2004 Research and News. Chronic Back Pain Survey “Survey: Chronic back pain sufferers prefer...

2004 Research and News

Chronic Back Pain Survey

“Survey: Chronic back pain sufferers prefer drug-free pain management.” ACA press release. 8/20/2004

• 71% had suffered chronic LBP for 5 years or more.• 84.6% had suffered back pain for a minimum of 3 years.• Most common remedy…drugs…41% reported back pain was “not

under control”, or “not under control at all”.• 64.4% would consider consulting a DC for LBP.• 80.3% would prefer to avoid the use of medication.• Highest income respondents were the group least likely to prefer using

medications for their back pain.

Observation: DC profession must do a better job of promoting itself as a provider of safe, natural, drug-free methods of pain relief…and not just for back pain.

Displacement value of Chiropractic care.

“Chiropractic Care: is it substitution care or add-on care in corporate medical plans?” Matz, et al. J. Occupational

Environmental Medicine. 2004;46:847-855.• The results “indicate that patients use chiropractic care as a direct

substitute for medical care.”• 4 year study: 1997-2001• Not a survey….used actual claims data.• 1,394,070 patients; 174,209 were DC pts; 332,548 were medical pts;

887,313 were medical pts w/o DC coverage.• Results: nearly half chose DC care when offered a choice.• “Within a MC setting, the inclusion of a DC benefit does not increase

the overall rates of pt. complaints….pts appear to be directly substituting DC care for medical care”.

Whooping Cough

“Whooping Cough: Vaccines not stopping global rise of disease.” AP 4/28/02

• Scientists suspect that protection from immunization wears off after a few years and that the bug has outsmarted vaccines used to control it for decades.

• Caused by: Bordetella pertussis.

• “…after something like 15 years, you may be fully susceptible again, but it may even be shorter.”

• Symptoms: 80-90% have cough that lasts more than 3 wks, cough disturbs sleep, vomiting, 30-second sweating attacks, complications like hernias, and rib fractures.

Vioxx and Celebrex

“Arthritis drugs may boost risk of blood clotting, heart attacks.” 4/19/02 The Columbus Dispatch

• University of Pennsylvania, Science, 4/02• New research bolsters the growing suspicion that some popular

arthritis drugs [Vioxx and Celebrex] could increase certain people’s risk of heart attacks by causing a chemical imbalance that spurs blood clots.

• …blocking the cox-2 enzyme (which dilates blood vessels and prevents platelets from clumping together) might help contribute to heart disease….could allow the clotting tendencies of the cox-1 enzyme to run amok.

Smallpox vaccinations

“Small pox vaccinations: A shot in the dark.” USA Today 10/07/02

• “Terror threat too low, health risk too high for kids, doctors say.”

• Robert Baltimore of Yale Medical School: “Smallpox vaccinations are not nearly as safe as other vaccinations….and they’re for diseases that are around, unlike smallpox.”

• “Estimate on adverse reactions…based on 1960’s data, could be low….Americans now have weaker immune systems.”

Estrogen: Hormone Replacement Therapy

“Group recommends short, low-dose HRT.”

USA Today 10/07/02

• “Postmenopausal women who opt for hormone therapy should go on it for as short a period and as low a dose as possible, according to recommendations from the North American Menopause Society.”

• “In July a government-sponsored study halted because the risks were found to outweigh the benefits.”

• Estrogen plus progestin failed to protect against heart attacks.

Smallpox

“Bush set to order shots for smallpox.”USA Today 11/27/02

• Shots discontinued in 1972.• Of 1 million shots, 14 would develop life-threatening complications,

and 1-2 could die.• Last known case in the world..1977.• Those previously vaccinated, may no longer be fully protected.

• “There is some uncertainty about the effectiveness of the vaccine, which works on the old form of the smallpox virus.”

