Two Is Not Better Than One
Suffering from a combination of neck pain and sciatica may prove more debilitating than back pain alone.
Although previous research has examined the economic impact of back and neck pain on employees, most studies have evaluated each condition separately.
To assess the combined impact of multi-site spinal pain, Finnish researchers surveyed 6, 934 municipal employees. 15% of women and 23% of men suffered from low-back pain, sciatica, or neck pain.
While having at least one type of pain increased participants' risk of sick leave, suffering from multiple types of spinal pain exacerbated that risk. Over the course of three years, participants with both neck pain and sciatica had the highest number of medically-certified sick days. Compared to women without pain, those with sciatica and neck pain were twice as likely to have medically-certified sick days.
Researchers suggested that employee health care address the multiple site of spinal pain to prevent decreased work ability.
Kääriä S, Laaksonen M, et al. Scan J Public Health 2012; 40: doi 10.1177/1403494811435490.
An estimated 30-40% of women with migraine feel their symptoms worsen during pregnancy, likely because of hormonal changes. These women often wonder whether it's safe to continue their current migraine medications, or if they should seek conservative treatments like chiropractic care.
At least one migraine drug should be avoided during pregnancy, according to new FDA warnings, because the drug (valoprate) was tied to lower IQ scores in children. The FDA warnings are based on a new study that children whose mothers took valoprate drugs during pregnancy had lower I.Q. scores at age six compared to children exposed to other antiepileptics.
Valoprate products already had labels warning of fetal risks and birth defects. In 2011, the FDA announced interim results from the Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) study that demonstrated that children exposed to valoprate had cognitive deficits at age three. Many of these children continued to have lower IQ scores at age six, prompting the FDA to strengthen its existing warning labels.
“Valproate medications should never be used in pregnant women for the prevention of migraine headaches because we have even more data now that show the risks to the children outweigh any treatment benefits for this use,” explained Russell Katz, MD, who directs the FDA's research on neurology products. The FDA recommended that women consult with their health-care provider before stopping any medications.
Case Study of Chiropractic for Migraine in Pregnancy
The findings from the NEAD study are enough to make many women wary of relying on migraine medications during pregnancy. Instead of risking the potential effects of drugs, women often opt for natural treatments in pregnancy such as chiropractic care.
One case study demonstrates how chiropractic can safely ease headache in pregnancy. A 24-year old women who had suffered from migraines her whole life had noticed her symptoms worsening during pregnancy. In addition to her headaches, she suffered from nausea and sensitivity to light and noise. She tried a host of conservative and medical treatments to no avail, and decided to see a chiropractor while 32 weeks pregnant.
The patient was treated with a multimodal treatment plan that included chiropractic spinal adjustments, trigger point therapy, massage therapy, and lifestyle changes. The women felt her symptoms improve within one week of treatment. The case study suggests that chiropractic can offer a safe alternative for women searching for effective migraine relief in pregnancy.
Alcantara J and Cossette M. Intractable migraine headaches during pregnancy under chiropractic care. Complementary Therapies in Clinical Practice 2009; 15:192-7.
Got an achy back? You're better off going to a chiropractor than popping another pain pill, suggests the results of a new study.
The study, published in the medical journal Spine, shows that that chiropractic adjustments are more effective than a drug for easing back pain.
To compare the efficacy of drugs and chiropractic, researchers tested the effects of spinal adjustments and a non-steroidal anti-inflammatory drug called diclofenac. They divided 38 patients with acute back pain into three treatment groups. One group received spinal adjustments and a placebo drug; the second group received sham adjustments and real diclofenac; and the control group received sham adjustments and a placebo drug.
While both the active treatment groups improved, patients receiving spinal adjustments were significantly better off than patients taking diclofenac. They experienced greater improvements in physical disability, function, time off work, and rescue medication.
This led researchers to conclude that "spinal manipulation was significantly better than non-steroidal anti-inflammatory drug diclofenac and clinically superior to placebo."
