Medical No Good For Low Back Pain

Acute low back pain patients demonstrate significantly greater improvement with chiropractic than "usual care."

By Editorial Staff

With the publication of the Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study1 in The Spine Journal, one of the most frequently cited spine research journals in the world,2 the health care community at large may finally appreciate what the chiropractic profession has known for more than a century: Patients with acute mechanical low back pain enjoy significant improvement with chiropractic care, but little to no improvement with the usual care they receive from a family physician.

Published in the December 2010 edition of The Spine Journal, the study found that after 16 weeks of care, patients referred to medical doctors saw almost no improvement in their disability scores, were likely to still be taking pain drugs and saw no benefit with added physical therapy - and yet were unlikely to be referred to a doctor of chiropractic.

The study is "the first reported randomized controlled trial comparing full CPG [clinical practice guidelines]-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician-directed UC [usual care] in the treatment of patients with AM-LBP (acute mechanical low back pain)." (Evidence-based clinical practice guidelines have been established for acute mechanical low back pain in many countries around the world, but sadly, most primary care medical doctors don't follow these guidelines.) Researchers found that "treatment including CSMT [chiropractic spinal manipulative therapy] is associated with significantly greater improvement in condition-specific functioning" than usual care provided by a family physician.

Study Parameters

The Chiropractic Hospital-based Interventions Research Outcome (CHIRO) initiative was "designed to evaluate the outcomes of spinal pain patient management strategies that involve a component of chiropractic assessment and/or spinal manipulative therapy, administered in a hospital-based spine program outpatient clinic." The study utilized the CHIRO framework "to examine the effectiveness of current evidence-based CPG-recommended treatments for patients with AM-LBP pain."

CPG "study care" (SC) was compared with the usual care (UC) provided by family physicians. Patients were first seen by a spine physician and then randomly assigned to either the SC group or the UC group.

Patients in the SC group received acetaminophen, a "progressive walking program" and up to four weeks of lumbar chiropractic spinal manipulative therapy. The manipulative therapy was provided "using conventional side-posture, high-velocity, low-amplitude techniques" to the lumbar region only, and only by a chiropractor.

Patients assigned to the UC group were referred back to their family physician, who was "simply advised to treat at their own discretion." Patients in this group received treatment from "a variety of professionals including family physicians, massage therapists, kinesiologists, and/or physiotherapists."

All care was provided at a hospital-based spine program outpatient clinic. The primary outcome measure was the Roland-Morris Disability Questionnaire (RDQ), administered at the beginning of care and at 16 weeks, when acute low back pain is considered to become chronic. The RDQ was also administered at eight and 24 weeks.

Other Important Findings

After 16 weeks, "78% of patients in the UC group were still taking narcotic analgesic medications on either a daily or as needed basis." (Only 6 percent of this group received chiropractic care.)

Condition-specific improvement after 16 weeks "clearly favored the SC group, with mean RDQ improvement scores of 2.7 in the SC group compared with only 0.1 in the UC group (p=.003)."

While the difference in improvement "was not quite significant at 8 weeks," it was found to be "clearly significant at 24 weeks of follow-up (0.004)."

Both groups showed improvement in bodily pain and physical functioning, but "patients in the UC group uniquely showed no improvement whatsoever in back-specific functioning (RDQ scores) throughout the entire study period."

The inclusion of NSAIDs and manipulation/mobilization performed by physical therapists were no more effective in treating patients than family doctors who offered patients advice and acetaminophen. The study found: "[T]he addition of NSAIDs and a form of spinal manipulative therapy or mobilization administered by a physiotherapist to the lumbar spine, thoracic spine, sacroiliac joint, pelvis, and hip (compared with a detuned ultrasound as placebo manipulative therapy), to family physician 'advice' and acetaminophen were shown to have no clinically worthwhile benefit when compared with advice and acetaminophen alone." 

The study criticizes a 2007 report that had derided the efficacy of spinal manipulation by pointing out that the older report based its conclusions on the outcomes of therapies performed by non-chiropractors. The 2007 study concluded that patients "do not recover more quickly with the addition of diclofenac or spinal manipulative therapy."3 By contrast, the CHIRO study noted: "Although spinal-manipulative therapy is currently administered by many different healthcare professionals, including: chiropractors, osteopaths, orthopedic surgeons, family physicians, kinesiologists, naturopaths, and physiotherapists, the levels of training and clinical acumen vary widely. The study design used by Hancock, et al., therefore, differs from our study because [their study] did not use chiropracticspinal manipulation, and current guideline based care does not endorse any forms of spinal manipulation administered by any other practitioners."

