29-4 Chronic Pain Management

Letter from the Editor-in-Chief

How does a clinician objectively assess a patient who complains of low back pain...

How does a clinician objectively assess a patient who complains of low back pain that is chronic? Oftentimes, the condition is primarily subjective, with little objective clinical findings that would validate the complaint. Whether it is chronic low back pain or any number of similar complaints, the conundrum presents itself to the doctor as a challenge to seek and determine any positive physical, orthopedic or neurological signs that would corroborate the complaint, and lead to a direction for appropriate treatment.

We have the benefit of input from doctors Joel Carmichael, Brian Bond, Susan St. Claire and Lisa Killinger to help the clinician to better assess and determine possible cause(es) (mechanical, neurologic, psychological, vascular, infectious, neoplastic), and form an effective treatment plan. Some modalities and other treatment approaches are discussed, some of which may be outside the scope of practice of the average chiropractic physician (e.g., opioids). But, just because we cannot utilize a specific approach, does not mean we are not responsible to be aware of what is available to the clinician and patient for effective management of the condition, as well as the downsides of some of these other approaches. With respect to opioids, Dr. Bond provides a helpful overview of availability, utilization, effects and dangers associated with their use.

It is interesting how both experience and ongoing study eventually redirect the enthusiastic new practitioner into the realistic view that each case is not always an opportunity to affect a cure, but is a challenge to effectively manage with sound clinical judgment and well- developed skills.

Respectfully,

Vincent P. Lucido, DC, DACBO
Editor-in-Chief

In This Issue:

  • FEATURE ARTICLE: Nutritional Interventions for Chronic Neuropathic Pain
    Susan St. Claire, DC, MS, DCBCN, CCN
  • AUDIO LECTURES:
    • Chronic Low Back Pain Management Strategies
      Joel P. Carmichael, DC, DACBSP®
    • The Role of Opioids in the Management of Chronic Low Back Pain
      Brian M. Bond, DC, MS, PhD
  • ABSTRACTS AND COMMENTARIES:
    Lisa Zaynab Killinger, DC

    • Association of Lumbar Spine Stiffness and Flexion-Relaxation Phenomenon with Patient-Reported Outcomes in Adults with Chronic Low Back Pain – A Single-Arm Clinical Trial Investigating the Effects of Thrust Spinal Manipulation
    • Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Randomized Controlled Trial
    • Provider and Patient Perspectives on Opioids and Alternative Treatments for Managing Chronic Pain: A Qualitative Study
    • The Effectiveness of Acupuncture, Acupressure and Chiropractic Interventions on Treatment of Chronic Nonspecific Low Back Pain in Iran: A Systematic Review and Meta-Analysis
  • CONTINUING EDUCATION QUESTIONNAIRE

29-3 Metabolic Syndrome

Letter from the Editor-in-Chief

Have you been somewhat frustrated in the management of your patients...

Have you been somewhat frustrated in the management of your patients who battle (or succumb to) obesity, elevated blood sugar, along with other abnormal blood chemistries, and cardiovascular problems? Well, even if you are not frustrated, I think you will enjoy and profit from this issue of D.C. Tracts as it deals with Metabolic Syndrome. Dr. Brian Anderson’s lectures will provide a detailed overview covering metabolic syndrome history, prevalence, effective treatment approaches, risk factors such as epigenetics, genetics, lifestyle, and social risk factors.

Pay attention to the title of Dr. Susan St. Claire’s article. It will let you know the comprehensive scope of her article. It will also prepare you for the journey through the five criteria to determine a diagnosis of metabolic syndrome, to nutritional interventions, recognizing the importance of micronutrients, factors that influence intestinal health, lifestyle modifications, phytochemicals, the Mediterranean Diet, and intermittent fasting. She wraps it up with the encouragement for early intervention, and to also pursue regular exercise, caloric restriction, and avoidance of high glycemic foods. While each topic we cover in D.C. Tracts is clinically significant, I feel that this particular topic is so important because too many Americans are eating themselves to death.

