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 By Frank M. Painter, D.C. in Announcement on May 26th, 2012 at 12:02 pm
The Bivouac of the Dead
The muffled drum’s sad roll has beat
The soldier’s last tattoo’
No more on life’s parade shall meet
That brave and fallen few;
On Fame’s eternal camping ground
Their silent tents are spread;
But Glory guards with solemn round
The bivouac of the dead.
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on November 27th, 2011 at 8:06 pm
Clinical Disorders and the Motor System
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 9 from RC’s best-selling book:
“Basic Principles of Chiropractic Neuroscience”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 9: Clinical Disorders and the Motor System
OVERVIEW
Such clinical features as fatigue, weakness, nervousness, pain, tenderness, paralysis, sensory loss, paresthesia, and abnormalities of muscle mass or tone are the most common signs and symptoms noted in neural disorders. Fatigue, weakness, and nervousness are frequently presented together. This triune can usually be attributed to a functional disorder or appear as a complication in organic disease.
Abnormal striated muscle function has its origin in diseases of the brain, spinal cord, peripheral nerves, or muscle tissue itself. Dysfunction occurs in a variety of symptoms and signs such as:
(1) impaired movements,
(2) spontaneous movements,
(3) coordination defects,
(4) abnormal reflexes,
(5) distortions of muscle tone, and
(6) postural and movement distortions.
Weakness, wasting, and sometimes paralysis are represented in these conditions. Common types of motor lesions are shown in Table 9.1.
Basic Neuromuscular Activities
There are two fundamental types of neuromuscular activity. One type consists of reflex postural contractions, which are the basis of posture and physical attitudes and maintain muscle tone. The other type consists of phasic contractions, which produce movement. Phasic contractions may be either reflex or volitional in origin. While reflex actions are always purposeful, predictable, and involuntary, cortical activity is not.
Neurons carrying phasic and tonic impulses have distinctive characteristics. Phasic motor neurons are large, have a rapid conduction velocity, have a high threshold of physiologic excitability, present large impulses of short duration, and are electrically silent during rest. In contrast, tonic motor neurons are smaller, have a slower conduction velocity, have a lower threshold of physiologic excitability, present smaller impulses of longer duration, and are electrically active during rest.
Muscle and Joint Correlations
Continue reading …
By Frank M. Painter, D.C. in Editorial on September 13th, 2011 at 6:47 pm
Is “Expanded Practice” our Pandora’s Box?
The Chiro.Org Blog
Editorial Commentary:
I just read a Press Release from the Foundation for Vertebral Subluxation (FVS) this morning, titled “Chiropractors Lash Out in Massive Campaign Against Accrediting Agency“.
Previous press releases from this group have denounced (perhaps rightly) any movement to include prescribing rights for DCs, and this Blog has published extensively about both sides of that debate in the past. [1–15]
Personally, I think that seeking prescription rights is a bad idea because of the political and legal turmoil it will invite from Organized Medicine. The authors of the Foundation typically paint the “Pro Drug” movement as an attack against the idea of the Vertebral Subluxation and of the profession’s historical foundation, as one that does not use drugs and surgery to accomplish our goals.
It’s now time for the Profession to determine if this is “Chicken Little” paranoia, or if the FVS has a valid concern that MUST be addressed.
According to their Press release, there is a “massive and historic outpouring” of dissatisfaction by “at least 6000 chiropractors” via “Facebook, Twitter and e-mail“. The author goes on to state that “At issue is the systematic remaking of the profession by these groups into a branch of medicine.” OK, that got my attention.
NOTE: It may be true that this page has 6000 “members”, but MANY of them (like myself) were added to that list without our knowledge or permission. So their claim of 6000 “members” is spurious. Further, even if it WAS true, 6,000 DCs represents less than 10% of our Profession. Hardly a ground swell.
Continue reading …
By Frank M. Painter, D.C. in Editorial on August 24th, 2011 at 8:30 pm
Double Standards Exist in Judging Traditional and Alternative Medicine
The Chiro.Org Blog
SOURCE: British Medical Journal 1998 (Jun 6); 313: 1694
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This posting is dedicated to all those evidence-based nay-sayers out there, who love to criticize without contributing anything back except negativity. Dr. Chalmers is the head of the Cochrane group in the UK. He speaks for the REAL evidence people.