References

1. Bishop PB, Quon JA, Fisher CG, Dvorak MFS. 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. Spine Journal, 2010;10:1055-1064. www.ncbi.nlm.nih.gov/pubmed/20889389

2. Brunarski D. "Impact of the Chiropractic Literature." Dynamic Chiropractic, Dec. 2, 2010;28(25).

3. Hancock MJ, Maher CG, Latimer J, McLachlan AJ, Cooper CW, Day RO, Spindler MF, McAuley JH. Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial. Lancet, 2007 Nov 10;370(9599):1638-43. www.ncbi.nlm.nih.gov/pubmed/17993364

Say Goodbye to Low-Back Pain with Regular Chiropractic Care

 

It is estimated that in the United States, the annual costs associated with the treatment of low back pain (LBP) total approximately $100 billion.  High recurrence rates and chronic disability are believed to play a large role in the overall cost of back pain, and studies have shown that only a fraction of LBP patients remain pain free and recover completely, even one year after the problem first occurred. 

In a recent study, 30 patients with chronic, nonspecific low back pain lasting at least six months were separated into two groups. The first group received 12 treatments over a one-month period, but no treatments for the subsequent nine months; the second group received 12 treatments over a one-month period, along with "maintenance spinal manipulation" every three weeks for the following nine months.  

Results: Patients in both groups experienced significant decreases in low back pain scores after the first series of treatments. The greatest difference, however, was seen in disability scores over the duration of the study. Analysis of the data showed that in patients who received maintenance spinal manipulation, "the disability scores were significantly lower after the 10-month period than before the initial phase of treatment." In the other group, however, "the mean disability scores went back to their pretreatment level."

Based on these results, it is clear that regular chiropractic care not only helps reduce  LBP and disability associated with LBP, but that continued chiropractic treatment following the acute treatment phase assists in keeping pain from recurring. If you suffer from LBP or any other dysfunction, your doctor of chiropractic can design an effective treatment plan. 

For more information on the benefits of chiropractic, visit  www.chiro.asia     

Reference: Descarreaux M, Blouin JS, Drolet M, et al. Efficacy of preventive spinal manipulation for chronic low-back pain and related disabilities: a preliminary study. Journal of Manipulative and Physiological Therapeutics; October 2004;27(8):509-514.

Ultrasound: Pretty Much Worthless

Is Therapeutic Ultrasound Effective for Musculoskeletal Problems

By Warren Hammer, MS, DC, DABCO

The answer to the above question is still in doubt. According to Wong, et al.,1 if clinicians based their decision to use ultrasound on clear demonstration of effectiveness in the scientific literature, then many would not use it based on lack of supporting evidence.

How many times have we heard this statement about much of what soft-tissue clinicians do, or for that matter, about what practitioners do in all of the healing professions? Yet ultrasound has been widely used and well-accepted as a physical therapy adjunct modality throughout the world since the '50s.1

What the Research Says

Randomized, controlled trials (RCTs) have been conducted; 10 of 35 RCTs were judged to have acceptable methods. Two of these 10 trials suggested that ultrasound was more effective for calcific tendinitis of the shoulder and carpal tunnel than placebo, but the other eight trials did not recommend its use.2 In the journal Pain,3 a systematic review of 38 studies was performed; the review authors also concluded that there seemed to be little evidence to support the use of ultrasound in the treatment of musculoskeletal disorders.

That said, does this mean we should abandon the use of ultrasound? Not necessarily. Most of these studies do not consider dosage, treatment time and the type of tissue it is used on. Like many things we do that seem to help patients, the final word is not yet in. There are studies that conclude ultrasound works. One paper concluded that the results of high-quality studies indicated there was evidence (albeit weak) in favor of ultrasound for lateral epicondylitis.3 I wonder if insurance decision-makers are aware of this literature. Regardless, at present, you have to make up your own mind.