Respectfully,

Vincent P. Lucido, DC, DACBO
Editor-in-Chief

In This Issue:

  • FEATURE ARTICLE: Nutritional Interventions to Prevent and Treat Metabolic Syndrome: From the Basics and to the Latest
    Susan St. Claire, DC, MS, DCBCN, CCN
  • AUDIO LECTURES:
    • Metabolic Syndrome: History, Epidemiology and Etiology
      Brian Anderson DC, CCN, MPH, MS, CertMDT
    • Metabolic Syndrome: Diagnosis and Management
      Brian Anderson DC, CCN, MPH, MS, CertMDT
  • ABSTRACTS AND COMMENTARIES:
    Christopher Roecker, DC and Lisa Zaynab Killinger, DC

    • Metabolic Syndrome
    • An Overview of the Identification and Management of the Metabolic Syndrome in Chiropractic Practice
    • Effects of a Home-Based Intervention on Diet and Physical Activity Behaviours for Rural Adults with or at Risk of Metabolic Syndrome: A Randomised Controlled Trial
    • Yoga for Adults with Type 2 Diabetes: A Systematic Review of Controlled Trials
  • CONTINUING EDUCATION QUESTIONNAIRE

29-2 Non-Neuromusculoskeletal Pediatric Conditions

Letter from the Editor-in-Chief

There is a paucity of studies dealing with the subject of non-musculoskeletal pediatric conditions...

This is especially noteworthy since there are millions of visits to chiropractors for these conditions. This issue of DC Tracts primarily deals with autism, colic, asthma, otitis media, and nocturnal enuresis.

The feature article makes note of various studies that have reported significant reduction of crying duration in colicky infants with various spinal and craniosacral interventions. With respect to asthma, the findings were that no significant changes were made with primary outcome studies (peak expiratory flow measured by spirometry), but most of the patients experienced relief of symptoms, such as coughing, difficulty breathing, etc. The studies on nocturnal enuresis were also significantly positive with regard to outcomes. Only the reports on treatment of otitis media were not as encouraging as far as patient outcomes. With regard to safety, Dr. Gleberzon says that “published cases of serious adverse effects in infants and children receiving chiropractic, osteopathic, physiotherapy, or manual medical therapy are rare…no deaths associated with chiropractic care were found in the literature to date.”

Dr. Lisa Killinger comments on pertinent abstracts that relate to our topic. In her remarks, she makes a statement of important consideration, “A chiropractor seeing pediatric patients also must be familiar with, and respectful of, professional best practices related to pediatric care.” The abstracts cover advertising regarding alternative interventions for pediatric conditions, such as allergy and asthma, safety concerns in pediatric care, and the advice of some chiropractic physicians concerning immunization.

Dr. Brian Gleberzon’s audio lecture on autism measures up to the high quality of his previous lectures. He comments on the original misapplied diagnosis given to this problem: “Infantile Dementia.” The importance of this topic becomes more significant in light of the increasing incidence of autism and the lack of confirming evidence of any single primary cause. The appropriateness or effectiveness of chiropractic intervention in such cases has not been documented in any randomized clinical trials, but does show merit from best available evidence that has been gathered. At present he states that practice-based clinical trials have an advantage in pursuing answers to these concerns. To date, case reports have given some indication of benefit from chiropractic intervention in these cases. However, there is a downside because of outrageous and unfounded claims with regard to suspected causes and benefits of treatment for autism by some chiropractors.

Dr. Sharon Vallone’s lecture on dysfunctional feeding and airway obstruction in infants addresses the possible role of chiropractic care for these problems. She emphasizes the importance for the chiropractor to distinguish what problems motivated the parent to seek help, and also for the doctor to consider the various possible causative factors, such as birth injuries, tongue tie, neurologic dysfunction, genetic abnormalities, musculoskeletal problems, and a mother’s emotional/physical status that could affect breast feeding. She makes an obvious point, which still needs emphasis – determining the best therapeutic approach requires an accurate diagnosis. This would include evaluation of mouth, jaw, spine, and the sympathetic nerve system. In addition, she alerts chiropractic physicians treating feeding problems in infants to avail themselves of the services of a lactation consultant to help co-manage the problem. Awareness and inquiry about previously diagnosed congenital anomalies should also be a part of the initial consultation.