These findings add to the growing body of research showing that chiropractic is more effective than drugs for back pain and sciatica. And it's easy to see why. While drugs temporarily dull the pain, they do little to treat the root of the problem. Instead, chiropractic can relieve symptoms while addressing the underlying cause of pain.
von Heymann, et al. Spinal high-velocity low amplitude manipulation in acute nonspecific low back pain: a double-blinded randomized controlled trial in comparision with diclofenac and placebo. Spine 2013; 38 (7): 540-48. doi: 10.1097/BRS.0b013e318275d09c.
In our North St. Louis, MO practice, it's common for us to see people troubled with sciatica pain, and Dr. Holland has helped many of them improve with chiropractic. What makes chiropractic care so beneficial to those who suffer with sciatica? For starters, it reduces their time of recovery and a Norwegian medical study confirms it.
In the article, which took place in a Norwegian hospital's orthopedic division, the authors looked at 44 patients who presented with sudden low back pain that was diagnosed as acute sciatica. The participants were all treated by a chiropractor, with the average follow-up being two years after treatment.
The researchers found that all but two patients returned to their jobs after receiving chiropractic adjustments, which is a 95% success rate. What's more, the average amount of time that the individuals spent off work "was reduced by two thirds as compared with that associated with conventional medical treatment."
Given the fact that the Bureau of Labor Statistics reports that over 170,000 workdays were lost in 2013 due to employees dealing with back or spine-related issues, that is about 112,500 work days that could potentially be recovered each and every year solely by receiving chiropractic care. Not only could that increase productivity, but it could also decrease costs to businesses and workers from lost work.
If you live in North St. Louis, MO and you suffer with sciatic pain, Dr. Holland is here to help. Give us a call at (314) 588-9100 and we'll work with you to find the source of your sciatic pain and get you back on the road to health.
Orlin JR, Didriksen A. Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. Journal of Manipulative and Physiological Therapeutics 2007;30(2):135-139.
Dysfunction in the sacroiliac joint (SIJ), located in the pelvis, is thought to be a possible cause of sciatica, resulting in back pain that radiates down the leg and below the knee.
Scientists have questioned what the best treatment option is for patients with SIJ-related leg pain. In a recent study, researchers compared three treatment options: physical therapy, chiropractic manual therapy, and intra-articular injections of corticosteroids. Patients included 51 adults with leg pain associated with the sacroiliac joint. Researchers analyzed the effectiveness of each method after 6 weeks of selected treatments, and again after 12 weeks. The results for each patient was categorized as either a success or failure, based on relief or worsening of symptoms and average pain scores.
The study's findings revealed that manual therapy is the superior choice for treating leg pain associated with the SIJ. The success rate for chiropractic manual therapy was 72%, compared to just 20% for physiotherapy and 50% for corticosteroid injections. Researchers also found that neither physical therapy nor injections resulted in significant pain relief, whereas manual therapy resulted in a significant improvement on pain scores.
Due to the success rate and pain reduction of manual therapy, the study authors concluded that chiropractic should be the first treatment of choice in patients with SIJ-related leg pain. They hoped that their findings would be confirmed by further research with a larger sample size.
Additional research has highlighted the efficacy of chiropractic for sciatica, even after surgery has failed.
Visser L, Woudenberg N, et al. Treatment of the sacroiliac joint in patients with leg pain: a randomized-controlled trial. European Spine Journal 2013 [online]. doi: 10.1007/s00586-013-2833-2.
Trigger point therapy reduced cervicogenic headache pain by 71% for patients in a new study. The patients also experienced a 59% reduction in neck pain symptoms, as well as improved range of motion and muscle function.
Trigger point therapy is a treatment commonly used by chiropractors to relieve trigger points (TrPs), or hyperirritable spots of pain located in taut bands of skeletal muscles. Earlier research has shown that chiropractic spinal adjustments are effective for cervicogenic headache, but few studies have tested the efficacy of trigger point therapy for the condition.
