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chiropractic evidence

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Cardiovascular Safety of Pain Meds Questioned

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A meta-analysis recently published in the British Medical Journal questions the safety of common pain medications.  This article, which can be found here, analyzed 31 trials which contained 116,429 patients with more than 115,000 patient years of follow-up. These trials compared one type of non-steroidal anti-inflammatory medication (NSAID) to another, or to placebo. They looked for outcomes such as heart attack, stroke or death from cardiovascular disease.

They concluded that “little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Naproxen seemed least harmful.” Vioxx and Prexige had the highest risk of heart attack, while ibuprofen and diclofenac showed the highest risk of stroke.

It should make us take pause that one of the most common over the counter pain medications (ibuprofen) was associated with a 3-times higher risk of stroke when compared to placebo. We need to start educating ourselves on the real risks associated with quick-fixes for pain, and start looking to treat the cause of our pain and not just the symptoms. Manual therapies such as chiropractic are a drug-free, non-surgical, safe and effective option.

The CBC has a somewhat-simplistic but interactive comparison of the 3 major over the counter pain relievers here.

Dr. Debbie Wright is a practicing Courtenay Chiropractor.

Chiropractic Care for Neck Pain – Is it Safe?

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A current study published in Spine set out to determine the relationship between benign adverse events (reactions to treatment) and outcomes (neck pain and disability, perceived improvement) in a group of people who received chiropractic care for their neck pain.

529 patients participated in the study. 56% of the participants reported an adverse event during the first 3 treatments, and only 13% graded it as “intense”. Muscle or joint pain events were the most common types reported, and none of the events were considered serious.

The researchers found that if someone reported an “intense” adverse event during any one of the first 3 visits, they were less likely to report recovery on the fourth visit. What is interesting about this is that they didn’t have significantly more neck pain or disability than those who didn’t experience an adverse event.

At a follow-up 3 months later, those who had “intense” adverse events experienced the same recovery and pain reduction as those who didn’t have any adverse events.

The bottom line here is that even if someone reports an adverse event or reaction after treatment, it did not negatively affect their outcomes or recovery at 3 months. Moreover, it was only those who had an “intense” adverse events that reported less recovery in the short term (13% of participants).

It is also important to note that out of 4,891 treatments, no serious adverse events occurred. This adds validity to the current view that “the benefits of chiropractic care for neck pain seem to outweigh the potential risks.”

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Easing Chronic Muscle Pain – What works?

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Myofascial Pain Syndrome can be defined as chronic muscle pain. This pain originates around certain points of pain and sensitivity in your muscles called trigger points. A recent study was published in the Journal of Manipulative and Physiological Therapeutics that sought to identify and review the most common treatments for myofascial pain syndrome.

This study identified many different types of treatment used, and some of them are as follows:

  • Spray and Stretch – vapo-coolant spray followed by muscle stretch
  • Soft Tissue Massage
  • Ischemic Compression – compressing the trigger point in the muscle
  • Occipital Release Exercises – a form of massage and mobilization for the occiput (base of skull)
  • Strain/Counter-strain – stretching a muscle and then having the patient contract that muscle
  • Myofascial Release – compressing and tensioning the trigger point while stretching the muscle through its full range
  • Chiropractic Spinal Adjustments

Immediate (after treatment) benefits were demonstrated with the chiropractic adjustments, spray and stretch, compression, massage and strain/counter-strain. The authors therefore concluded that there is moderately strong evidence to support the use of these manual therapies for the treatment of trigger point pain. These treatments, however, didn’t show as strong benefits as long term solutions.

Recommendations for other types of treatment for trigger points and myofascial pain syndrome can be drawn from this review.  They are as follows:

  • There is strong evidence that laser therapy is effective.
  • There is moderately strong evidence that electrical therapy is effective on a short term basis.
  • There is moderately strong evidence that acupuncture is effective for up to 3 months after treatment.
  • There is limited evidence for modalities such as muscle stimulation, interferential current, an other such stims.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Routine X-rays Not Needed

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Following up on my previous post about the necessity of X-rays, I came across a review of the literature for low back imaging.