Respectfully,

Vincent P. Lucido, DC, DACBO
Editor-in-Chief

In This Issue:

  • FEATURE ARTICLE: Chiropractic Therapies for Pediatric Non-Neuromusculoskeletal Conditions: The Current State of the Evidence
    Brian J. Gleberzon, DC
  • AUDIO LECTURES:
    • Best Practice Recommendations for the Chiropractic Care of Children with Autism
      Brian J. Gleberzon, DC
    • Chiropractic Care for Infants: Biomechanical Dysfunction and its Effects on Breastfeeding and Breathing
      Sharon A. Vallone, DC
  • ABSTRACTS AND COMMENTARIES:
    Lisa Zaynab Killinger, DC

    • Attitudes and Opinions of Doctors of Chiropractic Specializing in Pediatric Care Toward Patient Safety: A Cross-Sectional Survey
    • Complementary and Alternative Medicine and Influenza Vaccine Uptake in U.S. Children
    • Selling Falsehoods? A Cross-Sectional Study of Canadian Naturopathy, Homeopathy, Chiropractic and Acupuncture Clinic Website Claims Relating to Allergy and Asthma
  • CONTINUING EDUCATION QUESTIONNAIRE

29-1 Adjunctive Therapies

Letter from the Editor-in-Chief

Dr. Brett Martin’s lecture on the efficacy of cold laser therapy for the treatment of tendinopathies...

Dr. Brett Martin’s lecture on the efficacy of cold laser therapy for the treatment of tendinopathies is a comprehensive insight into how this modality can be effectively utilized in various musculoskeletal conditions affecting the tendons. He discusses the different types of laser with respect to their power, penetration, wavelengths, and physiologic effects. He also discusses the comparison of cold laser therapy with other interventions and their therapeutic efficacy. Additionally, he cautions about certain contraindications and safety measures that should be observed when using cold laser therapy. There were five studies comparing the effects of NSAID therapy to laser therapy. The efficacy of both forms of treatment were virtually synonymous for pain reduction. However, the laser therapy group also potentiated tissue healing and repair.

Dr. Brynne Stainsby’s lecture on the clinical effects of vibration therapy provides the clinician with information on the various components of vibration therapy, the mechanism of its mechanical and physiologic effects on the nervous and musculoskeletal system. She covers the benefits in different populations and conditions that benefit from vibration therapy, and some of the contraindications and safety concerns.

Dr. Carlo Guadagno is our feature article author. He deals with a subject that is of critical importance to any clinician that has the occasion to treat an athlete whose sport involves forceful physical contact, or anyone who may have accidentally suffered head trauma. He covers the incidence, epidemiology, and symptoms associated with head trauma that may result in concussion, with particular attention to football injuries. He raises the caveat to never minimize a blow to the head, and the importance of striving to minimize occurrences leading to concussion. In order to accomplish the latter, he lists preventative measures that will facilitate this goal. His feature article also contains several therapeutic approaches in management of concussion injuries, and various methods of retraining the injured athlete.

Dr. Lisa Killinger follows up with several salient abstracts and commentaries on adjunctive therapies in neurogenic claudication, whiplash associated disorders, neck pain, and carpal tunnel syndrome. The outcomes vary from improved outcome with the approaches to the neurogenic claudication, to limited effectiveness with respect to nerve gliding in carpal tunnel syndrome, and no effectiveness for neck pain when using heat, cold, diathermy, hydrotherapy, and ultrasound.

Respectfully,
Vincent P. Lucido, DC, DACBO
Editor-in-Chief

In This Issue:

  • FEATURE ARTICLE: Concussion: Modalities for Assessment and Management
    A. Carlo Guadagno, DC, CCSP, ICCSP, FIC
  • AUDIO LECTURES:
    • Cold Laser Therapy: Overview and Efficacy for the Treatment of Tendinopathies
      Brett R. Martin, DC, MSAc
    • Whole Body Vibration
      Brynne Stainsby, BA, DC, FCCS(CA)
  • ABSTRACTS AND COMMENTARIES:
    Lisa Zaynab Killinger, DC

    • Clinical Outcomes for Neurogenic Claudication using a Multimodal Program for Lumbar Spinal Stenosis: A Retrospective Study
    • Are Manual Therapies, Passive Physical Modalities, or Acupuncture Effective for the Management of Patients with Whiplash-Associated Disorder or Neck Pain and Associated Disorders? An Update of the Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders by the OPTIMA Collaboration
    • Effectiveness of Nerve Gliding Exercises on Carpal Tunnel Syndrome: A Systematic Review
  • CONTINUING EDUCATION QUESTIONNAIRE