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  Chronic Spinal Pain:
Spinal Manipulation vs. Acupuncture vs. Drugs
— A Brilliant Series of 3 Research Projects


   The Pilot Study (1999)   

Chronic Spinal Pain Syndromes: A Clinical Pilot Trial Comparing Acupuncture, A Nonsteroidal Anti-inflammatory Drug, and Spinal Manipulation
J Manipulative Physiol Ther 1999; 22 (6): 376–381

Randomization was successful. After a median intervention period of 30 days, spinal manipulation was the only intervention that achieved statistically significant improvements (all expressed as percentages of the original scores) with (1) a reduction of 30.7% on the Oswestry scale, (2) an improvement of 25% on the neck disability index, and (3) reductions on the visual analogue scale of 50% for low back pain, 46% for upper back pain, and 33% for neck pain (all P<.001). Neither of the other interventions showed any significant improvement on any of the outcome measures.

   The Randomized Trial (2003)   

Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation
Spine 2003 (Jul 15);   28 (14):   1490–1502

The highest proportion of early (asymptomatic status) recovery was found for manipulation (27.3%), followed by acupuncture (9.4%) and medication (5%). Manipulation achieved the best overall results, with improvements of 50% (P = 0.01) on the Oswestry scale, 38% (P = 0.08) on the NDI, 47% (P < 0.001) on the SF-36, and 50% (P < 0.01) on the VAS for back pain, 38% (P < 0.001) for lumbar standing flexion, 20% (P < 0.001) for lumbar sitting flexion, 25% (P = 0.1) for cervical sitting flexion, and 18% (P = 0.02) for cervical sitting extension. However, on the VAS for neck pain, acupuncture showed a better result than manipulation (50% vs 42%).

   The Long-term Follow-up (2005)   

Long-Term Follow-up of a Randomized Clinical Trial Assessing the Efficacy of Medication, Acupuncture, and Spinal Manipulation for Chronic Mechanical Spinal Pain Syndromes
J Manipulative Physiol Ther 2005; 28 (1): 3–11

The results of this “fastidious” approach were able to add some information regarding the efficacy of treatment regimens in patients with chronic spinal pain syndromes. Overall, patients who have chronic mechanical spinal pain syndromes and received spinal manipulation gained significant broad-based beneficial short-term and long-term outcomes. For patients receiving acupuncture, consistent improvements were also observed, although without reaching statistical significance (with a single exception). For patients receiving medication, the findings were less favorable. Larger studies are now clearly justified.

   End of Acupuncture Trial Series   


Adverse Drug Events in Children
Pediatrics 2008 (Apr);   121 (4):   e927–935

Adverse drug event rates in hospitalized children are substantially higher than previously described. Most adverse drug events resulted in temporary harm, but 22% were classified as preventable. [Editorial Commentary: The findings that only 3.7% of adverse events find their way into hospital error reports is very alarming, and suggests that previous reports have only documented the tip of the iceberg.]



Do 40% of Patients Seek Wellness Care?
J Can Chiropr Assoc 2008 (Aug);   52 (3):   175–184

This new survey reveals that a much higher percentage of chiropractic patients seek more than “musculoskeletal care” than has previously been recognized. Carefully worded questionnaires provided to 1316 patients revealed that more than 40% of patients seeking care reported doing so for the purpose of “optimizing health” or “preventing illness” (including the prevention and/or early intervention of potential risk factors) . These findings differ from a previous World Federation of Chiropractic survey, which indicated less than 5–10% of patients seeking care for non-musculoskeletal conditions.


Wellness Care and Chiropractic
Chiropractors have recommended spinal adjustments for correction and prevention of musculoskeletal and visceral conditions for a significant period of time. Let's review the literature supporting wellness or maintenance care.


Are German Orthopedic Surgeons Killing People With Chiropractic?
Journal of Neurology 2006 (Mar 6) ~ FULL TEXT

Editorial Commentary: I present for your review an abstract from the Journal of Neurology. This abstract blatantly conceals the facts stated in the body of the paper when it states that “we describe 36 patients with vertebral artery dissections and prior chiropractic neck manipulation”. When I read that sentence, I am led to believe that “real-live chiropractors” (meaning licensed Doctors of Chiropractic, who received their training at a CCE/WCCE accredited schools) were the ones to provide the “chiropractic neck manipulation”. Unfortunately, that couldn't be further from the truth! You may review other articles like this in the Stroke Page


What is the Identity of the Chiropractic Profession?
The World Federation of Chiropractic (WFC) just completed a 2-year comprehensive identity consultation that lead to describing our profession as the spinal health care experts in the health care system. Read all about it now!


