Conservative Care First: Spinal Manipulation, Not Medication

by All American Healthcare Comments Off on Conservative Care First: Spinal Manipulation, Not Medication
Medical staff at All American Healthcare holding clipboard and making notes in patient file

All American Healthcare Doctor Holding Clipboard

Article by Christina Acampora in ACA News.  CHRONIC LOWER-BACK PAIN. For chiropractors it’s an area in which our services shine and that contributes to our strong rates of patient satisfaction. Chronic lower-back pain is one condition that can open doors for chiropractic physicians within the medical community, as it is lacking conservative care treatment options.

Guidelines have been established to manage nonspecific chronic back pain with a focus on medication as a first choice option.1,2 Some of these guidelines are based on traditional standards of care and reasonableness, concluding that they may have an impact on pain for the better, but often lack scientific evidence to support this claim. The recent Lancet study on the lack of efficacy of paracetamol, discussed below, provides a perfect example.

While chiropractic manipulation is commonly listed as a reasonable course of care and suggested in the Journal of the American Medical Association’s (JAMA) patient handout as a valid treatment option,3 it is still highly underutilized. Most MDs continue to focus on prescription medications as the starting point of pain management, with limited consideration of chiropractic referrals.

In an effort to help increase patient access to chiropractic services and improve understanding of where chiropractic can be utilized alongside of, or in place of medication, the following review provides some talking points for your next conversation with an MD.

Common Pharmaceutical Interventions PARACETAMOL: The most recently published data for paracetamol considered acute back pain, finding that paracetamol made no impact on pain, disability and several other outcomes compared with placebo.4 Thus, the authors have called into question the reasonableness of prescribing paracetamol for acute back pain. Findings are scarce for paracetamol use on its own to treat chronic pain.

NSAIDS: A 2008 Cochrane systematic review of nonsteroidal anti-inflammatory drugs (NSAIDs) for back pain indicated that NSAIDs performed only marginally better than paracetamol for controlling back pain but had significantly more side effects.5 In 2007, the American Heart Association published a scientific statement warning against chronic use of NSAIDs for pain in patients with, or at risk of, cardiovascular conditions.6 A 2010 Danish study supported these findings,7 and this warning has now encompassed over-the-counter versions as well. Thus, limiting the reliance on these medications is of clinical concern.

Studies that compared manipulation with NSAIDs or featured NSAIDs and manipulation as primary treatments often show a benefit in favor of manipulation without the risk of adverse symptoms. Manipulation instead of, or alongside, NSAIDs could help limit the need and reliance upon NSAIDs.

MUSCLE RELAXANTS: A 2007 systematic review of medications found muscle relaxants useful for acute lower-back pain in the short term.8 A 2003 Cochrane review concluded: “Muscle relaxants are effective in the management of nonspecific low-back pain, but the adverse effects require that they be used with caution.”9 There are multiple chiropractic therapies and strategies for managing the muscular aspects of back pain.

OPIOIDS: It’s postulated that restrictions in health care benefits, the FDA’s 2007 decision to deny marketing approval for the COX-2 inhibitor etoricoxib and reduced access for non-pharmacological treatments helped contribute to an alarming rise in opioid prescriptions. The growing documentation in lawsuits against the pharmaceutical companies marketing these medications argue the benefits have been overstated, while serious risks have been minimized, and that opioids are not approved for general pain management for common non-cancer chronic pain like back pain, arthritis and headaches.10,11 Specialists conclude that because much pain management takes place in MDs’ primary care offices where a significant rise in opioid prescriptions has been noted, more education is needed to properly advise these physicians on the safety and proper use of opioids.12

Simply stated, opioids are not conservative care. It would make sense to provide a short-term trial of manipulation prior to opioid prescriptions.

