Background   Neck pain is a common complaint in patients presenting for chiropractic treatment. The few studies on predictors for improvement in patients while undergoing treatment identify duration of symptoms, neck stiffness and number of previous episodes as the strong predictor variables. The purpose of this study is to continue the research for predictors of a positive outcome in neck pain patients undergoing chiropractic treatment.

Methods   Acute (< 4 weeks) (n = 274) and chronic (> 3 months) (n = 255) neck pain patients with no chiropractic or manual therapy in the prior 3 months were included. Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire (BQ) at baseline prior to treatment. At 1 week, 1 month and 3 months after start of treatment the NRS and BQ were completed along with the Patient Global Impression of Change (PGIC) scale. Demographic information was provided by the clinician. Improvement at each of the follow up points was categorized using the PGIC. Multivariate regression analyses were done to determine significant independent predictors of improvement.

Results   Baseline mean neck pain and total disability scores were significantly (p < 0.001and p < 0.008 respectively) higher in acute patients. Both groups reported significant improvement at all data collection time points, but was significantly larger for acute patients. The PGIC score at 1 week (OR = 3.35, 95% CI = 1.13-9.92) and the baseline to 1 month BQ total change score (OR = 1.07, 95% CI = 1.03-1.11) were identified as independent predictors of improvement at 3 months for acute patients. Chronic patients who reported improvement on the PGIC at 1 month were more likely to be improved at 3 months (OR = 6.04, 95% CI = 2.76-13.69). The presence of cervical radiculopathy or dizziness was not predictive of a negative outcome in these patients.

CONCLUSIONS:   The most consistent predictor of clinically relevant improvement at both 1 and 3 months after the start of chiropractic treatment for both acute and chronic patients is if they report improvement early in the course of treatment. The co-existence of either radiculopathy or dizziness however do not imply poorer prognosis in these patients.

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Chronic Neck Pain and Chiropractic Page

The following article appears to be the first study to track and review the progression of back pain in the same group of children, over a prolonged period, to see how (or if) it is a contributor to those same complains in adulthood.

Of particular interest is Table 2, because it breaks down and tracks complaints of either neck, mid back, or low back pain in the same group of children at 3 different time periods: ages 9, 13 and 15 years old.

Table 2: Prevalence rates of different types of back pain in a cohort of Danish children/adolescents surveyed at three time points

The Abstract and Full Text Article:

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Upper-thoracic spasms and trigger points are common within the milder complaints heard in a chiropractic office. Typical posttraumatic injuries of the posterior thorax involve the large posterior musculature, thoracic spine, spinocostal joints, and tissues supporting and mobilizing the scapula (especially the rhomboids). Upper right abdominal quadrant ailments (eg, gallbladder, liver) commonly refer pain and sometimes tenderness to the right scapular area.

By ANAHAD O’CONNOR>

Seeing a chiropractor or engaging in light exercise relieves neck pain more effectively than relying on pain medication, new research shows.

The new study is one of the few head-to-head comparisons of various treatments for neck pain, a problem that affects three quarters of Americans at some point in their lives but has no proven, first-line treatment. While many people seek out spinal manipulation by chiropractors, the evidence supporting its usefulness has been limited at best.

But the new research, published in The Annals of Internal Medicine, found that chiropractic care or simple exercises done at home were better at reducing pain than taking medications like aspirin, ibuprofen or narcotics.

“These changes were diminished over time, but they were still present,” said Dr. Gert Bronfort, an author of the study and research professor at Northwestern Health Sciences University in Minnesota. “Even a year later, there were differences between the spinal manipulation and medication groups.”

Moderate and acute neck pain is one of the most frequent reasons for trips to primary care doctors, prompting millions of visits every year. For patients, it can be a difficult problem to navigate. In some cases the pain and stiffness crop up without explanation, and treatment options are varied. Physical therapy, pain medication and spinal manipulation are popular options, but Dr. Bronfort was inspired to carry out an analysis because so little research exists.

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Background: Back pain is a common problem and a major cause of disability and health care utilization.

Purpose: To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain.

Data Sources: Records without language restriction from various databases up to February 2010.

Data Extraction: The efficacy outcomes of interest were pain intensity and disability.

Data Synthesis: Reports of 147 randomized trials and 5 non-randomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically non-significant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature.

Conclusions: CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments.

Introduction:

Back pain is a general term that includes neck, thoracic, and lower-back spinal pain. In the majority of cases, the aetiology of back pain is unknown and therefore is considered as “nonspecific back pain”. Back pain is considered “specific” if its aetiology is known (e.g., radiculopathy, discogenic disease). Although back pain is usually self-limited and resolves within a few weeks, approximately 10% of the subjects develop chronic pain, which imposes large burden to the health-care system, absence from work, and lost productivity [1]. In a recent study, the direct costs of back pain related to physician services, medical devices, medications, hospital services, and diagnostic tests were estimated to be US$ 91 billion or US$ 46 per capita [2]. Indirect costs related to employment and household activities were estimated to be between US$ 7 billion and US$ 20 billion, or between US$25 and US$ 71 per capita, respectively [3–5]. One study published in 2007 showed that the 3-month prevalence of back and/or neck pain in USA was 31% (low-back pain: 34 million, neck pain: nine million, both back and neck pain: 19 million) [6].