Chiropractic BootcampA Review of the Literature

2006 Research

New Study Finds Increased Risk Of Birth Defects Related To First Trimester Use Of Ace Inhibitors

[6/8/06 NEJM]

• Infants born to mothers who took angiotensin converting enzyme (ACE) inhibitors during the first trimester of pregnancy had an increased risk of major congenital malformations compared with infants whose mothers didn’t take these drugs. [HHS’ AHCPR and the FDA]

• FDA “black box”

ANTIBIOTICS UP ASTHMA RISK CHEST – March 2006;129:610-8

[http://www.chestjournal.org]

According to a report in the journal CHEST, Children treated with at least one antibiotic during their first year of life are twice as likely as untreated children to develop asthma.

And, the more courses of antibiotics a child is given, the risk continues to grow.

Lead author Carlo Marra, Pharm D, PhD.

ACETAMINOPHEN CAUSES STAGGERING NUMBER OF LIVER FAILURES

[University of Michigan – March 2006.]

Tylenol® and other products containing acetaminophen account for a staggering 40% to 50% of all acute liver failure cases each year in the United States, says Robert J. Fontana, MD, and fellow researchers.

An adult should not take more than 8 Tylenol® Extra Strength pills, which contains 500 milligrams per tablet, in a 24-hour period (i.e. the maximum daily dose is 4,000 milligrams per day). Exceeding that dosage, could lead to inadvertent liver or kidney damage, Dr. Fontana says.

BASKETBALL TOPS FOR INJURIES[Loyola University Health System – June 14, 2006.]

In 2005, more than 512,000 injuries related to recreational basketball were treated at hospital emergency rooms in the US, making this sport number one for injuries.

• 2nd Bicycles (485,000 injuries)• 3rd Football (418,000 injuries)• 4th Soccer (174,000 injuries.)• 5th Baseball (155,898 injuries)• 6th Skateboarding(112,544 injuries)• 7th Trampolines (108,029 injuries) • 8th Softball (106,884 injuries)

CHIROPRACTIC PATIENTS MORE SATISFIED WITH CARE

[Spine – March 15, 2006;31:611-21.]

• DC vs Medical patients• RCT: 681 LBP pts..MC facility• Chiropractic with or without physical modalities• Or medical care with or without physical therapy• 18 months• Primary outcome variables: LBP intensity,

disability, and complete remission. • Secondary outcome: Perception of improvement

in low back symptoms.”

CHIROPRACTIC PATIENTS MORE SATISFIED WITH CARE

[Spine – March 15, 2006;31:611-21.](cont’d)

“Compared with medical care only patients, chiropractic and physical therapy patients were much more likely to perceive improvement in their low-back symptoms.”

CHIROPRACTIC CARE STAVES OFF PREGNANCY-RELATED BACK PAIN

[Journal of Midwifery & Women’s Health – January 2006;51:e7-10.]

• Researchers at the University of Bridgeport College of

Chiropractic in Bridgeport, NY, investigated 17 cases of pregnant women with LBP who received chiropractic care.

• No adverse effects were reported in any of the 17 cases.

• The results suggest that chiropractic treatment was safe in these cases and support the hypothesis that it may be effective for reducing pain intensity.”

RESEARCH CONFIRMS CHIROPRACTIC ADJUSTMENTS WORK

Spine Journal – March 2006;6:131-7.

Italy…..102 pts. w/ moderate pain, or radiating character, or both…..underwent either chiropractic manipulative therapy or sham “simulated” manipulations.

“manipulations or simulated manipulations were done 5 days per week by experienced chiropractors, with a number of sessions which depended on pain relief or up to a maximum of 20, using a rapid thrust technique. Patients were assessed at admission and at 15, 30, 45, 90 and 180 days.”

http://www.sciencedirect.com/science/journal/15299430

RESEARCH CONFIRMS CHIROPRACTIC ADJUSTMENTS WORK

Spine Journal – March 2006;6:131-7.

(cont’d)

Results:

Patients receiving genuine chiropractic adjustments enjoyed significant improvement beyond patients undergoing simulated adjustments.

http://www.sciencedirect.com/science/journal/15299430

Clinical test of musculoskeletal dysfunction in the diagnosis of cervicogenic headache. Zito G, et a.

Manual Therapy. May 2006; Vol. 11, Iss. 2, pp. 91-166

The incidence of cervicogenic headache is estimated to be 14 - 18% of all chronic headaches,

77 subjects, 27 with cervicogenic headache, 25 with migraine with aura and 25 control subjects.