Four Articles Which Describe the Relationship Between the Upper Cervical Spine, Headaches, and Chronic Head Pain

1.  Atrophy of Suboccipital Muscles in Chronic Pain Patients
We have observed previously unreported muscle atrophy in the rectus capitis posterior minor (RCPMI) muscles of a group of chronic pain patients. We hypothesize that chronic pain, in this select group of patients, is a consequence of tramua that occurs to the C1 dorsal ramus during whiplash.

2.  Magnetic Resonance Imaging of the Upper Cervical Spine
We are currently using MRI to investigate the functional integrity of the upper cervical spine. We started out looking for hypertonic muscles in a population of patients who were suffering from chronic head and neck pain. My first task was to collect MRI data and to identify suboccipital muscles within the MR images.

3.  Anatomic Relation Between the Rectus Capitis Posterior Minor Muscle and the Spinal Dura Mater
We observed that the PAO membrane was securely fixed to the surface of the dural tube by multitudinous fine connective tissue fibers. There was no real interlaminar space between these two structures and they appeared to function as a single entity. The influence of the RCPMI muscle on the dura mater was artificially produced in the hemisected specimen. Artificially functioning the muscle produced obvious movement of the spinal dura between the occiput and the atlas, and resultant fluid movement was observed to the level of the pons and cerebellum.

4.  Visualization of the Muscle-Dural Bridge in the Visible Human Female Data Set
SPINE Journal 1995;   20 (23):   2484–2486

It has been speculated that the function of the muscle dural bridge may be to prevent folding of the dura mater during hyperextension of the neck. Also, clinical evidence suggests that the muscle dural bridge may play an important role the pathogenesis of the cervicogenic headaches.


Inappropriate Use of the Title Chiropractor ~ FULL TEXT
The results of this year-long prospective review suggests that the words chiropractor and chiropractic manipulation are often used inappropriately by European biomedical researchers when reporting apparent associations between cervical spine manipulation and symptoms suggestive of traumatic injury. Furthermore, in those cases reported here, the spurious use of terminology seems to have passed through the peer-review process without correction. Additionally, these findings provide further preliminary evidence, beyond that already provided by Terrett, that the inappropriate use of the title chiropractor and term chiropractic manipulation may be a significant source of over-reporting of the link between the care provided by chiropractors and injury. You may also want to read this Editorial Comment by the author.


The THOUGHT for Today
This page collects “Deep thoughts” from a variety of sources!


Review the Articles Section for our older articles


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Since 1-15-2006

Updated 1-10-2009

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The Safety of Chiropractic
Millions of patients love their chiropractor and appreciate our unique and safe approach to recovery from pain. Significant research suggests that chiropractic is the safest approach available for relief from neck pain, back pain, headaches and other “musculo–skeletal” complaints. Lets review that research, and discuss how modern medicine has contributed to the Myth that chiropractic care is dangerous.


 
Predictors For Immediate Improvement With Chiropractic
J Manip Physiol Ther 2008 (Mar);   31 (3):   172–183

Data, collected from 28,807 treatment consultations and 19,722 new patients, revealed that presenting symptoms of "neck pain," "shoulder, arm pain," "reduced neck, shoulder, arm movement, stiffness," "headache," "upper, mid back pain," and "none or one presenting symptom" emerged in the final model as significant predictors for immediate improvement with care. The presence of any 4 of these predictors raised the probability for an immediate improvement in presenting symptoms after treatment from 70% to approximately 95%.


 
Chiropractic Effective For Chronic Dysmenorrhea
J Manip Physiol Ther 2008 (Mar);   31 (3):   237–246

A group of 16 women, who had experienced symptoms of primary dysmenorrhea for an average of 12 years, all achieved significant reductions in pain following a 4-week period chiropractic care.


 
Chiropractic Reduces Blood Pressure
J Human Hypertension 2007;   21 (5):   347–352

In this University of Chicago randomized, double blind, placebo-controlled trial, chiropractic adjusting of the upper cervical spine was associated with marked and sustained reductions in blood pressure, similar in magnitude to the use of two-drug combination therapy.


Diagnosis and Treatment of Low Back Pain
Ann of Int Med 2007 (Oct 2);   147 (7):   478–491

You will enjoy these recommendations from the Oct 2, 2007 issue of the Annals of Internal Medicine. Their ONLY recommendation for active treatment of acute low back pain is spinal adjusting (manipulation).