How to Make Ultrasound More Efficient

Ultrasound is thought to exert both a thermal and non-thermal effect. Early on, many perceived its effect primarily as thermal, but studies have shown that the warmth felt by the patient is mostly in the thermal skin receptors and does not create a significant thermal affect in the deeper tissues, even when continuous ultrasound is administered at a relatively high power.4 Some studies have revealed no advantage between ordinary heat therapy and ultrasound with regard to tissue extensibility and stretching; the effect of ultrasound on extensibility lasted only 3 minutes immediately following treatment.5

Non-thermal effects refer to its effect in relation to soft-tissue injury. Rather than thermal, the physical mechanisms thought to be involved are cavitation and acoustic streaming.6 Before discussing non-thermal effects, it is important to note that the absorption of ultrasound into the tissues depends on the particular tissue's ability to absorb the energy.4

Tissues with a higher protein content absorb ultrasound more than tissues with high water content and low protein content. Therefore, tissues with the high collagen content such as ligaments, tendons, fascia, joint capsule and scar tissue are the best absorbers. Immediately after injury (in the bleeding phase), ultrasound is not recommended since it is thought that it may increase blood flow. After the acute bleeding phase, ultrasound is considered pro-inflammatory by stimulating mast cells, platelets, and white cells, which is necessary in the early phases of the repair process.

Some studies4 have shown the possibility that ultrasound may aid in the remodeling scar-tissue phase by influencing collagen fiber orientation. There are even studies involving techniques similar to friction massage and Graston Technique that suggest ultrasound creates increased fibroblastic proliferation and collagen formation.7

There is still a debate regarding dosage of ultrasound in relation to therapeutic effects. Also, while continuous ultrasound may cause a more rapid delivery of energy, pulsed ultrasound may be more effective in the early inflammatory and proliferative inflammatory stages. In comparison to other modalities, Watson4 states that there is an overlap with laser therapy and some pulsed EM fields (short wave). Ultrasound is best on tissues made of dense collagenous tissues, but less effective than these other modalities in tissues like muscle, nerve and edematous tissue.

So, after at least 50 years of use, ultrasound has not yet reached a high level of evidence-based acceptance. Newer methods are often rejected by insurance companies because they are considered to still be in the "experimental" phase. The question of what is responsible for healing continues.

Chiropractic: It Works and It's Safer than Physiotherapists or Medical Doctors

I Love Research!

The real kind done by real scientists not the kind done by companies to prove their product works best.

Another New LBP Study Reveals Chiropractic Is Superior to PT and MD Care. This study revealed you are twice as likely to end up disabled if you got your care from a PT, rather than from a DC.  Thank you Dr. Frank Painter from Chiro.org

OBJECTIVES:   To compare occurrence of repeated disability episodes across types of health care providers who treat claimants with new episodes of work-related low back pain

CONCLUSIONS:   In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than in chiropractic services or no treatment.

Way Cool!!!

ObamaCare Gives Even More To The Rich

"There is nowhere this greed is more pervasive than among those companies responsible for the health of roughly 300 million of Americans - Big Pharma" [AP]

During the ultimate scene of betrayal in the movie Wall Street, a young stockbroker named Bud Fox learns that his idol, the golden-calf worshipping Gordon Gekko, has not only lied to him but left his father’s company exposed to the whims and hunger of the wolves of Wall Street. In a climactic moment, Fox asks Gekko, “how much is enough? How many yachts can you water ski behind?”

Even though this film was mid-1980s fare, one can once again repeat that old refrain, the more things change the more they stay the same. Perhaps not for the actor who played Bud Fox, Charlie Sheen, who should share Natalie Portman’s Oscar for real-time transformation into the Black Swan.

But for the rest of us, who have watched as greed has become the foundational structure upon which much of our modern economy is built, it is often difficult to see how we might close the Pandora’s Box and return to saner times. You know, back when being Donald Trump wasn’t considered an asset in a hair-club-for-men commercial, much less a race to be President of the United States.

There is nowhere this greed is more pervasive than among those companies responsible for the health of roughly 300 million of Americans - Big Pharma. You know, the guys who got a better sweetheart deal from George Bush’s Medicare prescription drug benefit than Ana Nicole Smith did from that old rich guy.

Later, re-importation from Canada and bulk negotiation for Medicare prescription drugs were written out of any Obama healthcare plan, even though each was at the heart of Democratic Party campaign promises in 2006 and 2008.

Maybe money can not buy you love - but the halls of Congress have a more Heidi-Fleiss-kind-of ethic to them.
Steve Lendman of RINF.com, in providing a summary of David Sirota’s bestselling book, Hostile Takeover, clarifies:

This industry is one of the most profitable in the country making about 18 cents profit on every dollar of sales; it is aided by government using our tax dollars to fund about one third of all research on new drugs the industry gets at no charge; the industry spends about twice as much on advertising, promotion and administrative costs as they do on R & D to develop new drugs; the prices charged for prescription drugs in the US are inordinately high compared to the rest of the world and are rising at about four times the rate of inflation; these rising costs plus those for most all health services are rising so fast, companies are forcing their employees to pay a greater share of them or are reducing overall health care benefits.

