Archive for category: KDT Blog

Spine (Phila Pa 1976). 2006 Dec 1;31(25):2942-9.

Carragee E¹, Alamin T, Cheng I, Franklin T, Hurwitz E

Abstract

STUDY DESIGN:

Prospective, 5-year, cohort study of working subjects.

CONCLUSIONS: Age and sex-adjusted prediction models, including abnormal psychometric testing, smoking, and compensation issues, accurately identified 80% of serious LBP events and 93% of LBP disability events.

In this study cohort, minor trauma does not appear to increase the risk of serious LBP episodes or disability. The vast majority of incident-adverse LBP events may be predicted not by structural findings or minor trauma but by a small set of demographic and behavioral variables.

Dr. Kennedy Comment: This study is yet another (and nearly10 years old) indicating psychometric, financial/compensation and likely lifestyle issues (e.g. smoking) are huge drivers of long-term LBP & disability. But we can’t lose sight of the connection our counsel, enthusiasm, kindness & confidence have in establishing a positive and substantial healing environment. High-power Laser and decompression and ‘movement therapy’ play a major role in those aspects.

Marienke van Middelkoop, ¹ Sidney M. Rubinstein,² Ton Kuijpers,³ Arianne P. Verhagen,¹Raymond Ostelo,⁴ Bart W. Koes,¹ and Maurits W. van Tulder⁵

The most promising interventions for a physical and rehabilitation treatment in chronic LBP patients are a multidisciplinary and behavioral treatment approach. All types of behavioral therapy were more effective in reducing pain intensity than controls. Multidisciplinary treatment was found to be more effective in reducing pain intensity compared to controls and active treatments (e.g. exercise therapy, physiotherapy, and usual care) sick leave is also reduced at short-term follow-up. Added exercise therapy reduced pain intensity and disability significantly compared to usual care.

Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial BMC Med. 2011; 9: 128.

Steven Z George, ^1,7 John D Childs,^2,3 Deydre S Teyhen,^3,4 Samuel S Wu,⁵ Alison C Wright,³Jessica L Dugan,³ and Michael E Robinson^6,7

Dr. Kennedy comment: and multidisciplinary practices make significantly more revenue as well. (Chiro Eco June 2015. Practice income profiles), Laser, decompression and adjusting are powerful but the evidence on long term chronic LBP seems more and more to point towards a multidiscipline and behavioral approach.

CONCLUSIONS:

Early DD in adolescent patients with low back pain predicted the evolution of enhanced DD and herniation in adulthood, but it was not associated with severe low back pain or increased disability or frequency of spinal surgery.

Dr. Kennedy comment:  Many population studies (some as early as 1990) conclude MRI findings rarely dispose a patient to an accurate diagnostic or future outcome profile. Twin-separation studies also conclude DD is likely highly familial. Focusing on impaired motions, ergonomics, psychological risk factors and attending to the patients’ pain (and not on MRI findings) is still the most reasonable approach.  JACA 13 years ago (spring 2002) recommended DC’s use caution in relying on and being too quick to recommend MRI for typical back presentations. That remains even truer today given the many studies like this.

Dr. Kennedy comment: Here is one of the most intriguing and interesting discussions on acupuncture I’ve seen. Not only does it present an important challenge to the procedure but presents a great potential neurologic explanation. It’s important to note that recent studies utilizing electro-acupuncture during traction demonstrate subjective benefits vs. either alone.

 Abstract:

Most controlled trials of acupuncture have used minimal, superficial, sham, or ‘placebo’ acupuncture. It has recently been demonstrated that light touch of the skin stimulates mechanoreceptors coupled to slow conducting unmyelinated (C) afferents resulting in activity in the insular region, but not in the somatosensory cortex. Activity in these C tactile afferents has been suggested to induce a ‘limbic touch’ response resulting in emotional and hormonal reactions. It is likely that, in many acupuncture studies, control procedures that are meant to be inert are in fact activating these C tactile afferents and consequently result in the alleviation of the affective component of pain. This could explain why control interventions are equally effective as acupuncture in alleviating pain conditions that are predominantly associated with affective components such as migraine or low back pain, but not those with a more pronounced sensory component, such as osteoarthritis of the knee or lateral epicondylalgia.

Spine (Phila Pa 1976). 2007 Mar 15;32(6):681-4.

Disc degeneration in low back pain: a 17-year follow-up study using magnetic resonance imaging.

Waris E¹, Eskelin M, Hermunen H, Kiviluoto O, Paajanen H.

 

This study, which began in 1987 is yet another indicator of the difficulty of using MRI (unarguably the most sophisticated imaging process available) to predict future pain or LBP disability. As has been noted in at least a dozen “follow-up” studies over the last 25 years very few findings are associated with actual patient outcome i.e. disability, future medical costs, future pain or severity of future pain. What is interesting is that early findings of degenerative disc  “disease” is generally indicative of progression of degeneration (in this case over the next 17 years) however those changes were not able to predict future pain and in fact were not directly associated with pain, severity of pain or disability. It is immensely tempting to want to MRI everyone and, as patients tend to believe; “find out what’s really going on”. The trouble is knowing what’s going on hardly ever tells us what’s actually going on…and that’s doubly frustrating due to the fact 80% of the population with the same findings are not in pain.