In a new preliminary study, researchers tested the effects of trigger point therapy for the treatment of cervicogenic headache. Twenty patients were randomly assigned to receive either trigger point therapy (TrP therapy) or a sham treatment for three sessions during a one week period. The treatments were applied to active trigger points located in the neck.
Patients receiving TrP therapy experienced markedly better outcomes than the sham group. TrP therapy patients had significantly improved neck range of motion and increased functioning of the deep cervical flexor muscles. They also had substantially reduced pain sensitivity, neck pain, and headache. On average, patients' headache pain scores dropped from a 7.6 out of 10 to a 2.2, or about a 71.1% reduction. Their neck pain scores also decreased from a 7.4 to a 3.0 after treatment, or about a 59.5% reduction.
More research is needed to understand why TrP manual therapy lead to these improvements. It has been hypothesized that trigger points play a role in the development of headache, since earlier studies have reported trigger points present in patients with tension headache, cluster headache, and migraine. However this is one of the first studies to confirm the presence of trigger points in people with cervicogenic headache, and to suggest that trigger point therapy can help.
Chiropractors frequently use trigger point therapy in conjunction with spinal adjustments, spinal mobilization, and exercise rehabilitation. This study adds further evidence of the efficacy of chiropractic care for cervicogenic headache.
Bodes-Pardo G, et al. Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: a pilot randomized clinical trial. Journal of Manipulative and Physiological Therapeutics 2013; doi 10.1016/j.jmpt.2013.05.022.
Recent data suggests that expanding insurance coverage of alternative therapies like chiropractic could drive down overall health-care costs. A new study, published in the January 2013 issue of Health Affairs, provides further information into expenditure patterns and utilization of complementary alternative medicine (CAM). Since chiropractic is the predominant source of CAM utilization, the study sheds light on how chiropractic can contribute to patient savings.
According to the study, between 2002 and 2008 the use and spending on CAM services, which had previously been rising, largely plateaued. This suggests that “Any attempt to reduce national health care spending by eliminating coverage for complementary and alternative medicine would have little impact at best." According to the authors, cutting coverage for CAM and chiropractic services could even have the opposite effect, since excluding services currently covered by private and public insurance could “trigger increased spending.”
The analysis of the Medical Expenditure Panel Survey revealed a trend towards increased usage of CAM services, up 6% from 2002 to 2008. In 2002, there were an estimated 15.2 million adult users; this increased to 16.1 million in 2008. The number of chiropractic patients increased from 11.5 million in 2002 to 11.9 million in 2008, while acupuncture saw a 16% increase in adult visits.
Despite the increasing number of patients, total visits to chiropractors and other CAM providers decreased. Chiropractic visits decreased by 3%, from 98.6 million visits in 2002 to 96.1 million in 2008. Acupuncture visits decreased 16% over the same time period, from 6.4 million to 5.4 million. According to the study authors, “The higher proportion of out-of-pocket responsibility for payment for services may explain the lack of growth.”
The study also investigated the costs associated with chiropractic and other CAM services. Expenditures on chiropractic care increased from $6.2 billion in 2002 to $6.9 billion in 2008. Meanwhile, expenditures on acupuncture, massage, and other CAM treatments remained stable.
This data has important implications for national health-care policy. In their attempt to reduce waste, health-care policy makers often target complementary and alternative medicine services for exclusion. However, this tactic would, at best, result in only a small cost savings. Since CAM appears to be relatively inexpensive when compared with allopathic treatments, if medical providers are able to collaborate with local CAM providers, offering alternative and complementary medicine services could help health-care policy makers achieve their goals of cost savings.
The researchers conclude that health-care policy makers should consider the potential offset effect, in which patients substitute the excluded services with other services, which are covered by their health insurance, at an increased cost.
This study comes at the heels of another recent study suggesting that chiropractic patients have lower annual medical costs than patients in traditional care.