Results: Cervicogenic headache group had less range of cervical flexion/extension (P=0.048) and significantly higher incidences of painful upper cervical joint dysfunction assessed by manual examination (all P<0.05) and muscle tightness (P<0.05).

Clinical test of musculoskeletal dysfunction in the diagnosis of cervicogenic headache. Zito G, et a.

Manual Therapy. May 2006; Vol. 11, Iss. 2, pp. 91-166

(cont’d)

A discriminant analysis revealed that manual examination could discriminate the cervicogenic headache group from the other subjects (migraine with aura and control subjects combined) with an 80% sensitivity.

Do Exercise Balls Provide a Training Advantage for Trunk Extensor Exercises? A Biomechanical Evaluation

Drake JDM, et al. Journal of Manipulative and Physiological

Therapeutics. June 2006; Vol. 29, Iss. 5, pp. 354-362.Objective: Evaluate differences in the biological response of muscle activation, lumbar spine posture, and loading variables for extensor exercises performed on 2 surfaces. (mat vs. ball)

Methods: Bilateral muscle activation was recorded from 7 sites (rectus abdominis, external/internal obliques, latissimus dorsi, thoracic/lumbar erector spinae, and multifidus) on 8 subjects.


(cont’d)

Results: Cocontraction of trunk flexor and extensor muscles was reduced by up to 30% for the extension exercises when performed on the ball. Peak muscle activation remained unchanged or decreased, and spinal loading (compression and anterior-posterior shear) decreased when the extension exercises were performed on the ball. The lumbar spine postures attained during the exercises did not differ between surfaces.


(cont’d)

Conclusions: The assumption that the use of an exercise ball will always create a greater challenge for the musculoskeletal system was not supported by the findings of this study. Likewise, in a healthy, young population, there does not appear to be any training advantage to performing extensor exercises on a ball versus a mat.

However, in a rehabilitation scenario, these exercises performed on a ball could reduce low back loading and hence reduce the potential for reinjury.

Does Research Support Use of Electrotherapies for Mechanical Neck Disorders?

Spine – November 20051;30:E641-8.

Researchers reviewed 14 studies.

“For the pain outcome, we found limited evidence of benefit, i.e., pulsed electromagnetic field (PEMF) therapy resulted in only immediate post-treatment pain relief for chronic MND and acute whiplash (WAD).


Spine – November 20051;30:E641-8.(cont’d)

Unclear or conflicting evidence (Galvanic current for acute or chronic occipital headache; iontophoresis for acute, subacute WAD; TENS for acute WAD, chronic MND; PEMF for medium- or long-term effects in acute WAD, chronic MND); and limited evidence of no benefit (diadynamic current for reduction of trigger point tenderness in chronic MND, cervicogenic headache; permanent magnets for chronic MND; electrical muscle stimulation (EMS) for chronic MND).”


Spine – November 20051;30:E641-8.(cont’d)

The article concludes that “in pain as well as other outcomes, the evidence for treatment of acute or chronic MND by different forms of electrotherapy is either lacking, limited, or conflicting.”

http://www.spinejournal.com/

Factors Influencing Neck Pain Intensity in Whiplash-Associated Disorders

Holm LW, et al. Spine. February 15, 2006; Vol. 31, Iss. 4, pp. E98-E104.

Study Design: Cohort study of subjects with whiplash-associated disorders (WAD).

Objective: To assess the association between preinjury factors and neck pain intensity within 30 days after a motor vehicle collision.

Methods: The subjects (n = 5970) either filed a claim or were treated for neck pain within 30 days after a collision. Neck pain intensity was measured on the visual analog scale.

Factors Influencing Neck Pain Intensity in Whiplash-Associated Disorders

Holm LW, et al. Spine. February 15, 2006; Vol. 31, Iss. 4, pp. E98-E104.

Results: Fair or poor health before the collision was associated with severe neck pain in females

…females…low education and prior neck pain. …males…low family income was associated with severe neck pain, prior headache and being unaware of the head position at the time of collision.

Conclusion: The results suggest that neck pain intensity in WAD seems to be influenced by several factors other than characteristics related to the injury event itself.