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Dr Iain Chalmers, the director of the UK Cochrane Centre and a vociferous proponent of systematic reviews, told delegates:
“Critics of complementary medicine often seem to operate a double standard, being far more assiduous in their attempts to outlaw unevaluated complementary medical practices than unevaluated orthodox practices.”
He also said:
“These double standards might be acceptable if orthodox medicine was based solely on practices which had been shown to do more good than harm, and if the mechanisms through which their beneficial elements had their effects were understood, but neither of these conditions applies.”
Continue reading …
By Frank M. Painter, D.C. in Editorial on August 15th, 2011 at 1:30 pm
The Inherent Problems With Randomized Controlled Trials (RCTs)
The Chiro.Org Blog
FROM: J Manip Physiol Ther 2003 (Sep); 26 (7): 460–467 ~ FULL TEXT
Anthony Rosner, PhD
For 50 years, the accepted standard by which the usefulness of a therapeutic treatment is judged has been the randomized controlled trial (RCT), building from Hippocrates’ premise 2000 years ago that experience combined with reason was the therapy of choice for patients; that is, any treatment plan should both seem reasonable in theory and then be tested experimentally. Assuming that threats to both internal and external validity could be ruled out, the RCT became what is commonly regarded as the highest quality of clinical outcome study that could be mounted to allow inferences about cause and effect relationships to be drawn. The thinking was that the more rigorous and fastidious the design, the more credibility could be attached to the conclusions drawn from the outcomes of the study and the more likely the intervention was thought to have brought about those outcomes. [1] One of the strongest proponents of the RCT through the 1950s and 1960s was the British epidemiologist Archie Cochrane, who held that this type of experimental approach was essential for upgrading the quality of medical evidence. [2] In common hierarchical schemes of clinical experimental design, the RCT has been ranked the highest in rigor, as shown in Table 1.3 Even greater rigor has been presumed to occur with the statistical combination and weighting of the results of multiple RCTs in a meta-analysis to generate a more conclusive estimate of effect size. [4-5]
Table 1. Hierarchy of Experimental Designs [3]
- Control group outcomes study (including RCTs).
- Single-subject experiment, replicated single-subject experiments.
- Single-group outcome study.
- Systematic case study.
- Anecdotal case report.
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Designs are presented in descending order of rigor.
Continue reading …
By Frank M. Painter, D.C. in Editorial on August 8th, 2011 at 10:31 am
Director of Chiropractic Research Testifies at the National Institute of Medicine
The Chiro.Org Blog
Anthony L. Rosner, Ph.D.
Foundation for Chiropractic Education and Research
EDITOR’S NOTE: Anthony Rosner, Ph.D., Director of Research and Education for the Foundation for Chiropractic Education and Research, presented testimony on behalf of chiropractic research and practice standards at hearings conducted at the Institute of Medicine (IOM) headquarters in Washington, D.C., on February 27, 2003. The occasion marked the first of six meetings of a study committee planned by the IOM over the next 18 months to explore the scientific and policy implications of the use of complementary and alternative medicine (CAM) therapies by the American public.
The objectives of the study committee are as follows:
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To describe the use of CAM therapies by the American public, including the populations that use them and what is known about how they are provided;
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To identify major scientific and policy issues related to CAM research (including gender effects), regulation, interactions with conventional medicine, and training and certification; and
The Institute of Medicine is a private, non-governmental organization that initiates studies in areas of medical care out of appropriations made available to federal agencies. It is a branch of the National Academy of Sciences, which was created by the federal government to be an advisor on scientific and technological matters.
The following is Dr. Rosner’s presentation to the Institute of Medicine.
The Use of CAM by the American Public
INTRODUCTION
My dear colleagues:
I want to thank the Institute of Medicine (IOM) for two reasons; first, for inviting my testimony this afternoon, but especially for carrying what I believe is the unfulfilled work of both the National Center for Complementary and Alternative Medicine and the White House Commission on Complementary and Alternative Medicine an essential step forward by calling us to the table today.
