Chronic pain symptoms and the ability to manage and cope with them can be strongly influenced by what are generally referred to as psychological factors. These factors have the capacity to substantially hinder clinical improvement, cause symptom aggravation and reduce self-management capacity. Though these concepts are well-supported in the scientific literature, they are not inherently usable. Practical methods of revealing relevant psychological factors are needed. To explore whether psychological factors are clinically relevant, clinicians can ask questions during the consultation and/or use one of several screening questionnaires.

ICSC presenter Carolina Cancelliere, DC, PhD, is a clinical epidemiologist who serves as research chair in knowledge translation for the Canadian Chiropractic Research Foundation and as a faculty member in health sciences at Ontario Tech University. She and her team are working to demonstrate how chiropractic care can be applied to help patients suffering from disabilities related to spinal disorders. At ICSC, she will participate in the session “Translating Spinal Care Research into Practice." In this ACA Blogs post, she answers questions about her upcoming presentation.

The Interprofessional Collaborative Spine Conference (ICSC) will bring together members of the chiropractic, osteopathic medicine and physical therapy professions to tackle topics related to manual therapy and its use—amid the opioid epidemic—in treating low back pain and other conditions. In his presentation, “Implementation Science/Knowledge Translation Session: Osteopathic Perspective,” Michael Seffinger, DO, a professor at the College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, unpacks the sometimes conflicting and sometimes incomplete evidence using his osteopathic lens.

Anthony Delitto, PT, PhD, FAPTA, dean of the School of Health and Rehabilitation Sciences, University of Pittsburgh, will be the keynote speaker at the Interprofessional Collaborative Spine Conference (ICSC), Nov. 8-9 in Pittsburgh, Pa. In his presentation, “Non-Pharmacological Back Pain Management: Collaborative Solutions,” Dr. Delitto will discuss how, in the wake of today’s opioid crisis, there is an elevated value placed on chiropractic, physical therapy and osteopathic therapies. He will review the evidence surrounding non-pharmacological treatments and spinal manipulative therapy for back pain, and how manual therapy providers implement this kind of pain management—including how they educate patients about pain.  

The topic of clinical effectiveness for spinal manipulation and exercise is extremely timely and relevant to today’s healthcare provider. However, there is one aspect of this topic that continues to confuse both clinicians and patients: namely, how to interpret the mixed messages about the clinical effectiveness of manual therapy and exercise for management of low back and neck pain. There have been multiple systematic reviews of the spinal manipulation literature with conflicting conclusions. The same is true of the literature regarding therapeutic exercise. How then does one justify the use of these treatments?

Research evidence suggests following guideline recommendations can improve quality of care and clinical outcomes. However, translating recommendations into clinical care for individuals can be challenging because guidelines, by nature, tend to inform care on a general level. Further complicating guideline adherence is confusion caused by inconsistent terminology and the existence of multiple guidelines for single conditions, among other issues. Inconsistent recommendations within guidelines raises the question, “Is there common ground among guidelines for musculoskeletal conditions?” To answer this question,  researchers identified 11 recommendations that consistently appear within current guidelines. 

Problems involving the hip are some of the most frequently undiagnosed or misdiagnosed conditions. When a patient presents with hip pain, chiropractors immediately consider the most probable culprits—like greater throchanteric pain syndrome and osteoarthritis. But what if the diagnosis is not so straightforward? A new paper by Lee¹ identified the four top undiagnosed causes of hip pain.

The biopsychosocial model is a widely recommended method of clinical evaluation and management. The model identifies three important areas. “Bio” refers to evaluating/treating biological problems (e.g., pathology), “psych” refers to psychological health, and “social” refers to a person’s relationships with others and the environment. However, some evidence suggests that practitioners, as a group, may not be addressing “social” components of health as much as they could.

The healthcare landscape in the United States is rapidly evolving. Population Spine Health Management and other contemporary practice principles are being implemented by hospital systems and physicians nationwide. Author David J. BenEliyahu, DC, who is an administrator of back pain and chiropractic programs at Mather Hospital/Northwell Health in Port Jefferson, N.Y., believes chiropractors should become versed in these contemporary practice principles and consider implementing them into their practices, which will not only improve outcomes but also enhance the progressive identity of the chiropractic profession.

Chronic pain is a complex condition influencing behaviors, thoughts and mood. With opioid issues coming to light, there has been more emphasis and research into multi-faceted, biopsychosocial models to treatment. Cognitive Behavioral Therapy (CBT) is a type of talk-therapy treatment that focuses on addressing and removing the negative impacts chronic pain has on thoughts and functions. The Office of Mental Health and Suicide Prevention (OMHSP) has implemented a national initiative to disseminate Cognitive Behavioral Therapy for Chronic Pain throughout the Veterans Health Administration to make this treatment widely available to veterans.