SPINE JOURNAL regarding chiropractic, "a statistically and clinically significant benefit..."

In 2013, SPINE Journal produced the research article, "Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients with Acute Low Back Pain: The Results of a Pragmatic Randomized Comparative Effectiveness Study."  

In it, the authors came to the following conclusions-

“The results of this trial suggest that Chiropractic Manipulative Therapy in conjunction with standard medial care offer a significant advantage for decreasing pain and improving physical functioning when compared to standard care alone, for men and women between the ages of 18-35 with acute low back pain.”

“There was a statistically and clinically significant benefit to those patients receiving chiropractic manipulative treatment...”

“The majority of systematic reviews find that chiropractic manipulative therapy appears to reduce pain and disability at least moderately for many low back pain patients.”

“73% of participants in the SMC plus CMT group rated their global improvement as pain completely gone, much better, or moderately better, compared with 17% in the SMC group.” 

This is further proof that working together and promoting multidisciplinary care will yield superior outcomes for our patients.  

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Chiropractic Care Supported by the American Pain Society and American College of Physicians - by The Evidence Based Chiropractor

A variety of clinical guidelines support and encourage the use of chiropractic care due to its safety and efficacy.  In 2007, the Annals of Internal Medicine released a series of clinical guidelines.  The clinical guidelines for the treatment of low back pain were supported by the American Pain Society and the American College of Physicians.  

These guidelines reveal some interesting data.  They report 65% of primary care physicians recommend massage, 55% recommended ultrasound, and 22% recommended (of performed) spinal manipulation.  They also found that only 2 treatment options show strong efficacy for the management/treatment of acute (<4 weeks duration) low back pain.  These treatment options were spinal manipulation and heat.  For sub-acute and chronic low back pain the researchers still found spinal manipulation to be a valuable treatment option.

When we look at this study we can draw a few conclusions.  First, only a small minority (22%) of physicians are recommending spinal manipulation to their patients.  Second, spinal manipulation is a recommended treatment option.  

The discrepancy in the recommendations from the clinical guidelines and the recommendations by the physicians is no surprise.  Other studies have shown that primary care physicians recommendations for low back pain are "high discordant" with current research.  Without a profession wide marketing and outreach campaign for the promotion of this research, the task falls to us, as individual providers to build referral relationships. 

-The Evidence Based Chiropractor is the leading DC/MD marketing and outreach group in the world.  Our service is dedicated to increasing chiropractic utilization by showcasing research.  Marketing to medical doctors through research is efficient, cost effective, and can dramatically improve your incoming referrals.  Join us.  Lets grow chiropractic together.

Statins for Every Man in America? - by The Evidence Based Chiropractor

A remarkable and frightening new set of guidelines were recently released by the American Heart Association and the American College of Cardiology.  They have decided to expand the "treatment" of cholesterol by including an additional 13 million people who should be recommended statin "therapy".  

Looking closely at the guidelines it appears that nearly 90% of men ages 60-75 years old will now be recommended to be prescribed statins.  Women in this age group who qualify for statins under the new guidelines are over 50%.  Eligibility will now be determined on a "10 year risk for cardiovascular disease" as opposed to being based on LDL/HDL levels.  

Despite a lack of randomized controlled trials and grade 1 evidence these new guidelines have been adopted by the powerful organizations mentioned above.  As these guidelines are adopted by Medicare, primary care physicians will undoubtedly be pressured into prescribing these medications.  By not following the guidelines they may be placing themselves as risk for penalties.  There is no doubt that these guidelines were heavily supported by the controlling pharmaceutical companies in the US.  

The side effects of statin use are well documented.  It is imperative that our patients, neighbors, and friends are well informed regarding cholesterol levels and the various treatment options available to them.  

http://www.medscape.com/viewarticle/822210?src=wnl_edit_newsal&uac=193860MN#2

http://www.webmd.com/cholesterol-management/side-effects-of-statin-drugs

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-The Evidence Based Chiropractor is the leading DC/MD marketing and outreach group in the world.  Our service is dedicated to increasing chiropractic utilization by showcasing research.  Marketing to medical doctors through research is efficient, cost effective, and can dramatically improve your incoming referrals.  Join us.  Lets grow chiropractic together

Adult ADHD Prescription Rates Increase by Over 50%- by The Evidence Based Chiropractor

Research produced by Express Scripts (a pharmacy benefit management company) indicates that between 2008-2012 the prescription rates for adult ADHD medications increased by over 50%.  While childhood prescriptions of ADHD medications tend to favor boys (2:1), the medications prescribed in adulthood tend to slightly favor women.  This study looked at over 400,000 adults.  