I also want to offer my strongest assent and congratulations to the Institute for its most pertinent and insightful assessment of American healthcare — first, in its forthright reporting of medical errors in 1999; [1] second, in providing one of the most equitable definitions among the many offered for “primary care; [1] [2] ” and finally, for having published two years ago the most candid and uncompromising assessments of U.S. healthcare, Crossing the Quality Chasm: A New Health System for the 21st Century. [3]
This last publication courageously concluded that “the American healthcare system is in need of a fundamental change,” especially because “what is perhaps most disturbing is the absence of real progress toward restructuring health care systems to address both quality and cost concerns. . . .” [3]
Continue reading …
By Frank M. Painter, D.C. in Editorial on August 3rd, 2011 at 9:49 pm
The Obstacles and Barriers to CAM or Alt-Med Research
The Chiro.Org Blog
Testimony to the White House Commission On
Complementary and Alternative Medicine Policy
By Anthony L. Rosner, Ph.D.
FCER Director of Research and Education
Introduction:
Until 25 years ago, chiropractic research was vastly underdeveloped and appeared to some as an oxymoron. In 1975, a conference at the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institutes of Health (NIH) concluded that “There are little scientific data of significance to evaluate this (chiropractic’s) clinical approach to health and to the treatment of disease.” [1] From that time onward, both clinical and basic research have advanced to the point at which:
(i) over 40 randomized clinical trials comparing spinal manipulation with other treatments in the management of back pain have been published in the scientific literature, [2, 3]
(ii) meta-analysis and systematic reviews attesting to the support of spinal manipulation in the management of back pain [4, 5] have also appeared, and
(iii) multidisciplinary panels representing the governments of the United States, [6] Canada, [7] Great Britain, [8] Sweden, [9] Denmark, [10] Australia, [11] and New Zealand [12] have expressed similar recognition of the robust evidence base in support of spinal manipulation for managing low back conditions.
Barriers:
The efforts to launch and develop a National Center for Complementary and Alternative Medicine (NCCAM) within the framework of the NIH are indeed admirable, taking the Center from a humble $2 million annual budget in 1991 to one that approaches $70 million today. This has taken place despite the comments of highly visible and influential individuals within the medical community to discredit alternative medicine in virtually any shape or form, a topic that I shall return to momentarily.
The following are what I believe to be the most significant barriers to research efforts in alternative medicine, the barriers having either remained in place or only recently having been removed.
1. Collaborative Arrangements:
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By Frank M. Painter, D.C. in Editorial on June 20th, 2011 at 12:49 pm
Plastic Surgery For Headaches???
The Chiro.Org Blog
Now I’ve heard everything (well. . . maybe). A recent full text article in the journal Plastic and Reconstructive Surgery [1] fully describes how plastic surgeons attempt to mimic the common outcome of chiropractic upper cervical adjusting by: removal of a small segment of the semispinalis capitis muscle and shielding of the nerve with a subcutaneous flap to fully decompress the greater occipital nerve. (from Page 604)
[2]
No mention is made in their celebratory article about the benefits of chiropractic care (or “spinal manipulation”) for headaches, but then again, these are surgeons, forging ahead, looking for an approach they can call their own. Good for them.
However, Chiropractors developed a non-surgical and cost-effective way to decompress the greater occipital nerve many decades ago, by adjusting the occiput, and by using NIMMO technique to naturally eliminate trigger points of the suboccipital muscles (the myofascial component).
Travell’s 1983 landmark magnum opus on trigger points titled: “Myofascial Pain and Dysfunction: The Trigger Point Manual” clearly identifies the various suboccipital muscles as being primary triggers for several varieties of headache. This Blog, and our Headache and Chiropractic Page have published regularly on the success of chiropractic care for headaches of all sorts. [2-7]
Continue reading …
By Frank M. Painter, D.C. in Editorial on June 11th, 2011 at 12:36 pm
The Dangers of “GroupThink”
The Chiro.Org Blog
SOURCE: ACA News
By William Morgan, DC
The term “group think” was coined by the psychologist Irving Janis in his 1972 work, Victims of Group think: A Psychological Study of Foreign- Policy Decisions and Fiascoes. Group think describes what happens when individual thought cedes to the will of group consciousness. This may sound like a cross between an Orwellian novel and a bad zombie movie, but its prevalence in the world is common, and the dangers of group think are all too real, especially when it comes to decision-making in health care. Group think suppresses dissenting views and can lead to an over simplified view of problems and solutions.
Symptoms of Groupthink
Dr. Janis presented eight symptoms of group think:
- Group attitude of invulnerability. The group feels that it is “bulletproof,” so it takes unnecessary risks and is overly confident.
