CHRONIC PAIN

CHRONIC BACK PAIN IMPAIRS DECISION MAKING

CHRONIC BACK PAIN EATS AWAY AT BRAIN

EARLY RECOVERY FROM LOWER BACK PAIN PREDICTS LONG-TERM OUTCOME

MAINTENANCE CHIROPRACTIC CARE PREVENTS RELAPSE IN DISABILITY, STUDY SUGGESTS

SPINAL MANIPULATION IS MOST COST EFFECTIVE FOR LOWER BACK PAIN

"Vast majorities of people suffering from chronic pain are actually the result of unnecessary back surgery. In one study, I demonstrated that at least 80% of those who had lumbar surgery for a presumed ruptured disc had not had a ruptured disc before their first surgery. (Shealy CN. Percutaneous radiofrequency denervation of spinal facets. Treatment for chronic back pain and sciatica. J of Neurosurgery.1975;43:448-451.)

By the time they had between 5 and 7 unsuccessful back operations they certainly were invalids....In selective patients with back pain, we have found two significant problems: locked or degenerative facet joints or a sacral shear."

Source: C. Norman Shealy, MD Ph.D.
Chronic Pain Management.in the.Townsend Letter
for Doctors and Patients. Jan. 2005.
PP 22-23

Scientific evidence supports the hypothesis that chronic pain impairs an individual's decision-making capability.

As part of one study, investigators compared 26 healthy people with 26 patients with chronic back pain (CBP) and 12 patients with a condition called chronic complex regional pain syndrome (CRPS). CRPS is a chronic nerve disorder typically afflicting the arms or legs, which usually onsets following an injury.

The study participants were asked to perform a test researchers use to assess emotional decision- making. The test, called the Iowa Gambling Task, is a gambling card game.

Subjects with CBP performed 41% worse than did pain-free individuals. Those with CRPS performed even poorer.

The study's authors conclude that "our evidence indicates that chronic pain is associated with a specific cognitive deficit, which may impact every day behavior especially in risky, emotionally laden, situations."

"Other cognitive abilities, such as attention, short- term memory, and general intelligence tested normal in the chronic pain patients."

Source: Pain - March 2004;108:129-36.
http://www.sciencedirect.com/
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Scientists in Chicago have discovered new clues into what role the brain plays in chronic back pain (CBP).

The investigators used magnetic resonance imaging brain scans to compare the morphology of 26 individuals with CBP with 26 pain-free control subjects.

According to the report "patients with CBP showed 5-11% less neocortical gray matter volume than control subjects. The magnitude of this decrease is equivalent to the gray matter volume lost in 10-20 years of normal aging. The decreased volume was related to pain duration, indicating a 1.3 cm(3) loss of gray matter for every year of chronic pain."

The study also showed that CBP patients had decreased gray matter density.

"Our results imply that CBP is accompanied by brain atrophy and suggest that the pathophysiology of chronic pain includes thalamocortical processes," conclude the authors.

Source: Journal of Neuroscience - November 2004;24:10410-5.
http://www.jneurosci.org/
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What demographic factors affect a chiropractic patient's recovery from chronic low-back pain (LBP). To find out, 115 chiropractors in Norway pooled data
on 875 patients. All patients had suffered LBP for at least 2 weeks at the time of their initial chiropractic consultation and a minimum of 30 days altogether during the preceding year.

According to the report, gender, social benefit, severity of pain, duration of continuous pain at first consultation and additional neck pain all influenced outcome at the fourth visit and at 3 months.

Early recovery was identified as a strong predictor of long-term outcome. Specifically, being free of back pain at the fourth visit was associated with triple the odds of remaining pain-free at 3 and 12 months.

Source: JMPT - October 2004;27:494-502.
http://www.mosby.com/jmpt
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Maintenance care appears to accomplish exactly what chiropractors have long claimed it does. According to a new study, maintenance care prevents chronic disability in patients with low-back pain (LBP).

Investigators tracked 2 groups of 15 patients with chronic nonspecific LBP. Both groups underwent intensive chiropractic care for a 1-month period. One group received no maintenance care while the other received adjustments every 3 weeks. Nine months later both groups were reevaluated.

The study's authors write that "for both groups, thepain and disability levels decreased after the intensive phase of treatments. Both groups maintained their pain scores at levels similar to the post-intensive treatments throughout the follow-up period. For the disability scores, however, only the group that was given spinal manipulations during the follow-up period maintained their post-intensive treatment scores. The disability scores of the other group went back to their pretreatment levels."

"This experiment suggests that maintenance spinal manipulations after intensive manipulative care may be beneficial to patients to maintain subjective post-intensive treatment disability levels. Future studies, however, are needed to confirm the finding in a larger group of patients with chronic low-back pain."

Source: JMPT - October 2004;27:509.
http://www.mosby.com/jmpt
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A new study examines the cost effectiveness of adding spinal manipulation, exercise classes, or a combination of both to standard treatment for low-back pain (LBP) delivered by general practitioners. (A chiropractor, osteopath or physical therapist performed the spinal manipulation.)

The inquiry tracked 1,287 individuals with LBP from across the United Kingdom. Results revealed that adding spinal manipulation, exercise, or both significantly cut costs and boosted quality of living. The researchers also determined that "manipulation alone probably gives better value for money than manipulation followed by exercise."

Source: BMJ - November 29; doi:10.1136.
http://www.bmj.com/
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