Joseph Austerman, DO, head of the Section of Child and Adolescent Psychiatry at Cleveland Clinic Children's Hospital, in Ohio, wrote "...the fact that there's been a substantial spike in medicating adults for ADHD does raise the same questions we've asked about appropriate use of these treatments in children: are we now over-diagnosing and overmedicating in the adult population?"

The overprescription of these medications is well documented.  Additionally, the revenue generated from the sales/prescriptions of these medications is astounding.  As non-prescribing physicians it is important for us to be aware of the trends in prescription/medication use.  Many of our patients are presenting to our offices with a laundry list of prescribed medications.  These medications inevitably effect their nervous system.  As we evaluate our patients' , we must be aware of the challenges that may hinder the optimal progress of our care.  

-The Evidence Based Chiropractor is the leading DC/MD marketing and outreach group in the world.  Our service is dedicated to increasing chiropractic utilization by showcasing research.  Marketing to medical doctors through research is efficient, cost effective, and can dramatically improve your incoming referrals.  Join us.  Lets grow chiropractic together.

Top 5 Pain Interventions to Avoid- by The Evidence Based Chiropractor

The top 5 pain inventions to avoid by the ASA touch on a variety of spine related conditions.  This list was created because many medical doctors are commonly performing these procedures in spite of the fact that evidence based guidelines suggest they shouldn't.  

At the top of the list is a recommendation to avoid prescribing opioid analgesics for non cancer pain.  These are commonly prescribed even though there is an extremely high addiction rate and virtually no benefit in terms of outcomes.  

As you look through the list, you will find a array of procedures/interventions which are probably being performed on your current patients.  As evidence based practitioners it is imperative that we stay up to date on these topics and keep our patients informed regarding their health care choices.  

The following five recommendations were made-

http://www.medscape.com/viewarticle/819517

1. Don't prescribe opioid analgesics as first-line therapy to treat chronic noncancer pain. Consider multimodal therapy, including nondrug treatments, such as behavioral and physical therapies, before pharmacologic intervention. If drug therapy appears indicated, try nonopioid medication, such as nonsteroidal anti-inflammatory drugs, or anticonvulsants, before starting opioids.

2. Don't prescribe opioid analgesics as long-term therapy to treat chronic noncancer pain until the risks are considered and discussed with the patient. Inform patients of the risks of such treatments, including the potential for addiction. Review and sign a written agreement identifying both your and the patient's responsibilities (eg, urine drug testing) and the consequences of noncompliance with the agreement. Be cautious in coprescribing opioids and benzodiazepines. Proactively evaluate and treat, if indicated, the nearly universal adverse effects of constipation and low testosterone or estrogen.

3. Avoid imaging tests, such as MRI, computed tomography, or radiography, for acute low back pain without specific indications. Avoid these interventions for low back pain in the first 6 weeks after pain begins if there are no specific clinical indications (eg, history of cancer with potential metastases, known aortic aneurysm, progressive neurologic deficit). Most low back pain doesn't require imaging, and performing such tests may reveal incidental findings that divert attention and increase the risk of having unhelpful surgery.

4. Don't use intravenous sedation, such as propofol, midazolam, or ultra-short-acting opioid infusions for diagnostic and therapeutic nerve blocks, or joint injections, as a default practice. (This recommendation does not apply to pediatric patients.) Ideally, diagnostic procedures should be performed with local anesthetic alone. Intravenous sedation can be used after evaluation and discussion of risks, including interference with assessing the acute pain-relieving effects of the procedure and the potential for false-positive responses. Follow ASA Standards for Basic Anesthetic Monitoring in cases where moderate or deep sedation is provided or anticipated.

5. Avoid irreversible interventions for noncancer pain, such as peripheral chemical neurolytic blocks or peripheral radiofrequency ablation. Such interventions may be costly and carry significant long-term risks of weakness, numbness, or increased pain.

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-The Evidence Based Chiropractor is the leading DC/MD marketing and outreach group in the world.  Our service is dedicated to increasing chiropractic utilization by showcasing research.  Marketing to medical doctors through research is efficient, cost effective, and can dramatically improve your incoming referrals.  Join us.  Lets grow chiropractic together.