Hamstring Tightness Linked with Disc Herniation in Adolescents.

Spine – July 15, 2006;31:1810-14.

* “The incidence of hamstring tightness in adolescent lumbar disc herniation is much higher than that of adults,”

* 16 youths b/w 12 to 18. All subjects had lumbar disc herniation. A total of 10 of these cases had hamstrings tightness.* “The incidence of hamstring tightness in adolescent lumbar disc herniation is high,” * “The physical examination findings and prognoses of patients with hamstring tightness are different from those of simple disc herniation patients. The hamstring tightness appeared to have developed from a different mechanism.”


IS TRACTION EFFECTIVE FOR LBP?Spine – June 2006;31:1591-9.

Insufficient research is available to determine whether or not if traction is effective at ameliorating low-back pain (LBP), although the current evidence available suggests that it is ineffective.

Researchers reviewed a total of 24 randomized controlled trials (RCTs) comprising 2,177 patients.

IS TRACTION EFFECTIVE FOR LBP?Spine – June 2006;31:1591-9.

(Cont’d)

“Based on the current evidence, intermittent or continuous traction as a single treatment for LBP cannot be recommended for mixed groups of patients with LBP with and without sciatica. Neither can traction be recommended for patients with sciatica because of inconsistent results and methodological problems in most of the studies involved.”

“However, because high-quality studies within the field are scarce, because many are underpowered, and because traction often is supplied in combination with other treatment modalities, the literature allows no firm negative conclusion that traction, in a generalized sense, is not an effective treatment for patients with LBP.”


Efficacy of Treating Low Back Pain and Dysfunction Secondary to Osteoarthritis: Chiropractic Care Compared With Moist Heat Alone

Beyerman KL, et al. JMPT February 2006; Vol. 29, Iss. 2, pp. 107-114.

Objective: To evaluate the efficacy of chiropractic spinal manipulation, manual flexion/distraction, and hot pack application for the treatment of low back pain from osteoarthritis (OA) compared with moist heat alone.

Methods: 252 pts w/ LBP secondary to OA were randomly assigned …Treatment group (moist hot pack plus chiropractic care) or…Moist heat group …20 tx over several weeks. …At sessions 1, 5, 10, 15, and 20, VAS, activities of daily living using the Oswestry Low Back Pain Questionnaire, and a range of motion (ROM) using the J-Tech Dual Digital Inclinometer (JTECH Medical Model no. AA036).

Efficacy of Treating Low Back Pain and Dysfunction Secondary to Osteoarthritis: Chiropractic Care Compared With Moist Heat Alone

(cont’d)

Results: Session I ratings indicated that the two groups were equivalent on all pain and flexion scores. The treatment group reported greater and more rapid pain reduction and greater and more rapid ROM improvement than the moist heat group. The treatment group also had greater improvements than the moist heat group in daily living activities in 4 of the 9 areas measured. Conclusion: Chiropractic care combined with heat is more effective than heat alone for treating OA-based lower back pain. Pain reduction occurs more rapidly and to a greater degree, and ROM increases more rapidly and to a greater degree.

STEER CLEAR OF MOST LUNCH MEATJournal of the National Cancer Institute – August 2006;98:1078-87.

Processed meats, such as some deli meats, bacon and sausage, boost the risk of stomach cancer, according to a review of 15 studies comprising 4,704 people.

Specifically, an increased consumption of 30 grams of processed meat per day yielded a 15% to 38% jump in the risk of developing stomach cancer. The researchers point to nitrates, which are used to preserve most processed meats.

http://jncicancerspectrum.oxfordjournals.org/

Most scientific papers are probably wrong

02:00 30 August 2005 NewScientist.com news service Kurt Kleiner

Most published scientific research papers are wrong, according to a new analysis. Assuming that the new paper is itself correct, problems with experimental and statistical methods mean that there is less than a 50% chance that the results of any randomly chosen scientific paper are true.

Most scientific papers are probably wrong

(cont’d)

"We should accept that most research findings will be refuted. Some will be replicated and validated. The replication process is more

important than the first discovery," Ioannidis says.

