29-4 Chronic Pain Management

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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.


Vincent P. Lucido, DC, DACBO

In This Issue:

  • FEATURE ARTICLE: Nutritional Interventions for Chronic Neuropathic Pain
    Susan St. Claire, DC, MS, DCBCN, CCN
    • 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
    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