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Background: Neck pain (NP) is a common cause of disability. Accurate and efficacious methods of diagnosis and treatment have been elusive. A diagnosis-based clinical decision guide (DBCDG; previously referred to as a diagnosis-based clinical decision rule) has been proposed which attempts to provide the clinician with a systematic, evidence-based guide in applying the biopsychosocial model of care. The approach is based on three questions of diagnosis. The purpose of this study is to present the prevalence of findings using the DBCDG in consecutive patients with NP.

Methods: Demographic, diagnostic and baseline outcome measure data were gathered on a cohort of NP patients examined by one of three examiners trained in the application of the DBCDG.

Results: Data were gathered on 95 patients. Signs of visceral disease or potentially serious illness were found in 1%. Centralization signs were found in 27%, segmental pain provocation signs were found in 69% and radicular signs were found in 19%. Clinically relevant myofascial signs were found in 22%. Dynamic instability was found in 40%, oculomotor dysfunction in 11.6%, fear beliefs in 31.6%, central pain hypersensitivity in 4%, passive coping in 5% and depression in 2%.

Conclusion: The DBCDG can be applied in a busy private practice environment. Further studies are needed to investigate clinically relevant means to identify central pain hypersensitivity, oculomotor dysfunction, poor coping and depression, correlations and patterns among the diagnostic components of the DBCDG as well as interexaminer reliability, validity and efficacy of treatment based on the DBCDG.

Scott Haldeman chaired the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Related Disorders, the most comprehensive multidisciplinary review on neck pain ever undertaken.

As with similar projects, the Task Force reviewed and evaluated all existing research on the diagnosis and treatment of neck pain. But it went further, initiating original research in insufficiently explored areas, including the now-renowned study by David Cassidy and colleagues which demonstrated that strokes are no more likely after a visit to a chiropractor than after a visit to a medical doctor. In this Health Insights Today interview, Dr. Haldeman discusses the major findings of the Neck Pain Task Force and their implications for the management of this challenging condition.

Dr. Haldeman holds the positions of Clinical Professor, Department of Neurology, University of California, Irvine; Adjunct Professor, Department of Epidemiology, School of Public Health, University of California, Los Angeles; and Adjunct Professor, Department of Research, Southern California University of Health Sciences. He is Past President of the North American Spine Society, the American Back Society, the North American Academy of Manipulative Therapy, and the Orange County Neurological Society. He served on the Executive Council of the International Society for the Study of the Lumbar Spine.

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This newly published JMPT study attempted to identify those prognostic clinical factors that may potentially identify, a priori, patients with mechanical neck pain who are likely to experience a rapid and successful response to spinal manipulation of the cervical and thoracic spine.

Data from 81 subjects were included in the analysis, of which 50 had experienced a successful outcome (61.7%). Five variables were found to be associated with a positive response:

• Initial pain intensity greater than 4.5 points
• Cervical extension less than 46°
• Hypomobility at T1 vertebra

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Here’s a fascinating study, published in the January 2011 Military Medicine Journal.

This article is of particular interest because the Department of Defense was instructed during the Clinton Administration to start providing chiropractic care through the Department of Veterans Affairs to American servicemen, and even after all these years, chiropractic care is only available at 36 VA facilities across the country. This still leaves (at least) 100 major VA medical facilities without a chiropractic physician on staff. [1]

In this study, therapists at the School of Exercise and Nutrition Sciences in Victoria, Australia designed an 18-question survey to determine type and effectiveness of various strategies used by Royal Australian Air Force (RAAF) fast jet aircrew in self-referral and management of flight-related neck pain. [2]

They provided this questionnaire to 86 eligible RAAF aircrew to determine aircrew demographics, the incidence of flight-related neck pain, and their self-referral strategies to manage these neck complaints. The results are quite dramatic:

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Thanks to John Wiens, D.C. for drawing our attention to this study!

A report, prepared for the Foundation for Chiropractic Progress by the esteemed medical authors Niteesh Choudhry, MD, PHD (Harvard Medical School) and Arnold Milstein, MD, MPH (Mercer health and Benefits), produced these conclusions from the Executive Summary:

• Chiropractic care is more effective than other modalities for treating low back and neck pain

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“The most recent research (Neck Pain Task Force Report of the Bone and Joint Decade 2000-2010, a study sanctioned by the United Nations and the World Health Organization) indicates neck manipulation is a safe and effective form of health care,” according to Matt Pagano, DC, chiropractic profession spokesperson.

Respected researcher and epidemiologist J. David Cassidy, DC, PhD, DrMedSc, testified as a key witness last week at the hearings on informed consent before the Connecticut Board of Chiropractic Examiners in Hartford, Conn. Speaking as an expert witness and consultant to the International Chiropractors Association (ICA)—and with the support of all chiropractic organizations involved in the process, including the American Chiropractic Association, Association of Chiropractic Colleges, Foundation for Chiropractic Progress, Life West, New York College of Chiropractic, Parker College of Chiropractic, Palmer College of Chiropractic, and the University of Bridgeport College of Chiropractic—Dr. Cassidy addressed key facts and issues on the basis of the existing science and research record, to which he has been a significant contributor. The objective of his testimony was to bring the discussion from an emotional issue back to science and the objective research record.

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