In 1994, the AHPR began recommending against imaging of the low back in the early stages of acute low back pain. This study was undertaken to investigate the relationship between the use of immediate X-rays for the low back and the clinical outcome of the case.

479 articles were identified and reviewed. The authors found no differences in long term and short term outcomes between those who were X-rayed immediately and those who simply received treatment.

They concluded that for patients who present with simple uncomplicated low back pain (no red flags present), X-raying their back did not lead to any greater improvements. Since there is no benefit to imaging the back, but there are draw backs (radiation exposure, cost), routine imaging should be avoided.

Ultimately, every clinician has to rationalize their decisions when it comes to the assessment and treatment of their patients. I will often explain my decision not to X-ray with the fact that the X-ray result will not change my clinical management of their case. We know already from previous studies that many things are seen on X-ray and MRI that don’t have clinical relevance and may actually confuse the issue.

If you would like to read the original article, it can be found here.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

The Evidence Supports Chiropractic Care

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Myth #3: There is no evidence to support that chiropractic works.

I don’t even know where to start with this one. The fact is that there is are so many studies done on spinal manipulation that a Medline search would be overwhelming. Instead of going through the many systematic reviews and meta-analyses that exist, I think the evidence is well summed up by an review exploring international low back pain guidelines. The review can be accessed here.

Over the last 10 years, 12 countries have done critical reviews of the scientific literature concerning low back pain. The international consensus is that the balance of the evidence shows that chiropractic spinal manipulation is effective in managing low back pain, and therefore is included in the recommendations. Here is a summary of their findings:

Clinical practice guidelines for the treatment of acute lower back pain

  • Reassurance of the favourable natural history
  • Advice to stay active
  • Discourage bed rest
  • Acetaminophen, p.r.n.
  • Chiropractic spinal manipulative therapy
  • Advice against passive physiotherapy modalities, prolonged bed rest or specific back exercises.

Essentially the investigators found that following these treatment guidelines (including chiropractic spinal manipulation) led to better outcomes than usual medical care. It is important to note that the guidelines don’t recommend chiropractic as a stand alone treatment, but as one component of a continuum of care.

One of the authors of the study then went on to launch the 2-part C.H.I.R.O study (Chiropractic Hospital-Based Interventions Research Outcome study). The first part pitted chiropractic care (along with the above guideline recommendations) versus usual medical care. The people who received chiropractic care showed better functional and quality of life improvements. The results of this study have been presented at Canadian Spine Society Meeting, the International Society for the Study of the Lumbar Spine, and the North American Spine Society and will be published in an upcoming edition of Spine. A summary of the results can be found here.

In the opinion of this Comox Valley Chiropractor, we are so far past establishing that there is evidence supporting chiropractic care. We are now heading in the direction of trying to establish how to best use this tool in the management of patients, or whether certain subsets of patients will respond more favourably. In the past 5 years, Chiropractic Research Chairs have been established at many universities across Canada in order to further chiropractic research.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Chiropractic Care Better Than “Usual Care”

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A recent article in Lippincott’s Bone and Joint Newsletter caught this Comox Valley Chiropractor‘s eye concerning the effectiveness of chiropractic care when compared to “usual care” given by family doctors. The main author of the study is Dr. Paul Bishop, DC, PhD, MD, a professor of orthopedics at the University of British Columbia.

The study was presented at the International Society for the Study of the Lumbar Spine in Hong Kong. The results indicated that following the existing clinical practice guidelines (which include chiropractic spinal manipulation) produces better outcomes than family doctor-directed care for acute low back pain patients.

The guideline based care involved avoiding passive treatment, acetaminophen to control pain, reassurance and four weeks of spinal manipulation performed by chiropractic doctors at a frequency of two times per week. All patients returned to work within eight weeks.

Using pain and disability questionnaires, the chiropractic treatment group was found to have a significantly greater improvement than those who received “usual care” from their family physicians.

It was also stated that,

“Typically, the family physician-based care involved excessive use of passive therapies such as massage and passive physical therapy, excessive bed rest, and excessive use of narcotic analgesics, Bishop added.”

The evidence continues to mount that chiropractic care is an effective form of treatment for low back pain, and should be used as a first line of treatment for uncomplicated cases.