- Group rationalism—discrediting evidence that is contrary to the group beliefs.
- Group peer pressure inhibits the will to dissent. Members of the group are browbeaten into conformity of thought.
- Group belief of moral superiority.
- Stereotyping of outsiders in negative terms—such as “Oh, he is just a dumb straight.” Or, “Those medi-practors are so insecure in their ability to adjust.”
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By Frank M. Painter, D.C. in Editorial on June 5th, 2011 at 7:36 pm
Point/Counterpoint: Seeking A Second Opinion on Expanded Chiropractic Practice
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
There has been a lot of recent traffic to our postings about Alabama [1] and New Mexico’s attempts to gain prescription rights. For that reason, we are featuring 2 articles, both pro and con on the topic of expanding chiropractic practice into the realm of medicine. We hope you will find the following 2 articles of interest.
A Prescription for Professional Disaster
By Gerard Clum, DC, President Emeritus, Life Chiropractic College West
The expansion of the scope of practice of chiropractors to prescribe drugs is an absolute non-starter for me. In recent weeks, this conversation has moved to center stage, as evidenced by activities in the states of New Mexico, South Carolina and Alabama, as well as at the biennial gathering of the World Federation of Chiropractic (WFC).
Legislation proposed to expand the authority of chiropractors in New Mexico to prescribe broadly failed; the South Carolina measure appears to be mired in committee; and the Alabama State Chiropractic Association voted down a proposal to seek such an expansion. The WFC, while presenting a forum on this issue, has not changed its policy that the practice of chiropractic is without drugs and surgery.
The battle lines are rather well-drawn and clear. One element within the profession seeks to alter the history, tradition, conceptualization, culture, laws and regulations under which we have existed throughout our entire existence to include prescription authority of various extents. This view is being opposed by members of the profession who object and perceive the very heart of our clinical approach being hijacked and transformed into the practice of medicine.
“Conflicts Clarify!”
A recent legislative hearing in New Mexico did just that: it clarified the intent and extent of the drug lobby in chiropractic. In the past, whenever the question of prescription authority in chiropractic came up, it was always related to injected vitamins and nutritional support, as opposed to the common understanding of prescription medications associated with the practice of medicine.
In Santa Fe, N.M. on March 17, 2011, the veil was pulled back on that charade as representatives of the National University of Health Sciences and University of Western States joined members of the executive committee of the New Mexico Board of Chiropractic Examiners in seeking legislation that would allow the use of “primary care drugs.” Further, these representatives indicated that they were part of the solution for New Mexico’s primary care shortage with their willingness and self-perceived ability to treat patients with hypertension and diabetes, among other maladies. It is now clear and on the record that this is not about nutrition in any shape or form; this is about the practice of primary care medicine under the auspices of a chiropractic license.
Continue reading …
By Frank M. Painter, D.C. in Editorial on June 5th, 2011 at 7:04 pm
Best for the Profession or Best for the Public?
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
This is the second in a series of articles about expanding chiropractic practice into the realm of medicine. [1] We hope you will find these 2 articles of interest.
By James Winterstein, DC, President, National University of Health Sciences
Recently, I had the privilege of testifying for the chiropractic physicians in New Mexico who currently have some prescriptive rights and wished to expand that scope to improve their ability to provide stronger, more complete primary care.
It should be clear that I was asked to appear in behalf of the chiropractic physicians there or I would not have been there. It is not my purpose, as president of National University of Health Sciences, to dictate the direction of the chiropractic profession, but to provide the education that is required by the profession.
In this instance, the request to provide advanced education in pharmacology came to the university several years ago, just as requests to provide education in acupuncture came to the university 41 years ago and requests to provide education in “over-the-counter” medications came from Florida some 20 years ago. Our institutional charter says that we will “provide education,” which is what we have done in New Mexico, and which we intend to continue to do in New Mexico and elsewhere when asked.
Some members of the profession appeared before the New Mexico Senate Judiciary Committee and testified against the wishes of the New Mexico chiropractors – not as invited guests, but as intruders into state concerns. Some of the senators even received calls from out of the United States urging action against the wishes of the New Mexico DCs. I consider this kind of activity to be completely inappropriate and negative toward the profession. New Mexico DCs see a need that can be met with additional education and an expanded scope of practice. They, it appears, have a concern for the public, while their detractors have a fiercely held belief that the chiropractic profession must always remain what it was when formed by its originators.
