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Deconstructing Chronic Low Back Pain in the Older Adult –
Part IV: Depression

Chiro.Org Blog: To present the fourth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of twelve important contributors to pain and disability in older adults with CLBP. This article focuses on depression. […]

Nutritional Factors Affecting Postpartum Depression

Chiro.Org Blog: Pregnancy and lactation represent a period of substantial physiological changes for the mother and increased nutritional requirements to meet these adjustments. A number of nutritional depletions occur during pregnancy. Serum concentrations of iron and folate take months before they normalize to pre-pregnancy levels. Additionally, many micronutrients required during pregnancy interfere with each other, making absorption difficult. Postpartum depression is the primary complication of childbirth, possibly caused by several nutritional and non-nutritional factors. The current review highlights the impact nutrition may have on the etiology of this debilitating disorder, most notably on prevention of inflammation and maintenance of a healthy central nervous system. […]

Brief Screening Questions For Depression in Chiropractic Patients With Low Back Pain: Identification of Potentially Useful Questions and Test of Their Predictive Capacity

Chiro.Org Blog: Pain and depression often co-exist [1-3] , and although the causal relation between the two is not clear [4, 5] , evidence suggests that pain negatively affects outcome in depression as well as vice versa [6] . Low back pain (LBP) is a highly frequent pain condition with a substantial impact on global health [7] for which the risk of a poor prognosis is increased in the presence of depression [8, 9] . It is a condition for which there is no generally effective treatment, but non-pharmacological treatment addressing psychological symptoms in addition to the physical symptoms has been demonstrated to improve outcome in LBP patients with high scores on psychological questions [10]. […]

Clinical Brief: Depression Screening and Treatment

Chiro.Org Blog: Depression is a condition seen frequently in primary care practice as well as by practitioners who treat patients with chronic pain. The U.S. Preventive Services Task Force recommends that all adults be screened for depression and those who screen positive for depression be appropriately referred for additional assessment and management. Cognitive behavioral therapy, pharmacotherapy, physical activity and mindful exercise are all accepted approaches to treatment of depression. […]

Whiplash-associated Disorders: Who Gets Depressed? Who Stays Depressed?

Chiro.Org Blog: In a prior study we reported that post crash depression is common following crash related WAD. As a follow-up to that, we now report the characteristics that can assist clinicians to identify not only which patients are more likely to experience post-crash depression, but also identify which are at risk for a more severe course of depression. This is important because depressed mood in those with WAD is not only an additional health burden in itself, but is also associated with slower recovery. The most important characteristics in identifying those with WAD who are likely to experience depression were higher post crash pain, other post-crash symptoms, sustaining a fractured bone, the presence of post-crash anxiety, and the presence of prior mental health problems. […]

Systematic Review of Self-Reported Prognosis in Adults After Mild Traumatic Brain Injury

Chiro.Org Blog: Since the prognosis review of the WHO Collaborating Centre Task Force, there has been some progress in understanding MTBI prognosis. Our results add to the growing evidence that postconcussion symptoms are not specific to MTBI and occur commonly in the general population and after other nonhead injuries. Our results also confirm the importance of psychosocial determinants of recovery. We conclude that self-reported symptoms can be persistent after MTBI, and there is a need for more intervention research targeting modifiable prognostic factors. Finally, we found only 1 study of a clinical prediction rule, and we recommend more focus on this issue because it holds the potential of identifying those at risk of a poor recovery who might benefit from more focused clinical attention. […]

Cortical Changes in Chronic Low Back Pain

Chiro.Org Blog: There is increasing evidence that chronic pain problems are characterised by alterations in brain structure and function. Chronic back pain is no exception. There is a growing sentiment, with accompanying theory, that these brain changes contribute to chronic back pain, although empirical support is lacking. This paper reviews the structural and functional changes of the brain that have been observed in people with chronic back pain. […]