Ever feel like you are the bank and they are Dillinger? If not, you probably should.
I can attest to their greed personally, from working with preeminent plaintiff’s lawyer Ed Blizzard, who has challenged the right of pharmaceutical companies to poison Americans, like it is part of their business model. It is Blizzard who made Vioxx drug-maker Merck pay dearly - to the tune of $4.85 billion - for the scores of Americans who lost mothers, fathers, brothers and sisters, because Vioxx promised to help with arthritis and instead delivered sudden cardiac arrest.

Now, because a lack of any regulation, Americans are being poisoned by hip implants created by Johnson & Johnson subsidiary Depuy Orthopaedics Inc., that are not only not tracked by any regulated registry, but in many cases were never even tested before being put into people’s bodies - so the inside of victims hips could come to resemble a post-Deepwater Horizon Gulf of Mexico.
You can tell they’re confident that their 93,000 recalls, which they had been warned about as early as 2008, but did not do anything to address until 2010, aren’t proof of any wrongdoing. That is probably why Depuy’s President, David Floyd, just resigned.

Even worse, the chromium poisoning that is destroying victims’ bone and muscle is nothing new, in fact, you may remember a town of people who got cancer due to its ill effects from the movie Erin Brockovich. Now, they have Depuy and Johnson & Johnson to thank for this honor.

So one understands we are talking about real people here, one of Blizzard’s clients, 58 year-old construction worker Larry Barnett of Modesto, Illinois, “suffered debilitating pain - he had trouble even walking or standing after receiving the part” and now is “at much greater risk for cancer.” Barnett told reporter Mike Cronin of The Daily, that Depuy’s ASR hip replacement has "screwed up my life for three years." This man was a hard-working construction worker, who “only wants to get back to work".

One wonders if any pharmaceutical company had to give up income for three years, which they would do first - hand off the bill to American taxpayers or make Canada to accept re-importation of drugs from the United States for 150 per cent of the price.

As Blizzard has said, “nobody signed up for an oil spill in their body.” They did not sign up for cancer either.
So let me ask the question this time, as Sheen is a bit preoccupied with other matters: When is enough, enough?

Cliff Schecter is the President of Libertas, LLC, a progressive public relations firm, the author of the 2008 bestseller The Real McCain, and a regular contributor to The Huffington Post.
Follow Cliff Schecter On Twitter: @Cliffschecter

Japan Halts Use of Pfizer and sanofi Vaccines

Japan suspended the use of two pediatric vaccines, one made by Pfizer and one by sanofi, following the deaths of four children in three days. 

The deaths occurred shortly after vaccination with Pfizer’s Prevenar vaccine (known as Prevnar in the United States) and sanofi’s ActHIB vaccine. 

Although a panel of experts at Japan’s Health Ministry have found no link between the deaths and vaccination, the suspension will remain in place while further studies are conducted.

 In Hong Kong, the Department of Health said in astatement that it has “no record of untoward event report[s] associated with Prevenar, but we will inform all medical practitioners of the Japanese incident and request them to bring up any anomaly detected." sanofi’s vaccine is not used in Hong Kong, but both are widely used in the US. 

According to Reuters, FDA is monitoring the safety of both vaccines, but has not observed any safety concenrs in the US.

This is not the first time that Prevenar has faced safety suspicions. In 2009, a batch of Prevenar was pulled from the market in the Netherlands following the deaths of three infants after vaccination. In February 2010, however, it was announced that there was no link between the deaths and vaccination.

It’s OK to let fevers run their course

A fever can be a scary thing, especially in children. For parents of young children, the first impulse is to treat a child’s fever with an over-the-counter medication, and get the child’s temperature back down to normal — around 98.6 degrees.

The American Academy of Pediatrics’ guidance to pediatricians and other health care providers who look after children cautions against “fever phobia.” The AAP emphasizes that fever itself is not an illness but rather a beneficial reaction to infections. However, any newborn or infant aged 3 months or younger with a fever should be evaluated by their pediatrician or health care provider.

Through their advertising campaigns, pharmaceutical companies who make fever-reducing and pain-relieving medications have convinced most Americans that a fever is a serious problem that must be promptly and thoroughly treated.

But, the reality is that a fever isn’t a problem in and of itself. Fevers are the body’s natural reaction to an illness or infection. They are a sign the body’s immune system has recognized a problem and is actively fighting it off.

