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For Bad Backs, It May Be Time to Rethink Biases About Chiropractors
Advanced Back and Neck Care • May 03, 2017

About two of every three people will probably experience significant low back pain at some point. A physician like me might suggest any number of potential treatments and therapies. But one I never considered was a referral for spinal manipulation.

It appears I may have been mistaken. For initial treatment of lower back pain, it may be time for me (and other physicians) to rethink our biases.

Spinal manipulation — along with other less traditional therapies like heat, meditation and acupuncture — seems to be as effective as many other more medical therapies we prescribe, and as safe, if not safer.

Most back pain resolves over time, so interventions that focus on relief of symptoms and allow the body to heal are ideal. Many of these can be nonpharmacological in nature, like the work done by chiropractors or physical therapists.

Physicians are traditionally wary of spinal manipulation (applying pressure on bones and joints), in part because the practitioners are often not doctors and also because a few chiropractors have claimed they can address conditions that have little to do with the spine. Patients with back pain haven’t seemed as skeptical. A large survey of them from 2002 through 2008 found that more than 30 percent sought chiropractic care, significantly more than those who sought massage, acupuncture or homeopathy.

Researchers have been looking at the evidence supporting spinal manipulation for some time. Almost 35 years ago, a systematic review evaluated the available research, most of which was judged to be low in quality, and found that there might be some short-term benefits from the procedure. Two reviews from 2003 agreed for the most part, finding that spinal manipulation worked better than a “sham procedure”, or placebo, but no better or worse than other options.

Almost a decade later, a Cochrane review assessed the literature once more, and found 12 new trials had been conducted. This review was more damning. It found that spinal manipulation was no better than sham interventions.

But since then, data have accumulated, as more higher-quality studies have been performed. Recently, in The Journal of the American Medical Association, researchers looked for new studies since 2011, as well as those that had been performed before.

The evidence from 15 randomized controlled trials, which included more than 1,700 patients, showed that spinal manipulation caused an improvement in pain of about 10 points on a 100-point scale. The evidence from 12 randomized controlled trials — which overlapped, but not completely with the other trials — of almost 1,400 patients showed that spinal manipulation also resulted in improvements in function.

In February, in Annals of Internal Medicine, another systematic review of nonpharmacologic therapies generally agreed with the other recent trials. Based upon this review, and other evidence, the American College of Physicians released new clinical practice guidelines for the noninvasive treatment of subacute back pain. They recommended that patients should try heat, massage, acupuncture or spinal manipulation as first-line therapies.

The only things that might detract from the use of spinal manipulation in this situation would be its cost and potential harms.

Because they fear those potential harms, some physicians are hesitant to refer patients to chiropractors or physical therapists for care. But in all the studies summarized above, there were really no serious adverse events reported. It’s possible to find anecdotes of harm to the spinal cord from improper manipulations, but these are rare, and almost never involve the lower spine.

Some physicians are concerned about the cost of spinal manipulation, especially since most insurance carriers don’t cover it. Visiting a chiropractor costs more than taking many non-narcotic pain medications. But more invasive interventions can cost a lot of money. In addition, studies have shown that, in general, users of complementary and alternative medicine spend less over all for back pain than users of only traditional medicine.

Medication and surgery can also lead to harms. We shouldn’t forget that prescription pain medications, like opioids, can lead to huge costs, especially when they’re misused.

Some physicians are uncomfortable that we don’t have a clear picture of how spinal manipulation actually works to reduce pain. It’s also possible that some chiropractors do it “better” than others, and we can’t tell. This concern should be tempered by the fact that we don’t have a great understanding of why many other therapies work either. Some of the more traditional things we recommend don’t even work consistently.

Still, there is no merit to many other claims about spinal manipulation — that it has been proved to work for things like infantile colic, painful periods, asthma, gastrointestinal problems, and more. For most conditions, the therapy lacks a good evidence base.

But given the natural course of back pain — that most of it goes away no matter what you do — the ideal approach is to treat the symptoms and let the body heal. Noninvasive therapies seem to do that well enough.

Originally published on NYTimes.com. Written by Aaron E. Carroll .. a professor of pediatrics at Indiana University School of Medicine who blogs on health research and policy at The Incidental Economist and makes videos at Healthcare Triage. Follow him on Twitter at @aaronecarroll.

