Pain, Chronic Pain
Chronic spinal pain a randomized clinical
trial comparing medication, acupuncture, and spinal manipulation.
Giles LGF, Muller R. Spine 2003;28:1490-1503.
This was a randomized,
controlled clinical trial involving 115 patients with chronic
spinal pain (over 13-week duration) comparing spinal manipulation,
drugs and acupuncture. Those in the medication group were
given Celebrex or Vioxx and paracetamol. Chiropractic patients
were adjusted twice a week. The patients were assessed four
times using the Oswestry Questionnaire for low back and thoracic
spine pain ("back" pain),
the Neck Disability Index (NDI) for neck pain, and the Short-Form-36
Health Survey questionnaire (SF-36). Visual analog scales
(VAS) were used to assess subjective pain intensity. Objective
measurements were also used including range of motion.
At the
end of the study, the group receiving manipulation experienced
the most recovered patients compared to acupuncture (second)
and medication (third). Interestingly, the patients in the
manipulation group scored significantly higher on the SF-36
questionnaire that reveals the patient’s
perception of their overall health.
"The results of this efficacy study suggest that spinal
manipulation, if not contraindicated, may be superior to
needle acupuncture or medication for the successful treatment
of patients with chronic spinal pain syndrome, except for
those with neck pain. The NDI showed that for neck pain,
acupuncture achieved a better result than manipulation.” In
addition, "Medication…did not achieve a marked
improvement…and caused adverse reactions in 6.1% of
the patients. The adverse symptoms disappeared once medication
was stopped.”
Chiropractic management of chronic chest pain utilizing
mechanical force, manually assisted short-lever adjusting
procedures Polkinghorn B and Colloca, C J Manipulative Physiological
Therapeutics February 2003: Vol. 26 – No. 2
A 49-year-old
male suffering from chronic chest pain, dyspnea and anxiety
for over four months gradually progressed to the point of precluding
active employment and most physical activity. Prior efforts
to treat the condition had met with failure.
Chiropractic adjustments
were given to the thoracic spine; in particular, the costosternal
articulations. The patient responded favorably to the intervention,
obtaining prompt relief of his symptoms. Chiropractic care
rendered over a 14-week period of time resulted in complete
resolution of the patient's previously chronic condition, with
recovery maintained at 9 months follow-up.
Chiropractic care
for patients aged 55 years and older: report from a practice-based
research program. Hawk C, Long CR, Boulanger KT, et al Journal
of the American Geriatrics Society 2000:48, pp. 534-45.
Data
on over 805 patients 55 years or older were collected over
a 12-week period. Patients completed a questionnaire over this
12 week time which included information on their chief complaints
and health status. The Medical Outcomes Study 12-Item Short
Form Health Survey (SF-12) and the Pain Disability Index (PDI)
were also completed.
The study revealed that for two-thirds
of the patients, a chiropractor was the only provider for mild
to moderate musculoskeletal complaints.
72.3% of the patients
had pain related complaints (32.9% of these were for low back
pain). Patients decreased use of regular prescription or non-prescription
drugs by 7.3% during the 12-week period.
Chronic spinal pain
syndromes: a clinical pilot trial comparing acupuncture, a
nonsteroidal anti-inflammatory drug (NSAID), and spinal manipulation.
Giles LG, Muller R. Journal of Manipulative and Physiological
Therapeutics July/August 1999:22(6), pp.376-81.
Seventy seven
patients received needle acupuncture, a nonsteroidal anti-inflammatory
drug (NSAID) or chiropractic care. They were followed up after
30 days.
Spinal care was the only intervention to achieve a
statistically significant improvement. Patients receiving chiropractic
care demonstrated a 30.7% reduction in Oswestry scores and
a 25% reduction in neck disability index scores, a 50% reduction
for low back pain, 46% reduction for upper back pain and
33% reduction for neck pain. Acupuncture and NSAIDS achieved
no significant improvement.
An investigation of the interrelationship
between manipulative therapy induced hypoalgesia and sympathoexcitation.
Vicenzino B, Collins D, Benson H et al., Journal of Manipulative
and Physiological Therapeutics,, Sept. 1998:21(7), pp448-53.
This
study investigated a proposed model of how manipulation produced
decreased pain or pain inhibiting effects. Twenty-four patients
diagnosed with chronic lateral epicondylalgia were assigned
to either a placebo group, control group or a group receiving
chiropractic neck adjustments.
The patients receiving neck “manipulations” had
more pain diminishment and more activity of the sympathetic
system than the other patients.
Copyright 2004 Koren Publications,
Inc. & Tedd Koren,
D.C.