Looking Ahead

Conversing with MDs on safety and the side effects of medications will likely lead to a similar discussion on manipulation. The American Pain Society’s Clinical Guideline for the Evaluation and Management of Low Back Pain states that for manipulation, “including data from observational studies, the estimated risk for serious adverse events was lower than one per 1 million patient visits.”13

Finally, many surgical specialists remark that a majority of presenting patients are not surgical candidates nor have they had adequate courses of conservative care. It’s interesting to note that health plans such as the one for the University of Pittsburgh Medical School now mandate a course of manipulation for back pain prior to the authorization of surgical intervention.14

The causes of back pain are multifactorial, and there are opportunities to pursue other approaches as shown in a Cochrane review on low-back pain,15 but chiropractors are certainly a sensible starting point for conservative care. It will take proper collaboration and sound clinical advances among conservative care algorithms that must include spinal manipulation if we wish to see a positive change in the outcomes associated with nonspecific back pain.

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All American HealthcareConservative Care First: Spinal Manipulation, Not Medication

Study Finds Walnuts Appear to Delay Alzheimer’s

by All American Healthcare Comments Off on Study Finds Walnuts Appear to Delay Alzheimer’s

Article by Frederick Kunkle in the Washington Post about how eating walnuts may delay of Alzheimer’s.

Picture of WalnutsA handful of walnuts a day may help keep Alzheimer’s disease at bay, a new study has found.

Researchers at the New York State Institute for Basic Research in Developmental Disabilities said experiments with Alzheimer’s-susceptible mice found that subjects that consumed walnuts showed significant improvement in their learning skills and memory compared with mice without them in their diet.

The study also found improvement in motor skills and reduction in anxiety. The mice in the experiment consumed an amount of walnuts that would be the equivalent for humans of eating about 1 to 1.5 ounces of walnuts a day.

Abha Chauhan , the lead researcher, said Monday that the study follows up on previous work that found walnut extract offered protective benefits to the oxidative damage caused by amyloid beta, a protein that has been implicated in the dementia-causing disease.Previous studies have shown that walnuts — whose meat has an uncanny resemblance to the brain — contain a number of compounds that help protect the brain, including Omega-3 fatty acids, and perhaps ward off Alzheimer’s.

 The nuts also contain anti-oxidants and other components that combat the effects of cell-killing stress and inflammation. In fact, Chauhan said, walnuts rank second — just behind blackberries — on a list of 1,100 foods with anti-oxidative properties.

In the latest study, the team, using wild mice and mice genetically altered to be vulnerable to developing Alzheimer’s disease, fed the animals custom-mixed diets containing 6 percent or 9 percent walnuts and then subjected them to a battery of experiments and mazes that tested their spatial and learning ability and psychomotor skills and coordination. The mice in a control group performed much worse than the mice that consumed the walnut-enriched diet, the study found.

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All American HealthcareStudy Finds Walnuts Appear to Delay Alzheimer’s

Alternative Therapy Can Relieve Back Pain

by All American Healthcare Comments Off on Alternative Therapy Can Relieve Back Pain
All American Healthcare Chiropractor explaining disk herniation pain to a patient

All American Healthcare Chiropractor explaining lower back pain to a patient

Article by Dr. Anthony Komaroff in the Californian.

DEAR DOCTOR K: I have frequent back pain. I usually take acetaminophen (the Tylenol brand), but I hear it may not be effective for back pain. Is there anything to that?

DEAR READER: If you’d asked me that question even a year ago, I would have said, “Acetaminophen works fine for most people.” Lots of people are bothered by back pain. When it strikes, all you want is relief — and fast. Many folks turn to over-the-counter pain relievers like acetaminophen and non-steroidal anti-inflammatory drugs, or NSAIDs (ibuprofen, naproxen and aspirin).

Most doctors I know would have shared my impression that acetaminophen works for back pain. I respect the opinions of seasoned doctors, but I also know that there is no substitute for actually studying a question. Indeed, a recent study has challenged my long-standing assumption about the value of acetaminophen for back pain.

Researchers wanted to know if acetaminophen shortened the time from the start of acute back pain (back pain that comes on suddenly) to complete relief. What they found was surprising.