Chiropractic Management of a Patient With Chronic Fatigue

Chiro.Org Blog: The patient was placed on an anti-inflammatory ancestral diet and given recommendations to decrease the aerobic intensity of her exercise routine. On the basis of the result of conventional and functional laboratory tests, she was prescribed a treatment plan of targeted supplementation. After 12 weeks of application of dietary, lifestyle, and supplementation recommendations, the patient reported experiencing increased energy and weight loss of 15 pounds. Her thyroglobulin antibodies returned within reference range, salivary cortisol increased and closely followed the proper circadian rhythm, and dehydroepiandrosterone-sulfate increased. […]

Workers’ Compensation, Return to Work, and Lumbar Fusion for Spondylolisthesis

Chiro.Org Blog: This is an interesting follow-up to a 2011 study drawn from the Ohio Bureau of Workers’ Compensation database. [Startling New Study Reveals That Back Surgery Fails 74% of the Time] In the 2011 study, two years AFTER surgery, only 26 percent had returned to work. That translates to a resounding 74% failure rate! In this current study, researchers reviewed the files of 686 workers who underwent fusion surgery for spondylolisthesis between 1993 and 2013, revealing that only 29.9% of them ever returned to work (for at least 6 months). The failure rate (meaning return-to-work) was 70.1%. […]

Do Older Adults with Chronic Low Back Pain Differ from Younger Adults in Regards to Baseline Characteristics and Prognosis?

Chiro.Org Blog: A total of 14,479 participants were included in the study. Of these 3,087 (21%) patients were older adults, 6,071 (42%) were middle aged and 5,321 (37%) were young adults. At presentation older adults were statistically different to the middle aged and younger adults for most characteristics measured (e.g. less intense back pain, more leg pain and more depression); however, the differences were small. The change in pain and disability over 12 months did not differ between age groups. […]

Psychological and Behavioral Differences Between Low Back Pain Populations

Chiro.Org Blog: This study has described patients seeking chiropractic primary care for LBP with regards to psychological and behavioral characteristics and compared them to the characteristics of patients from a sample at high risk of developing chronic disabling NP and/or LBP and long term sick leave in primary care, and two secondary care samples with chronic LBP. Contrary to the hypothesis the chiropractic primary care sample was more affected by pain and worse off with regards to psychological and behavioral characteristics compared to the other primary care sample. Based on these findings the 4 samples may be considered statistically and clinically different. […]

A Population-based, Incidence Cohort Study of Mid-back Pain After Traffic Collisions

Chiro.Org Blog: Mid-back pain after traffic collisions is common, especially in women and in young individuals. A substantial proportion of participants in this cohort experienced a delayed recovery. Prognostic factors with the strongest influence on recovery were poor expectations for recovery and having a previous experience of a traffic injury. […]

Mechanisms of Low Back Pain:
A Guide for Diagnosis and Therapy

Chiro.Org Blog: CLBP represents the leading cause of disability worldwide and is a major welfare and economic problem. [1] Given this complexity, the diagnostic evaluation of patients with LBP can be very challenging and requires complex clinical decision-making. Answering the question, “what is the pain generator?” among the several structures potentially involved in CLBP is a key factor in the management of these patients, since a diagnosis not based on specific pain generator can lead to therapeutic mistakes. This article aims to provide a brief clinical guide that could help in the identification of pain generators through a careful anatomical description, thereby directing clinicians towards the correct diagnosis and therapeutic approach. […]

Factors Affecting Return To Work After Injury Or Illness

Chiro.Org Blog: Work disability is a major personal, financial and public health burden. [1] Annual productivity losses from missed workdays due to low back pain (LBP) are estimated at $28 billion in the United States alone [2] and LBP is now the leading cause of disability, affecting nearly 600 million people worldwide. […]

Efficacy of Selected Complementary and Alternative Medicine Interventions For Chronic Pain

Chiro.Org Blog: Complementary and alternative medicine (CAM) is a group of diverse medical and healthcare systems, therapies, and products that are not presently considered part of conventional medicine. This article provides an up-to-date review of the efficacy of selected CAM modalities in the management of chronic pain. Findings are presented according to the classification system developed by the National Institutes of Health National Center for Complementary and Alternative Medicine (formerly Office of Alternative Medicine) and are grouped into four domains: biologically based medicine, energy medicine, manipulative and body-based medicine, and mind-body medicine. […]