Multiplanar Cervical Spine Injury Due to Head-Turned Rear Impact

Panjabi MM, et al. Spine. February 15, 2006; Vol. 31, Iss. 4, pp. 420-429.

Study Design: Head-turned whole cervical spine model was stabilized with muscle force replication and subjected to simulated rear impacts of increasing severity. Multiplanar flexibility testing evaluated any resulting injury.

Objectives: To identify and quantify cervical spine soft tissue injury and injury threshold acceleration for head-turned rear impact, and to compare these data with previously published head-forward rear and frontal impact results.

Multiplanar Cervical Spine Injury Due to Head-Turned Rear Impact

Panjabi MM, et al. Spine. February 15, 2006; Vol. 31, Iss. 4, pp. 420-429.

Conclusions: Head-turned rear impact caused significantly greater injury at C0-C1 and C5-C6, as compared to head-forward rear and frontal impacts, and resulted in multiplanar injuries at C5-C6 and C7-T1.

OBESE PEOPLE MAY BE MORE SENSITIVE TO PAINAPS – March 4, 2006.

Obese individuals may be more sensitive to pain than non-obese people. These findings are from a study of 62 older adults with osteoarthritis (OA) of the knee.

http://www.psychosomatic.org/

Manual Examination of the Spine:

A Systematic, Critical Literature Review of Reproducibility

Study Design: A systematic review and meta-analysis. Relevant literature published 1965-2005 was identified.

Objectives: To critically analyze the literature pertaining to the inter- and intra-observer reproducibility of spinal palpation in order to investigate the consistency of study results and assess the level of evidence for reproducibility.

Manual Examination of the Spine: A Systematic, Critical Literature Review of Reproducibility

(cont’d)

Results: There was strong evidence that the inter-observer reproducibility of osseous and soft tissue pain is clinically acceptable (Kappa ¡Ý 0.4), and that intra-observer reproducibility of soft tissue pain and global assessment are clinically acceptable. The other spinal procedures are not reproducible or the evidence is conflicting or preliminary.

Interexaminer Reliability of the Hip Extension Test for Suspected Impaired Motor Control of the Lumbar Spine,

JMPT – June 2006;29:374-7 Murphy et al . .

ObjectiveThe hip extension test may be a clinical sign of impaired motor control in the lumbar spine, which may have a negative impact on spine stability.

The purpose of this study is to evaluate the interexaminer reliability of the hip extension test for suspected dynamic instability of the lumbar spine in patients with chronic low back pain.


(cont’d)

Methods: 42 pts., chronic LBP. Greater than 7 weeks duration in the area between T12 and the buttocks, with or without leg pain. Two doctors of chiropractic simultaneously observed and independently assessed the left and right prone hip extension test on all 42 patients.


(cont’d)

Conclusions

The hip extension test appears to have good reliability in detecting deviation of the lumbar spine from the midline.

Validity with regard to the test's ability to distinguish patients with chronic low back pain from normal individuals and its relation to lumbar spine stability remains to be determined.

Satisfaction as a predictor of clinical outcomes among chiropractic and medical patients enrolled in the UCLA low back pain study.

Spine. 2005 Oct 1;30(19):2121-8. Hurwitz et al.

• OBJECTIVES: The objective of this study is to estimate the effects of patient satisfaction on subsequent changes in pain and disability among low back pain patients randomized to chiropractic or medical care in a managed-care practice setting.

• METHODS: 681 LBP pts…3 Southern CA clinics …randomized to medical care with and without physical therapy, and chiropractic care with and without physical modalities, and followed for 18 months.

Satisfaction as a predictor of clinical outcomes among chiropractic and medical patients enrolled in the UCLA low back pain study.

(cont’d)

• RESULTS: Greater satisfaction increased the odds of remission from clinically meaningful pain and disability at 6 weeks but not at 6, 12, or 18 months

Perception of improvement was greater among highly satisfied than less satisfied patients throughout the 18-month follow-up period. The estimated effects of satisfaction on clinical outcomes were similar for medical and chiropractic patients. CONCLUSIONS: Patient satisfaction may confer small short-term clinical benefits for low back pain patients. Long-term perceived improvement may reflect, in part, perceived past improvement as measured by satisfaction.