Does Facet Joint Inflammation Induce Radiculopathy?
Spine 2007 (Feb 15);   32 (4):   406–412

The association between lumbar facet joint inflammation and radiculopathy was investigated using behavioral, histologic, and immunohistochemical testing in rats. When inflammation was induced in a facet joint, inflammatory reactions spread to nerve roots, and leg symptoms were induced by chemical factors. These results support the possibility that facet joint inflammation induces radiculopathy.


Antibiotic Use In Infants Linked To Asthma
Chest 2007 (Jun); 131 (6): 1753–1759

This article, published in the June issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), reports that children receiving antibiotics in the first year of life were at greater risk for developing asthma by age 7 than those not receiving antibiotics. The risk for asthma doubled in children receiving antibiotics for nonrespiratory infections, as well as in children who received multiple antibiotic courses and who did not live with a dog during the first year.


Study Confirms Chiropractic's Cost Effectiveness
J Manip Physiol Ther 2007 (May);   30 (4):   263–269

A new retrospective analysis of 70,274 member-months in a 7-year period within an IPA, comparing medical management to chiropractic management, demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance. This clearly demonstrates that chiropractic nonsurgical nonpharmaceutical approaches generates reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone. There are many other articles like this at the Chiropractic Cost Effectiveness Page


Editorial:  
End Medical Mis-Management of LBP

The medical “debate” has been going on for years...is spinal adjusting (a.k.a manipulation) effective for Low Back Pain? The original Meade study (British Medical Journal 1990) demonstrated that chiropractic was much more effective for LBP than conventional medical care.

In 1993 the province of Ontario, Canada hired the esteemed health care economist Pran Manga, PhD to examine the benefits of chiropractic care for low back pain (LBP) and to make a set of recommendations on how to contain and reduce health care costs. His report
A Study to Examine the Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain cited research demonstrating that: (1) chiropractic manipulation is safer than medical management for LBP;   (2) that spinal manipulation is less safe or effective when performed by non-chiropractic professionals;   (3) that there is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost-effective than medical management;   (4) and that there would be highly significant cost savings if more management of LBP was transferred from medical physicians to chiropractors. He also stated that “A very good case can be made for making chiropractors the gatekeepers for management of low-back pain in the Workers' Compensation System in Ontario.

In 1994, organized medicine was horrified when the Agency for Health Care Policy and Research (AHCPR) publications confirmed the untested, questionable or harmful nature of many current medical therapies for LBP , and also stated that, of all forms of management they reviewed, only chiropractic care could both reduce pain AND improve function.

In 1995, Meade did a follow-up to his 1990 BMJ article, again publishing in the
British Medical Journal. It demonstrated that those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals, especially for those who suffered from chronic (or long-term) low back pain!

A recent study in
SPINE Journal reveals that health care expenditures for back pain sufferers was a staggering $90.7 billion in 1998, and that prescription drugs accounted for more than 15% of that figure. This is alarming, since muscle relaxants have been associated with slower recovery rates, and steroid injections offer minimal relief.   One needs to ask why drug costs continue to climb with a track record like that? Even care by physical therapists has been shown to prolong recovery from low back pain.

A chronic pain study at the University of Washington School of Medicine recently compared which
treatments were most effective at reducing pain for neuromuscular diseases and found that chiropractic scored the highest pain relief rating (7.33 out of 10), scoring higher than the relief provided by either nerve blocks (6.75) or opioid analgesics (6.37).

A recent
4-year retrospective study of 700,000 health plan members revealed that offering chiropractic services within a managed-care environment could save insurers 27% in back pain episode-related costs! The Cost-effectiveness Page documents many other studies with similar findings.

In December 2004, the
British Medical Research Council published 2 papers in the British Medical Journal demonstrating both the efficacy and cost-effectiveness of chiropractic compared with medical management.   These two studies revealed:
  Spinal Manipulation, with or without exercise, improved symptoms more than medical care did at both 3 and 12 months.
  The authors concluded: “We believe that this is the first study of physical therapy for low back pain to show convincingly that both manipulation alone and manipulation followed by exercise provide cost effective additions to care in general practice.”

The most recent in a long line of articles showing the clear superiority of chiropractic management was
published in May of 2007 . 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 85% less pharmaceutical costs when compared with conventional medicine IPA performance.

That is rather significant savings, is it not?

So...what's the holdup?



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