For people who used acetaminophen only when their back pain bothered them, it took about 17 days to get complete relief. For those who took the medication three times a day, it also took about 17 days for full relief. And for those who took a placebo — a sugar pill with no medicine at all — the time to recovery was 16 days. In other words, the medication made no difference in how fast back pain went away and stayed away. In addition, all three groups had similar experiences in terms of the severity of their pain, disability and function.

Does this mean that you shouldn’t bother to use acetaminophen for back pain? Not necessarily. Randomized studies like this can tell you the reaction of the average person in the study. But people are all different. It may be that some people really do get good relief from acetaminophen, even if the average person doesn’t. So if it works for you, stick with it.

But acetaminophen does have its own risks and side effects. Taking too much acetaminophen can seriously damage the liver. Ideally, the average healthy adult shouldn’t take more than 3,000 milligrams a day.

The safest option is to try to get through the worst of your back pain without medication:

• Use cold compresses or an ice pack, not heat, immediately after an injury. About 48 hours after back pain hits, heat may be more helpful. The warmth soothes and relaxes aching muscles.

• Try to keep moving. A limited amount of activity is better than lying in bed. Ask your doctor about appropriate exercises to start sooner rather than later. Exercise therapy can help heal acute back pain and help prevent a repeat episode.

• Chiropractic manipulation, acupuncture, massage or yoga provide relief for some people with acute back pain. Several studies support using these alternative/complementary therapies.

Many people can relieve their back pain with these simple measures. If they don’t provide complete relief, then non-prescription NSAID medicines often will do the trick.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.

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All American HealthcareAlternative Therapy Can Relieve Back Pain

Five Ways You Sabotage Your Energy

by All American Healthcare Comments Off on Five Ways You Sabotage Your Energy

Cat lying on its backArticle by Diana Vilibert on care2.com.

You don’t need us to tell you that living off Pop Tarts and three hours of sleep drains you of energy. But those aren’t the only factors that can lead to a big dip. If you’re about an hour away from crawling under your office desk to take a nap, keep reading for sneaky, subtle ways you’re sabotaging your energy.

1. Bad posture

Sit up straight! And not just because your mother told you too…according to the American Chiropractic Association, your body actually consumes more energy when you’re slouching. Make sure you’re taking breaks to stretch, recommends wellness expert Scott Donkin, DC, DACBOH. “When you stretch, you elongate and elasticize your ligaments and muscles and lubricate the joints. Your joints will glide more, which will require less consumption of energy in the muscle.”

2. Being thirsty

If you’re often only remembering to drink water once you feel thirsty, you’re dehydrated. “Our thirst sensation doesn’t really appear until we are 1 [percent] or 2 percent dehydrated. By then dehydration is already setting in and starting to impact how our mind and body perform,” scientist Lawrence E. Armstrong explains. Just a 1.5 percent drop in normal water volume in the body has adverse effects on your energy level (along with your mood and ability to think clearly), two University of Connecticut studies found. Women are particularly susceptible to those effects.

3. Your gadgets…even when theyre off

From street lamps to the light from your charging laptop to the glowing numbers on your alarm clock, even a small amount of artificial light—anything that keeps your bedroom from being completely dark while you sleep—can suppress the production of a sleep-inducing hormone called melatonin. Not only will you have a harder time falling asleep, it’ll be tougher to stay that way. Consider covering up bright lights from laptops and phones, and add blackout curtains in your bedroom if the light is coming from outside.

4. Feeling lonely

Loneliness and isolation can wreak havoc on the body, leading to higher blood pressure, a weakened immune system, and issues with learning and memory. And sleep is less physically and psychologically restorative, with more frequent wake-ups in the middle of the night, often leaving socially isolated people feeling drained in the morning.

5. Your allergies

Think your season allergies are too mild for treatment? They may be draining you of energy—nasal congestion causes mini wake-ups during the night that you may not even be aware are happening. Come morning, you feel like you haven’t slept a wink.

 

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All American HealthcareFive Ways You Sabotage Your Energy