Spinal manipulation in physical therapist professional degree education: A model for teaching and integration into clinical practice.

Flynn et al. J Orthop Sports Phys Ther. 2006 Aug;36(8):577-87.

• Spinal manipulation for low back complaints is an intervention supported by randomized clinical trials and its use recommended by clinical practice guidelines. Physical therapists in this country and internationally have used thrust spinal manipulation at much lower-than-expected rates, despite evidence supporting its efficacy for the treatment of acute low back pain (LBP).

Spinal manipulation in physical therapist professional degree education: A model for teaching and integration into clinical practice.

(cont’d)

Physical therapist students used thrust spinal manipulation at rates that are more consistent with clinical practice guidelines and substantially higher then previously reported by practicing physical therapists. Education within an evidence-based framework is thought to contribute to practice behaviors and outcomes that are more consistent with best practice guidelines.

Lumbar stabilizing exercises improve activities of daily living in patients with lumbar disc herniation.

Bokhtiary et al. Journal of Back and Musculoskeletal Rehabilitation. 2005; Vol. 18, No. 3-4, pp. 55-60.

This study has been designed to investigate the effect of LSE in patients with herniated lumbar disc (HLD).

60 pts., aged 22-55, HLD at L4-L5 or L5-S1, randomized, two groups (A and B) of thirty.

Group A: LSE protocol for four weeks, then four week no-exercise periodGroup B performed the opposite.

Measurements: pain (VAS), trunk flexion; straight leg raising (SLR) angle without pain and time to complete ADL tasks such as climbing 5 steps, 10 meter walking, laying prone from standing position and standing up from prone position.

Lumbar stabilizing exercises improve activities of daily living in patients with lumbar disc herniation.

(cont’d)

Results: Significant pain relief, left and right SLR angle improvement , increased trunk flexion and improved ADL performance were found after first four week LSE period in group A.

The same results were found in group B following their exercise period. These findings indicate that a LSE protocol may improve ADL performance in patients with HLD.

STEROID INJECTIONS DON’T ALLEVIATE NECK PAIN

European Spine Journal – August 2006;15:Epub.

Steroid injections are frequently given to medical patients with neck pain. However, not only does this treatment have a myriad of possible side-effects, but it may also be ineffective, say scientists. The study: “prospective randomized study on transforaminal steroid injections for the treatment of radicular pain in the cervical spine focusing on short-term results.” Patients received either steroids with local anesthetic or a placebo treatment of saline with local anesthetic.

STEROID INJECTIONS DON’T ALLEVIATE NECK PAIN(cont’d)

At 3-week follow up, “there were no differences in treatment results in the two patient groups. Statistical analysis of the results confirmed the lack of difference in treatment effect.”

http://www.springerlink.com/

The Course of Low Back Pain From Adolescence to Adulthood: Eight-Year Follow-up of 9600 Twins. Health Services Research

Spine. 31(4):468-472, February 15, 2006. Hestbaek et al.

Study Design. Prospective study with 8-year follow-up.

Objective. To describe the evolution of low back pain from adolescence into adulthood.

The Course of Low Back Pain From Adolescence to Adulthood: Eight-Year Follow-up of 9600 Twins. Health Services Research

(cont’d)

Methods: 10,000 Danish twins born between 1972 and 1982; postal questionnaires in 1994 and again in 2002. The questionnaires dealt with various aspects of general health, including the prevalence of low back pain, classified according to number of days affected (0, 1-7, 8-30,>30).

Results. Low back pain in adolescence was found to be a significant risk factor for low back pain in adulthood with odds ratios as high as four.

Conclusions. Our study clearly demonstrates correlations between low back pain in childhood/adolescence and low back pain in adulthood. This should lead to a change in focus from the adult to the young population in relation to research, prevention, and treatment.

Use of a mental rotation reaction-time paradigm to measure the effects of Upper cervical adjustments on cortical processing: A pilot studyKellya et al. JMPT Volume 23, Issue 4, Pages 246-251 (May 2000)

Conclusion: The results of this study have

demonstrated a significant improvement in a complex reaction-time task after an upper cervical adjustment.

These results provide evidence that upper cervical adjustment may affect cortical processing.