Continue reading …
By Frank M. Painter, D.C. in Editorial on May 30th, 2011 at 8:57 am
The Bivouac of the Dead
The muffled drum’s sad roll has beat
The soldier’s last tattoo’
No more on life’s parade shall meet
That brave and fallen few;
Continue reading …
By Frank M. Painter, D.C. in Editorial on May 13th, 2011 at 3:32 pm
Health Coaching: A Model That Makes Sense for Chiropractic
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By Guy Riekeman, DC, President, Life University
As anyone who has ever raised a teenager knows all too well, telling someone to do something because it’s “good for them” can feel like so much wasted breath. Chiropractors also can find themselves winded from exhorting (encouraging, cajoling, threatening, nagging, etc.) patients to persist with their programs of care and enhance their overall well-being with more frequent chiropractic visits, better nutrition, more sleep, stress management and exercise.
Recent health care trends and research are supporting what you may have already suspected from years in practice: Simply telling people what to do often does not lead to them actually doing it. Showing them how and leading them through it stands a much better chance of working.
Patient Education vs. Coaching
Traditional patient education – loading people up with facts and figures and sending them home with a stack of brochures to tackle on their own – often doesn’t empower patients with the true understanding and skills they’ll need to persist and succeed with a health care regimen. Health coaching leaves less to chance. A health coaching approach provides a more interactive consultation model whereby the coach and patient work together to map out care plans. The coach proactively monitors progress, provides counseling and new strategies for navigating through rough patches, and holds the patient accountable to agreed-upon goals.
Continue reading …
By Frank M. Painter, D.C. in Editorial on March 13th, 2011 at 11:25 pm
For Those Who Wish To Be Medical Chiropractors —
Look, Before You Leap
The Chiro.Org Blog
SOURCE: The New York Times ~ Opinion Page
Treat the Patient, Not the CT Scan
By ABRAHAM VERGHESE
Published: February 26, 2011
THE other day as I walked through a wing of my hospital, it occurred to me that Watson, I.B.M.’s supercomputer, would be more at home here than he was on “Jeopardy!” Perhaps it’s good, I thought, that his next challenge, with the aid of the Columbia University Medical Center and the University of Maryland School of Medicine, will be to learn to diagnose illnesses and treat patients.
On our rounds of the wards, Watson would see lots of other computers with humans glued to them like piglets at a sow’s teats. We might visit a patient with a complex illness — one whose second liver transplant has failed, who has a fungal meningitis and now also has kidney failure and bleeding and is on a score of medications.
Watson might help me digest the sheer volume of data that is in the electronic medical record and might see trends in the data that speak of an impending disaster. And since Watson is constantly trolling the Web, he would perhaps bring to my attention a case report published the previous night in a Swedish journal describing a new interaction between two of the drugs my patient is taking.
Better still, if Watson could harness data from all the patients in our hospital and in every other hospital in America, we might be alerted to mini-epidemics taking shape. For example, Watson might recognize that the kidney failure in our patient is linked to kidney failure in a patient in Buffalo and another in San Antonio; all three patients, he might inform me, were taking a “natural” weight loss supplement that contained a Chinese herb, aristolochia, that has been associated with more than 100 cases of kidney failure.
In short, Watson would be a potent and clever companion as we made our rounds.
Continue reading …
By Frank M. Painter, D.C. in Editorial on February 7th, 2011 at 7:19 pm
Chiropractors, Wellness, and Our Office Websites
The Chiro.Org Blog
You know that feeling you get, when you read an article that rubs you the wrong way?
Well, I was all set to editorially unload on a new article, published in Chiropractic & Manual Therapies, titled:
Chiropractic Wellness on the Web: The Content and Quality of Information Related to Wellness and Primary Prevention on the Internet, because it ragged on about the use of the word subluxation. That always sets me right off.
But instead of checking my brain at the door, I read the whole article a second time, and decided to take a look at their websites, to see if they practiced what they preached.