Davis MA, et al. U.S. spending on complementary and alternative medicine during 2002-2008 plateaued, suggesting role in reformed health system. Health Affairs 2013;32(1):45-52.
An estimated 300 million people worldwide suffer from asthma. With 180,000 deaths attributed to the disease, asthma treatment has a significant financial burden. In the United States alone, asthma medication is estimated to cost between $1 billion and $6 billion per year. While often treated with medication, there are other natural treatments available, such as chiropractic care.
In recent years, manipulative therapy has been used in addition to medication for managing respiratory diseases in adults and children. While many chiropractors report success with such treatments, few studies have examined the overall effectiveness of using manual therapies for respiratory disease treatment.
A recent literature review sought to examine the efficacy of chiropractic care for patients with asthma. The study involved randomized controlled trials, case reports, case series, cohort studies, survey studies, commentaries, and systematic reviews. The researchers concluded that chiropractic care may offer an alternative care approach for patients with asthma. However, the authors concluded further randomized controlled clinical trials should be conducted for future investigation of this approach.
Another new literature review focused on the use of manual therapy to treat childhood respiratory disease. That study involved eight clinical trials on the effects of manual therapy on children and teens with respiratory diseases. Five of the studies involved children with asthma, while the others focused on the treatment of children with other respiratory conditions, including recurrent respiratory infections, cystic fibrosis, and bronchiolitis.
Six of the eight studies identified positive results of manual therapy, including reduced anxiety, better lung function, and improved levels of salivary cortisol. The use of manual techniques such as chiropractic, osteopathic medicine, and massage appear to be beneficial for children with respiratory disease.While more research is needed to confirm the results of these initial studies, the findings offer promise for families searching for natural relief of asthma.
A recent case study highlights the impact that chiropractic can have for children with asthma. The case study involved a ten-year old boy who found relief from headache and respiratory symptoms under the care of chiropractor.
Alcantara J, et al. The chiropractic care of patients with asthma: a systematic review of the literature to inform clinical practice. Clinical Chiropractic 2012; 15: 23-30.
Pepinoa VC, et al. Manual therapy for childhood respiratory disease: A systematic review. Journal of Manipulative and Physiological Therapeutics 2013; 36(1): 57-65.
When treating persistent back pain, it can be difficult to accurately predict how well a patient will recover from symptoms resulting from non-specific pain. Will the patient be plagued with a lifetime of back pain or can the symptoms be resolved in a matter of months? Although several factors influence the prognosis of back pain, studies suggest that prognosis may differ depending on which treatments patients receive. The identification of which patients are more likely to respond to specific treatments would have valuable clinical implications, yet little research has been done in this area.
A team of researchers recently sought to identify predictors of response to three conservative treatments for low back pain: spinal manipulation (SM), individual physiotherapy (IP), or back school (BS). The research involved 210 patients with chronic, non-specific low back pain. Each was randomly assigned to one of the treatment groups.
Significant improvement was found following all three intervention types. However spinal manipulation provided more functional recovery and pain relief than either of the other interventions studied. Overall 34% of the patients did not respond to treatment but spinal manipulation showed the lowest rate of non-responders.
The researchers then sought to identify specific patterns of response to treatment in order to identify predictors of outcome. They found that age, quality of life, work status, pain duration, patients' beliefs, and other variables studied did not predict response to treatment. Patients were more likely to benefit from spinal manipulation than from back school or physiotherapy, regardless of their baseline disability score and other clinical characteristics.
A lower initial disability score predicted poor outcome for back school and for individual physiotherapy, but not for patients treated with spinal manipulation. The researchers concluded that patients with chronic lower back pain and related disability should first consider spinal manipulation before other conservative treatments.
Other research has shown that combining chiropractic adjustments with exercise therapies can enhance back-pain treatment.
Cecchi F, et al. Predictors of functional outcome in patients with chronic low back pain undergoing back school, individual physiotherapy or spinal manipulation. European Journal of Physical and Rehabilitation Medicine 2012; 48: 371-8.