

BACKGROUND CONTEXT: Evidence-based clinical practice guidelines (CPGs) for the management of patients with acute mechanical low back pain (AM-LBP) have been defined on an international scale. Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments. To date, the value of implementing full and exclusively CPG-based treatment remains unclear.

PURPOSE: To determine if full CPGs-based study care (SC) results in greater improvement in functional outcomes than family physician-directed usual care (UC) in the treatment of AM-LBP.

STUDY DESIGN/SETTING: A two-arm, parallel design, prospective, randomized controlled clinical trial using blinded outcome assessment. Treatment was administered in a hospital-based spine program outpatient clinic.

PATIENT SAMPLE: Inclusion criteria included patients aged 19 to 59 years with Quebec Task Force Categories 1 and 2 AM-LBP of 2 to 4 weeks’ duration. Exclusion criteria included “red flag” conditions and comorbidities contraindicating chiropractic spinal manipulative therapy (CSMT).

OUTCOME MEASURES: Primary outcome: improvement from baseline in Roland-Morris Disability Questionnaire (RDQ) scores at 16 weeks. Secondary outcomes: improvements in RDQ scores at 8 and 24 weeks; and in Short Form-36 (SF-36) bodily pain (BP) and physical functioning (PF) scale scores at 8, 16, and 24 weeks.

METHODS: Patients were assessed by a spine physician, then randomized to SC (reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar CSMT, and return to work within 8 weeks), or family physician-directed UC, the components of which were recorded.

RESULTS: Ninety-two patients were recruited, with 36 SC and 35 UC patients completing all follow-up visits. Baseline prognostic variables were evenly distributed between groups. The primary outcome, the unadjusted mean improvement in RDQ scores, was significantly greater in the SC group than in the UC group (p=.003). Regarding unadjusted mean changes in secondary outcomes, improvements in RDQ scores were also greater in the SC group at other time points, particularly at 24 weeks (p=.004). Similarly, improvements in SF-36 PF scores favored the SC group at all time points; however, these differences were not statistically significant. Improvements in SF-36 BP scores were similar between groups. In repeated-measures analyses, global adjusted mean improvement was significantly greater in the SC group in terms of RDQ (p=.0002), nearly significantly greater in terms of SF-36 PF (p=.08), but similar between groups in terms of SF-36 BP (p=.27).

CONCLUSIONS: This is the first reported randomized controlled trial comparing full clinical practice guidelines-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician-directed UC in the treatment of patients with AM-LBP. Compared to family physician-directed usual care, full CPG-based treatment including chiropractic spinal manipulative therapy is associated with significantly greater improvement in condition-specific functioning.

Copyright © 2010 Elsevier Inc. All rights reserved.

PMID: 20889389 [PubMed - as supplied by publisher]