Continue reading …
By Frank M. Painter, D.C. in Editorial on December 18th, 2010 at 1:12 pm
Chiropractic’s Next Battle: AMA Ownership of the CPT Codes
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic ~ Dec 16, 2010
By Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher
As 2010 comes to a close, it is important to look ahead to see what we can do as a profession to brighten the future of chiropractic. Among the many bits of information that have come across my computer monitor of late is a very interesting article by John Weeks of The Integrator Blog, “an organizer-writer in the emerging fields of complementary, alternative and integrative medicine since 1983.” [1] The article points out that the American Medical Association (AMA) has owned the current procedural terminology (CPT) codes for more than 40 years.
The benefits of this ownership are probably much greater than you realize. Basically, they amount to the following:
- Control: By owning the CPT codes, the AMA effectively keeps a lid on what doctors of chiropractic (not to mention nurses, optometrists, acupuncturists, doctors of naturopathy, etc.) can be reimbursed for. None of the other health care professions is able to create new codes that are more reflective of what they do (and should be reimbursed for) without saying “AMA, may I?”
Continue reading …
By Frank M. Painter, D.C. in Editorial on September 25th, 2010 at 3:21 pm
If Not Chiropractic Care, Then What’s Your Alternative?
The Chiro.Org Blog
Editorial Commentary:
Informed Consent involves discussing the risks and benefits of the treatment you propose (in my case, chiropractic) AND reviewing the risks and benefits of the alternatives, which are “conservative” medical care, which typically involves prescribing muscle relaxers, NSAIDs (nonsteroidal anti-inflammatory drugs), and less frequently, prescribing physical therapy.
Many patients who present to a chiropractor for the first time have already gone the medical route, with minimal or negative results. Today I would like to review the risks associated with the most commonly recommended pain relieving analgesics (NASIDs).
Continue reading …
By Frank M. Painter, D.C. in Editorial on September 20th, 2010 at 5:44 pm
Do You Still Beat Your Wife?
The Chiro.Org Blog
Editorial Commentary:
There are certain types of accusations that are impossible to respond to, without sounding like a guilty party, trying to weasel out of a tight spot. The accusation that chiropractic somehow “causes stroke” is one such unsupported and impossible-to-defend claim.
The simple truth is that there is absolutely no scientific evidence to demonstrate that chiropractic adjusting in the cervical region has ever “caused” a stroke. Here’s a perfect example of how flawed that logic really is: If I sneeze, and there is a traffic accident down the street, it may be convenient to claim that the sneeze “caused” the accident (especially if you stand to benefit financially from that claim), but where is the evidence?
Continue reading …
By Frank M. Painter, D.C. in Editorial on September 3rd, 2010 at 9:17 am
Neck Pain Commentaries: Part 4
The Chiro.Org Blog
We conclude this series by reviewing a brilliant group of 3 consecutive studies comparing popular forms of treatment for chronic spinal pain (NSAID use, acupuncture, and spinal adjusting).
Editorial Commentary:
Lynton G.F. Giles, DC, PhD, a researcher at the National Unit for Multidisciplinary Studies of Spinal Pain at the University of Queensland, published the first of 3 studies in 1999. This pilot study involved 77 patients who reported to the Townsville General Hospital, Queensland, Australia with complaints of chronic spinal pain (either neck, mid back or low back). These patients were randomized to receive either NSAIDs, acupuncture, or spinal adjusting as the active form of treatment. [1]
Care was provided for 4 weeks, followed by assessment of improvement. The outcome measures included: (1) Oswestry Back Pain Disability Index, (2) Neck Disability Index, and (3) three visual analogue scales of local pain intensity. After the period of 30 days, the spinal manipulation group was the only intervention that achieved statistically significant improvements.
Continue reading …
By Frank M. Painter, D.C. in Editorial on September 2nd, 2010 at 11:16 am
Neck Pain Commentaries: Part 3
The Chiro.Org Blog
Today we will review a trial that Kaiser’s reviewers obviously ignored so that they could deny benefits for cervical adjusting.
Editorial Commentary:
First off, this article should have been very easy for their reviewers to find. Look at the title:
“The Benefits Outweigh the Risks for Patients Undergoing Chiropractic Care for Neck Pain”
This study was a prospective, multicenter, observational cohort study. Patients with neck pain of any duration, who fulfilled the inclusion criteria, were recruited in a practice-based study. Data were collected on the patients and from the chiropractors at baseline, the first 3 visits, and at 3 and 12 months. Clinical outcome measures included (1) neck pain in the 24 hours preceding the visit, (2) neck disability, (3) treatment satisfaction, (4) global assessment, and (5) adverse events.