VITAMIN B6 PREVENTS PARKINSON’SNeurology – July 2006;67:315-8.

“Dietary vitamin B6 may decrease the risk of Parkinson disease, probably through mechanisms unrelated to homocysteine metabolism,” concludes a new analysis of 5,289 participants.

The study’s subjects were free of Parkinson’s disease (PD) at the study’s onset. “After a mean follow-up of 9.7 years, the authors identified 72 participants with incident PD. Higher dietary intake of vitamin B6 was associated with a significantly decreased risk of PD.” Specifically, high dietary levels of B6 cut the risk of PD by 54%.

On the other hand, B12 and folic acid did not appear to alter the risk of PD, indicating that homocysteine does not play a role in the preventive effects of B6 on PD. http://www.neurology.org/

POST-WHIPLASH DEPRESSION COMMON Spine – July 15, 2006;31:E551-56.

Psychological depression is widespread following whiplash injury.

Design: “adults making an insurance claim or seeking healthcare for traffic-related whiplash were followed by telephone interview at 6 weeks, and 3, 6, 9, and 12 months post-injury. Depressive symptoms were assessed at baseline and at each follow-up.”

POST-WHIPLASH DEPRESSION COMMON (cont’d)

5,211 patients with no pre-injury mental health problems, an alarming 42.3% reported depressive symptoms within 6 weeks of the injury.

Another 17.8% reported developing depressive symptoms at later follow-up. These symptoms were “recurrent or persistent in 37.6% of those with early post-injury onset. Pre-injury mental health problems increased the risk of later onset depressive symptoms and of a recurrent or persistent course of early onset depressive symptoms.”

POST-WHIPLASH DEPRESSION COMMON (cont’d)

The study’s authors conclude that “depressive symptomatology after whiplash is common, occurs early after the injury, and is often persistent or recurrent.

This suggests that, like neck pain and headache, depressed symptomatology is part of the cluster of acute whiplash symptoms. Clinicians should be aware of both physical and psychologic injuries after traffic collisions.”


Manual therapy for patients with stable angina pectoris: a nonrandomized open prospective trial.

Christensen et al.

Objective: To examine if participants with chest pain originating from the spine would benefit from manual therapy.

Methods: Nonrandomized, open, prospective trial at a tertiary hospital. 275 pts., 59 were diagnosed as cervicothoracic angina (CTA)-positive 225 as CTA-negative.

The intervention performed was manual therapy according to chiropractic standards. Patient self reported questionnaires at baseline and 4-week follow-up, including pain measured with an 11-point box scale, Short Form 36 (quality of life), and perceived improvement.

Manual therapy for patients with stable angina pectoris: a nonrandomized open prospective trial.

(cont’d)

Results: Approximately 75% of CTA-positive patients reported improvement of pain and of general health after treatment, compared with 22% to 25% of CTA-negative patients (P < .0001). Pain intensity decreased in both groups with consistently larger decreases for all measures of pain among CTA- positive patients. Conclusion: This study suggested that patients with known or suspected angina pectoris and a diagnosis of CTA may benefit from chiropractic manual therapy. Methodologically sound randomized clinical trials are needed to corroborate our results.

Food buying habits of people who buy wine or beer: cross sectional study.

Johansen D, et al. British Medical Journal. March 4, 2006; Vol. 332, No. 7540, pp. 519-522.

Objective: To investigate whether people who buy wine buy healthier food items than those who buy beer.

Design: Cross sectional study. Supermarkets in Denmark.

Results: Wine buyers bought more olives, fruit and vegetables, poultry, cooking oil, and low fat cheese, milk, and meat than beer buyers. Beer buyers bought more ready cooked dishes, sugar, cold cuts, chips, pork, butter or margarine, sausages, lamb, and soft drinks than wine buyers. Conclusions: Wine buyers made more purchases of healthy food items than people who buy beer.

Copyright Protection Statement

The material in this packet is under copyright protection and may not be reproduced in any format without the expressed written consent of Dr. Ronald J. Farabaugh.

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2004 Research and News. Chronic Back Pain Survey “Survey: Chronic back pain sufferers prefer...

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