There is a growing amount of research showing that fever helps slow the reproduction of viruses and bacteria, and stimulates the production and effectiveness of infection-fighting cells in the body. Leaving fevers untreated has been shown to shorten the duration of an illness. In the case of chicken pox, children whose fevers were allowed to run their course recovered one day faster than children whose fevers were treated with medication.

These days, parents are likely to get this advice: “treat the child, not the fever.” If a normally healthy child has a fever but isn’t uncomfortable, it is not necessary to give fever-reducing medication. The goal should be the comfort of the child during an illness. There is no reason to wake a sleeping child to give him or her this type of medication — rest will likely do the child more good.

Over-the-counter medications such as acetaminophen and ibuprofen have dual action: they lower fevers and are pain relievers, too. Viral illnesses, such as the flu, often cause headache and body aches — so these medications are helpful for this type of pain.

For many years, parents have been counseled to give acetaminophen or ibuprofen or both to children with fevers. Although these are generally safe medications, calculating the dose according to the weight of the child and giving them at the correct time intervals can be complicated, especially if multiple caregivers are involved. Overdosing children on these medications can harm the liver and kidneys.

A common misconception is that treating high fevers in children prevents seizures — and that seizures can cause brain damage or epilepsy. The AAP studied this topic and found that giving children fever-reducing medication does not reduce the risk of a febrile seizure. Also, febrile seizures in children — though very disturbing to witness — cause no long-term effects and do not cause epilepsy.

So, the next time you or your child has a fever, it’s OK to not to rush to treat it. Pay attention to other symptoms and get medical advice if needed. Rest and fluids are always a good idea. If a fever is due to a cold or the flu, give medication if needed for comfort — but don’t focus too much on the number on a thermometer.

Glass of wine a day 'cuts dementia risk

Scientists followed 3,200 over 75s, who had no signs of dementia when they enrolled on the study, for three years. Of those, 217 went on to develop dementia.

They found those who drank between two and three units a day (20 to 30ml) were 29 per cent less likely to have started developing dementia by the end of the three-year period than those who were teetotal.

Two to three units is equivalent to a medium-sized (175ml) glass of wine (2.3 units) or a pint of beer (2.8 units).

The results for Alzheimer's, which accounts for two-thirds of dementia cases, were even more striking: such drinkers were 42 per cent less likely to have developed the disease.

The academics, led by Siegfried Wayerer of the Central Institute of Mental Health in Mannheim in Germany, concluded that "light-to-moderate" alcohol consumption could have a "protective effect" against dementia.

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They wrote in the journal Age and Ageing: "We found that alcohol consumption ... is significantly associated with lower incidence of overall dementia and Alzheimer dementia."

They believe alcoholic drinks could work to stave off dementia in a number of ways.

The alcohol itself could work by lowering cholesterol levels, stopping blood from clotting too much and improving insulin sensitivity to blood sugar levels.

The non-alcoholic elements "may have antioxidant, anti-inflammatory and vaso-relaxant [blood vessel relaxant] properties", they wrote.

"It is still an open question whether different alcoholic beverages, such as beer, wine and spirits, have a similar effect," they noted.

"Some studies have shown a positive effect of wine only, which may be due either to the level of ethanol [alcohol], the complex mixture that comprises wine or to healthier life-style ascribed to wine drinkers."

Interestingly, there was no such protective effect for vascular dementia and cognitive decline, two other common types of dementia.

This could be because they cause dementia - just an umbrella term for a range of mental symptoms - in very different ways to Alzheimer's.

The study supports previous research which found that alcohol appears to cut the chance of dementia and Alzheimer's in the younger retired.

However, the authors noted that prolonged heavy drinking is thought to be responsible for about one in 10 cases of dementia.

In Britain about 750,000 people are thought to suffer from dementia, although less than half has received a diagnosis. The number is expected to top one million by 2021.

Dr Anne Corbett, research manager at the Alzheimer's Society, said: "The idea that a drop of your favourite tipple could reduce risk of dementia will come as welcome news to many. This latest study adds real punch to the growing argument that this could be the case.

"However, it is still unclear whether all types of alcohol bring the same benefits and it is likely other lifestyle factors have a part to play."

She added: "What is important is that this is not seen as a green light to hit the bottle. As well as many other health dangers, heavy drinking has been linked to an increased risk of dementia. The best way to reduce your risk of dementia is to eat a healthy diet and exercise regularly."

The German academics said they could not prove that drinking in moderation had a causal effect on protecting against dementia, because to do so would require a randomised controlled trial where the volunteers did not know if they were receiving an alcoholic drink or a non-alcoholic one.

Such a trial would be "neither ethical nor practically feasible", they conceded.