American Chiropractic Association - low back pain
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Social Factors: A Sometimes-overlooked Opportunity

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.

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Article rating: 4.9

My VA Experience with Cognitive Behavioral Therapy for Chronic Pain

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.

Author: Jamie Zeman
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Psychological, Social Factors in Chronic Pain: The Impact on Chiropractic Patients

The current opioid epidemic in the United States brings long overdue attention to nonpharmacological approaches to managing pain.  Among the recommended therapies for low back pain by the American College of Physicians, for example, are spinal manipulation, acupuncture, yoga and cognitive behavioral therapy.  While it may be clear why body-based therapies were recommended, the inclusion of a psychological approach, such as cognitive behavioral therapy, may raise some eyebrows. Researchers Margaret Chesney, PhD, and Christine Goertz, DC, PhD, explore how psychological factors play a role in the experience of chronic pain as well as what patients and their providers should know.

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Article rating: 5.0

Choosing Outcome Assessments for Back Pain

Patient-reported outcome measures quantify patients’ subjective symptoms and are often more in line with accomplishing patient-centered goals. Patient-reported outcomes can give valuable information to evaluate the success of a treatment plan and aid in determining a prognosis based on past response. They are also used by insurance companies for re-imbursement purposes, such as determining medical necessity. Chiarotto et al. developed a core outcome set for use in clinical practice with accompanying suggested measures for patients with low back pain.

Author: Zac Shannon
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Article rating: 5.0

Research Review: Chiropractic Care and Risk for Acute Lumbar Disc Herniation: a Population-based Self-controlled Case Series Study

The objective of this study was to compare the associations between primary care physician and chiropractic care in relation to acute lumbar disc herniation (LDH) with early surgery. The clinical picture of LDH in the early stages (i.e. the prodromal phase), in which low back pain progresses to radicular leg pain and possible neurologic signs, is often uncertain and can be a confusing time for both patients and clinicians. Thus, making a diagnosis of LDH during the early course of symptoms is often very difficult. The study's hypothesis was that chiropractic care could only be thought to increase the risk for acute LDH if the measured association between chiropractic visits and acute LDH exceeded the association between PCP visits and acute LDH.

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Article rating: 5.0

Research Review: Manipulation and Mobilization for Treating Chronic Low Back Pain: a Systematic Review and Meta-analysis

Spinal manipulation and mobilization for the treatment of back and neck pain have been the topic of several systematic reviews, with some suggesting that the evidence in support of the view that spinal manipulative therapy is superior to other standard treatments for chronic low back pain is sparse. On the other hand, more recent systematic reviews have reported that spinal manipulation and mobilization are “viable” options for treating pain. Despite this degree of variability among studies, manipulation and mobilization are still considered to be effective treatments when compared with other therapies. The purpose of this systematic review was to unravel these differences and inconsistent findings. 

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WHO Collaboration Presents Public Health Opportunities for Chiropractic

The World Health Organization (WHO) held its 71st Assembly May 21-26, 2018 at the United Nations headquarters in Geneva. WHO is the directing and coordinating authority on international health, and uses the annual Assembly to set norms and standards for ethical and evidence-based healthcare policy. I had the honor of attending the Assembly this year as part of the World Federation of Chiropractic (WFC) delegation. Over four days of plenary sessions, committee meetings, and technical briefings, I observed an impressive breadth and depth of operations at WHO—and a chiropractic profession that is primed for more meaningful engagement with the broader public health community.

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Article rating: 5.0

Research Review: Spinal Manipulation vs. NSAID (Diclofenac) for Acute Low Back Pain

The purpose of this randomized, double-blinded, placebo-controlled, parallel trial was to compare high-velocity low-amplitude spinal manipulation with chemical treatment. In this case, the chemical treatment was diclofenac, a nonsteroidal anti-inflammatory. The trial also included comparison with placebo. Considering the staggering impact of low back pain, the authors of this trial felt there were too few studies comparing spinal manipulation to nonsteroidal anti-inflammatory drugs or placebo. They aimed to test patient satisfaction and function, time off from work, and rescue medication, specifically.

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Evidence-based Diagnosis for Low Back Pain

Health professionals from different disciplines use diverse diagnostic methods to inform clinical management for patients with low back pain. One person may diagnose someone as suffering from sacroiliac joint pain while another might classify the same patient with a movement disorder caused by poor muscle coordination. In a given circumstance, either or both individuals could be right or wrong. However, we can’t realistically discern this until we understand the underlying strength of the diagnostic tests we use.

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Article rating: 5.0

Research Review: Clinical Practice Guideline: Chiropractic Care for Low Back Pain

It is now well known that low back pain (LBP) is the leading cause of disability worldwide and that chiropractors can play a pivotal role in the management of this condition. However, the chiropractic profession can achieve wider acceptance and improved cultural authority, particularly within integrated health care delivery systems, by embracing and integrating current scientific research into our approach to evidence-based health care. It is in this context that this Clinical Practice Guideline (CPG) was developed. The aim of this systematic review was to update and combine three previously published clinical guidelines, while answering this question: “What is the effectiveness of chiropractic care, including spinal manipulation (SMT), for nonspecific low back pain?” 

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