Archive for March, 2012

We have all heard about the “placebo effect” and the “power of positive thinking.” A placebo, according to Wikipedia, is “…a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient.” When a placebo is used, it will sometimes have a perceived beneficial effect. When this occurs, it is referred to as “the placebo effect.” Placebos are commonly used in research where one group will be given the “real” treatment, another a “placebo” and a third group will be given nothing at all. The evaluators are usually blinded as to who received which of the 3 approaches. The group receiving the placebo is carefully compared to the other 2 groups (the real treatment group and the no treatment group). Common placebos include inert tablets (sugar pills), sham treatment (which may include surgery, detuned electrical stimulation, sham acupuncture, sham manipulation, and many more). What is compelling and interesting is that the placebo often has a surprisingly positive effect on the patient’s symptoms and because of this, research is quite extensive trying to figure out why even placebos can benefit patients.

The phrase, “…the power of positive thinking” has also been around a long time. Again, studies have shown that when a patient’s treatment plan is presented in a detailed fashion with a “positive spin” compared to when the health care provider seems skeptical that it might help, the results favor the positive presentation. Call it what you will – the power of positive thinking, faith, hope – it does appear to be an important part of the formula to obtain a positive outcome from treatment, any treatment.

When considering the placebo effect of chiropractic, specifically cervical manipulation and its effect on neck pain and headache, a landmark study published by medical doctors revealed significantly greater benefits of cervical manipulation for acute, as well as subacute and even chronic (pain > 3 months) neck pain when compared to other forms of treatment (muscle relaxants or “usual medical care”). They reported that the highest quality study demonstrated that spinal manipulation benefits patients with tension-type headaches. They also reported that the complication rate for cervical spine manipulation is low, estimated to be between 5-10 per 10 million manipulations. Another very supportive study looked at the immediate effects from only one cervical spine manipulation (CSM) using objective instruments that measured pain (algometry) and strength (grip strength dynamometer) on patients with elbow tendonitis pain (lateral epicondylitis). The patients received either CSM or a “sham” method they refer to as “manual contact intervention” or MCI. The “real” treatment group (CSM) showed a significant increase in grip strength and reduced pain compared to the MCI/sham group.

The “take-home” message here is clear. Cervical spine manipulation was found to be superior to sham manual treatment (placebo), as well as muscle relaxers, or “usual medical care” for neck pain and headaches. Second, cervical manipulation clearly out performed the placebo effect in patients with elbow pain. Simply put, chiropractic works!!!!

We realize that you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

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Fibromyalgia (FM) is a disorder involving chronic pain that has no known cause. It is characterized by widespread musculoskeletal pain, sleep disturbance, fatigue and mood disorders. FM affects about 2% of the US population and ranges between 1% and 11% in other countries. It is more prevalent in adult women than men (3.4% vs. 0.5%) and is most common with increasing age with the highest occurrence between 60-79 years of age. The criteria for the diagnosis of FM was established in 1990 by the American College of Rheumatology as widespread pain of at least 3 month duration and pain on palpation (pushing with the fingers) of at least 11 of 18 specific tender sites on the body. Pain, fatigue and sleep disturbance are observed in all patients with FM. Additional features can include: stiffness, skin tenderness, post-exertional pain, irritable bowel syndrome, cognitive disturbances, overactive bladder syndrome or interstitial cystitis, tension or migraine headaches, dizziness, fluid retention, paresthesias (numbness), restless legs, Reynaud’s phenomenon (white finger disease), and mood disturbances. FM is also strongly associated with anxiety, depression, chronic fatigue syndrome, myofascial pain syndrome, hypothyroidism, and many of the inflammatory arthritic diseases. Though there are no specific tests for FM, neurotransmitter deregulation including serotonin, norepinephrine, and substance P, result in an abnormal sensory processing in the brain and spinal cord. This results in a lower pain threshold commonly seen in FM.