By Ronald Grisanti D.C., D.A.B.C.O., DACBN, MS, CFMP 13 Mar, 2024
https://www.functionalmedicineuniversity.com/public/2000.cfm ** Feel free to use this article on your website. Compliments from Functional Medicine University . ** Read my past articles: http://www.functionalmedicineuniversity.com/public/department88.cfm ===================== View Rick Bramos Fitness YouTube Channel https://www.youtube.com/channel/UC_x4I27Z0DfYkfcroXxAhcA/videos Here is Rick's New Video of the Week: https://www.youtube.com/watch?v=W__EwtXJkyY Rick is now offering phone consultations for those wanting to lose weight or simply to improve their fitness. Rick can be reached at 2days2fitness@gmail.com for more details. ===================== ATTENTION DOCTORS AND ALL HEALTHCARE PRACTITIONERS Tell your friends and colleagues about Clinical Rounds. This is a great introduction to the field of functional medicine. Here is the webpage to subscribe: http://www.clinicalrounds.com Take care, Ron P.S. Please visit our facebook page and "Like It" Of course if you really like it. :) http://www.facebook.com/pages/Functional-Medicine-University/161486170671332
13 Mar, 2024
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Ronald Grisanti D.C., D.A.B.C.O., DACBN, MS, CFMP
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Ronald Grisanti D.C., D.A.B.C.O., DACBN, MS, CFMP Alzheimer's is the most common form of dementia. Its symptoms vary but may start with mild memory loss or difficulty remembering words or names. As it progresses, Alzheimer's causes worsening confusion and memory loss, changes in personality, the inability to perform everyday tasks and more. Alzheimer's is caused by a slow build-up of protein plaques and tangles in the brain that eventually cause brain cells to stop working properly. This build-up usually starts years before a person experiences symptoms. Alzheimer's-related memory loss is caused by brain cells working improperly and dying-a process known as neurodegeneration. Alzheimer's is estimated to account for about 60% of dementia cases. Diagnosing Alzheimer's Until recently, it has been difficult to identify the biological changes that indicate Alzheimer's. The typical evaluation, which includes physical exam, blood and urine tests and cognitive testing may provide ambiguous or conflicting answers, which can result in delayed referrals until symptoms become clearer. That has changed with new technology and testing. Labcorp has developed a new test called the Amyloid-Tau-Neurodegeneration (ATN) Profile ( ATN Profile) to help doctors detect evidence of biological changes consistent with Alzheimer's. These tests are the first objective tools that doctors have to help evaluate Alzheimer's, meaning that with a simple blood test , doctors and other health professionals allowed to order labs can get a clearer answers on Alzheimer's and its progression and get patients on a care plan earlier. This will in fact give physicians a simple, objective test for Alzheimer's disease pathology that can help shorten the time to diagnosis. Labcorp is the first company to make a fully blood-based ATN Profile commercially available. What is ATN? The ATN framework establishes a means for classifying biomarkers based on the biological evidence of Alzheimer's disease that each marker provides These markers are divided into three categories to reflect the three primary biological changes associated with Alzheimer's: A for amyloid plaques: Accumulations of beta-amyloid 42 proteins begin to form plaques in the brain years before initial symptom onset T for tau tangles: The beta-amyloid 42 accumulation causes misfolding of tau proteins, which tangle into knots and disrupt normal brain cell function N for neurodegeneratio : Brain cell functional impairment causes the cells to die, which exacerbates the characteristic cognitive impairment symptoms observed in Alzheimer's patients
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Ronald Grisanti D.C., D.A.B.C.O., DACBN, MS, CFMP Medical literature is very clear that oral dental health plays a significant role in your cardiovascular health. As odd as it sounds, regularly brushing and flossing your teeth could be what stands between you and a future heart attack. Research has linked bacteria from the Streptococcus genus to fatty plaque buildup in heart arteries. A new study published in the journal Circulation has pinpointed two specific oral microorganisms that play a role in whether we develop atherosclerosis (clogged arteries). In all people there should be a healthy balance of good and bad bacteria in our mouth (teeth). However when this balance is upset, it kicks off a chain of events that makes atherosclerosis far more likely to occur. The researchers used advanced technology for the study to reexamine the gut and oral bacteria assessments and cardiac imaging from 8,973 volunteers in the earlier SCAPIS study. Search in the medical literature has actually identified three bacteria associated with atherosclerosis when they were found in large numbers in the mouth. They include: Streptococcus anginosus Streptococcus oralis Streptococcus mutans The scientists who have published their research have two theories about why these bacteria might be a contributing factor for atherosclerosis. 1:These bacteria (streptococcus species) set off systemic low-grade inflammation that leads to plaque accumulation in heart arteries. 2: In an attempt to evade our immune system, the bacteria in our mouth enter our bloodstream and set up shop in our arteries. Steps to take to decrease the potential of Streptococcus genus compromising our cardiovascular health include: Regularly brushing your teeth Flossing Consider using a waterpik water flosser (this is my dentist strongest recommendations to clean out bacteria deep in the back molars.) This oral health appliance provides a stream of pulsating water to floss between your teeth and below the gumline. Don't forget the most important step of ideal dental health and that is regular dental cleanings. Here are some additional recommendations to be certain your oral health has the best opportunity to be bacteria free. Stop the Sugar Salt Water Rinse Tea Tree Oil and/or Oregano oil products. These essential oils have natural antibacterial qualities. If you battle gingivitis, look for mouthwash or toothpaste made with tea tree oil (never use straight oil) and/or Oregano oil. Olive Leaf Extract: Olive leaf extract is another natural antibacterial that can be used in mouthwash or toothpaste. One of my personal go to preventive measures to ensure optimal oral health is the Dentalcidin Oral Care System by Biocidin Botanicals. Clear here for more details on this dental care system. Start protecting your heart and reducing your risk of heart complications today by focusing on your oral care. You can find a qualified and certified functional medicine practitioner by going to: www.FunctionalMedicineDoctors.com References: https://www.sciencedirect.com/science/article/pii/S1882761608000045 https://www.sciencedirect.com/science/article/abs/pii/S1043276015000454 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1594668/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275337/ https://pubmed.ncbi.nlm.nih.gov/33825326/ https://journals.asm.org/doi/full/10.1128/iai.00897-19 https://pubmed.ncbi.nlm.nih.gov/37435755/ The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Grisanti and his functional medicine community. Dr. Grisanti encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional. Visit www.FunctionalMedicineUniversity.com for more information on our training in functional medicine. Look for practitioners who have successfully completed the Functional Medicine University's Certification Program (CFMP) www.functionalmedicinedoctors.com . This content may be copied in full, with copyright, contact, creation and information intact, without specific permission, when used only in a not-for-profit format. If any other use is desired, permission in writing from Dr. Grisanti is required
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