Continue reading …
By Frank M. Painter, D.C. in Editorial on September 1st, 2010 at 4:47 pm
Neck Pain Commentaries: Part 2
The Chiro.Org Blog
Our ongoing series of Editorials continues by reviewing what’s known about neck pain, and the success or failure of specific treatment approaches.
Editorial Commentary:
Today we will answer the question:
“Is Patient Advice Adequate for the Management of Neck Pain?”
The first article we will discuss is a Cochrane Database review [1] to assess whether patient education strategies, either alone or in combination with other treatments, are of benefit for pain, function, global perceived effect, quality of life, or patient satisfaction, in adults with neck pain with and without radiculopathy.
Continue reading …
By Frank M. Painter, D.C. in Editorial on August 31st, 2010 at 2:02 pm
Neck Pain Commentaries: Part 1
The Chiro.Org Blog
As a response to the actions of Kaiser, we will be publishing a series of editorials to review the alternatives, if chiropractic is eliminated from coverage. Informed Consent includes the process of reviewing the safety and efficacy of alternative forms of treatment. So let’s compare medicine’s success with resolving neck pain with chiropractic’s. I hope you will find these reviews of interest.
Editorial Commentary:
A recent balanced article in the Feb 13, 2008 issue of JAMA (Journal of the American Medical Association) revealed that between 1997 and 2005, the costs for “standard medical management” of spinal pain syndromes (both neck and back) increased by an inflation-adjusted 63%, while measurable outcomes for physical functioning, work or school limitations, and social limitations among adults actually declined. During this same period, there was also an overall increase in the number of individuals who experienced neck or back pain (from 20.7% to 24.7%).
Continue reading …
By Frank M. Painter, D.C. in Editorial on August 30th, 2010 at 12:06 pm
Kaiser, Chiropractic, and Chronic Neck Pain
The Chiro.Org Blog
Editorial Commentary:
I’m not enrolled in any of the Kaiser provider panels, so I have no vested interest in challenging their actions, but any time one Insurance Company explores a novel new way to reduce their costs, there’s always the chance that others will follow. Because Kaiser opened the conversation, asking whether chiropractic care actually provides benefits for those with neck pain, I draw your attention to the research we have gathered.
The Chiropractic and Chronic Neck Pain page contains numerous articles about the etiology of neck pain, as well as gathering many clinical trials, which have demonstrated the power of chiropractic management for neck pain.
Continue reading …
By Frank M. Painter, D.C. in Editorial on May 22nd, 2010 at 7:13 pm
Chiropractors had always been considered a “fringe” provider (or worse) by conventional medicine.
David M. Eisenberg’s article, Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use, published in the January 28, 1993 issue of the New England Journal of Medicine generated a rapid shift in that opinion. This article was a rude awakening, and a genuine “eye–opener” for organized medicine, since it described an amazing shift in public opinion.
During this same period, while Managed Care DRASTICALLY reduced medical incomes, Dr. Eisenberg revealed that “in 1990 Americans made an estimated 425 million visits to providers of unconventional therapy. That number far exceeds the number of visits to all U.S. primary care physicians (only 388 million)”. And Chiropractic Care was one of the most–utilized of these “unconventional” treatments.
Continue reading …
By Frank M. Painter, D.C. in Editorial on May 19th, 2010 at 3:13 pm
By Scott Haldeman DC, MD, PhD, FRCP(C)
Department of Neurology, University of California, Irvine, United States and the Department of Epidemiology, School of Public Health, University of California, Los Angeles, United States
Thanks to the Clinical Chiropractic (March 2010) for access to this article!
The past 20 years has seen a marked increase in the amount of research into the epidemiology, diagnosis, and treatment of disorders associated with the spine, especially back and neck pain. The therapeutic benefit of spinal manipulation for back and neck pain is no longer seriously questioned and there are growing research efforts to look into the impact of this treatment approach on other conditions, especially certain types of headache. At the same time, we are in a serious healthcare debate that is, amongst other issues, focusing more attention on cost containment and preventative heath care.
The research support for spinal manipulation has resulted in the situation where chiropractors are generally accepted as valuable members of the healthcare team. The acceptance of chiropractic has resulted in a debate within the profession concerning the future role it wishes to play within this team. There are three roles that chiropractors could potentially fulfill in the future and each requires consideration.
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