The treatment of FM may be best looked at from 3 specific goals which include: 1. Alleviate pain; 2. Restore sleep; and 3. Improve physical function. Thus the most successful approach to the treatment of FM has been reported to be multidisciplinary or, involving several different types of health care providers. Clinical tools often used by doctors to monitor symptom change include a 0-10 pain scale, a body function scale called the Fibromyalgia Impact Questionnaire (FIQ) which measures physical function, common FM symptoms and general well-being; and, for measuring the physical and emotional side of FM, the SF-12 or SF-36 (SF = “short form” and either a 12 or a 36 item tool). The use of these tools helps monitor the success of the treatment that is being applied to the patient.

Though medications are reported as an important treatment option (such as an anti-inflammatory, analgesic, anticonvulsant, hypnotic, corticosteroids, opiates, various injections and more), the focus of this discussion is aimed at the alternative or complementary treatment approaches, as many FM patients cannot tolerate the side effects of the many different medications. Alternative approaches include cognitive behavioral therapy (counseling), exercise (strength & flexibility), acupuncture, and chiropractic treatment approaches, particularly manipulation but also soft tissue therapies and guided exercise training. Physiological therapeutic approaches frequently used in chiropractic clinics include low-power laser therapy, hydrotherapy such as whirlpool, Balneotherapy – using minerals and oils in the moving water, pulsed electromagnetic field, traction and massage therapy. Another exercise approach that can have great value in managing stress and facilitating sleep is Yoga. The key to a successful treatment outcome requires finding a “team” of health care providers that are willing to listen to the patient and work together to improve the patient’s quality of life. Through this concerted team approach, in addition to the patient taking responsibility by performing exercises on a regular basis, following a proper diet, and getting adequate restful or restorative sleep, FM can be quite well “controllable” and, a relatively “normal” lifestyle can be enjoyed.

If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services!

When people think of chiropractic, they immediately think of low back pain and are often surprised to find out that chiropractic can benefit many conditions such as carpal tunnel syndrome, tennis elbow, rotator cuff tears, as well as hip, knee, and ankle conditions. There is also research support for manipulation (a key component of chiropractic) and its role in managing “somatovisceral” related conditions such as pneumonia, dizziness, stage 1 hypertension, PMS, asthma, colic, and bed wetting.

Research clearly shows that chiropractic manipulation out performs other forms of treatment for acute, subacute and chronic low back pain. But, the question remains, can “maintenance chiropractic” PREVENT problems down the road? Ironically, two medical doctors in August of 2011 published an article in a leading medical journal (SPINE) entitled, “Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?” The study’s objective was to determine if treating chronic low back pain patients (pain >6 months) after a course of 12 treatments in the first month would do better, the same or worse if treatments were continued at 2-week intervals for an additional 9 months. They compared 3 groups of patients: 1.) 12 treatments of “sham” (placebo) manipulation over a 1-month period. 2.) 12 treatment of “real” spinal manipulative therapy (SMT) for 1 month but no treatments for the subsequent 9 months. 3.) The same as #2 but with treatments every 2 weeks over the next 9 months. To determine the differences between these 3 groups, the authors measured pain and disability scores (using questionnaires), generic health status (questionnaire), and back-specific patient satisfaction (questionnaire) at 1, 4, 7 and 10-month intervals.

The results showed that groups 2 (SMT for 1 month only) and 3 (SMT for 1 month + every 2 weeks for 9 months) had significantly lower pain and disability scores than the 1st group (sham/placebo group) at the end of the 1st month or, 12 visits. However, only group 3 (treatments were continued for 9 months at 2 week intervals) showed more improvement in pain and disability scores at 10 months. Equally important, the scores for the non-maintained group 2 patients returned to near their pre-treatment levels by month 10!

The authors concluded that not only is spinal manipulative therapy effective for chronic low back pain, but more importantly, REGULAR ADJUSTMENTS EVERY 2 WEEKS after the initial course of concentrated care (3x/week for 4 weeks) was needed, “…to obtain long-term benefit,” suggesting that, “…maintenance SM after the initial intensive manipulative therapy,” is appropriate care to obtain long-term results.

This study FINALLY supports the recommendations made by chiropractors for many years –regular adjustments are beneficial to obtain a higher quality of life, less pain and less disability!

We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.