Study Suggests Potential Parent–Child Link in Chronic Musculoskeletal Pain

new study on over 11,000 families from BMC Journal shows that children of parents with CMP chronic musculoskeletal pain ( includes back, joint, and muscle) are 20-40% more likely to have CMP. Does not show how much is genetic vs environmental. 

http://www.anesthesiologynews.com/ViewArticle.aspx?d_id=2&a_id=29036&d=Pain+Medicine&i_id=1131&i=December+2014

Joint Commission to add chiropractic treatment to its pain management standard

An independent, not-for-profit organization, The Joint Commission accredits and certifies more than 20,500 health care organizations and programs in the United States including many of the nation's 
hospitals. The Joint Commission has updated its pain management standard to include chiropractic services, acupuncture, massage therapy and other nonpharmacologic strategies. The standard will be effective Jan. 1, 2015.
Do you think this is a good change for our healthcare system?

http://www.jointcommission.org/assets/1/23/jconline_November_12_14.pdf

Pain in the Forecast

Why do I hurt more when the weather changes? That is a question and comment I hear frequently from patients. Here is an article from my newsletter written by a Milwaukee chiropractic physician that reviews the science on this topic. The bottom line is like many topics in medicine we do not know for sure but the general consensus is that the most likely cause is a drop in the barometric pressure.
Are any of you a human barometer?

http://www.toyourhealth.com/mpacms/tyh/article.php?id=1919

spinal manipulation more effective than usual medical care for low back pain

Just published in the prestigious Spine Journal is another comparison study showing spinal manipulation (the most commonly used therapy by chiropractic physicians) to be more effective than usual medical care (anti-inflammatories, advice to stay active and to avoid prolonged bed rest).
Did you know that low back disorders are the number one cause of disability in people under 55 years old?

http://www.ncbi.nlm.nih.gov/pubmed/25423308

A recent study by John Hopkins pain specialists found no difference in effectiveness of steroid injections and conservative treatments for pinched nerves in the neck and best improvements with a combination of both types of treatments. For the study, the researchers recruited 169 individuals all of who were diagnosed with neck pain from a herniated disc or narrowing of the spinal canal (stenosis) that inflamed or pinched nerves in their neck and caused pain that radiated to their arms.
Has anyone had experience with treatment for a pinched nerve in the neck?
Study Identifies Best Way to Treat Neck Pain Combination therapy appears most effective

Forward head tilting during texting puts enormous stress on cervical spine of neck

There is a newer phrase called text neck. A soon to be published study from Dr. Kenneth Hansraj, chief of spine surgery at New York Spine Surgery and Rehabilitation Medicine shows that it puts enormous pressure on the neck and upper back. 
His study found that bending your head at a 60 degree angle to get a better look at your selfie is putting 60 pounds' worth of pressure on your cervical spine. That's more than the weight of the average 7 year old!
http://www.cbsnews.com/news/omg-youre-texting-your-way-to-back-pain/

This is a very important concept for you to understand. We now know from MRI research studies that many asymptomatic (no pain) people have rotator cuff and other tendon and cartilage tears, and these increase with age. This is also true in other parts of the body. So the bottom line is that a tear visualized on an MRI may not be causing a patient's pain. This leads to much unnecessary surgery. I treat many patients who have had unsuccessful surgery. 
Remember what I heard a chiropractic doctor say " I can take an MRI of your phone and it would show me everything in the phone, but it would not tell me if your phone was ringing" 

http://bangordailynews.com/2014/11/06/health/blogs-and-columns/got-shoulder-pain-dont-assume-its-a-rotator-cuff-tear/

Tips to reduce pain with sitting

I frequently explain to patients that the body is made for movement...and excessive inactivity such as with sitting is detrimental to health. Here are some tips from Dr. Steve Conway, the spokesperson for the American Chiropractic Society.

http://www.huffingtonpost.com/2014/11/06/sitting-pain-infographic-work-injuries-desk_n_6003922.html

Back Surgery: Too Many, Too Costly and Too Ineffective

Most people experience back pain, and much more often than not, it's caused by something that doesn't require extreme intervention, like a tumor, fracture, infection, etc. When back pain strikes, chiropractic is a great first choice, but too many people end up taking medication – or even worse, they end up in a vicious cycle of medical care that eventually can lead to the operating room – for back pain that could have been managed conservatively in the overwhelming majority of cases. That's something to think about the next time your back hurts.

http://www.toyourhealth.com/mpacms/tyh/article.php?id=1447&pagenumber=3

"For the first time, a major medical organization takes a stand on rampant overuse of opioids for treating back pain, headaches and migraines
Powerful painkillers do little to improve patients’ daily functioning, finds the American Academy of Neurology in a new position statement on opioid (narcotic) painkillers for chronic pain not related to cancer."
Below is an article from Time magazine.
Why do you think more medical organizations have not come out against this gross over-prescribing?

http://time.com/3445728/painkillers-opioids-dangerous/

Beat the Blues With Exercise

As a life long athlete, I speak continually to my patients about the benefits of exercise. Recent research has shown even more benefits including a reduction in depression. In fact some researchers now claim that exercise is as good as drug therapy for mild and moderate depression (the majority of cases) without the harmful side effects of drugs. I have included a link to my health letter.
Has anyone had their mood helped with exercise?

http://www.toyourhealth.com/mpacms/tyh/article.php?id=2047

Treating lower-back pain How much bed rest is too much?

Below is an instructional piece about bed rest for back injuries produced jointly by the American Board of Internal Medicine, the North American Spine Society ( of whom I recently mentioned), and Consumer Reports Health. Current guidelines recommend only up to 2 days of bed rest for the most severe back disorders, except for unstable fractures.
Soft tissue heals better with movement, just the opposite of bone.
Were you aware of the current recommendations?

http://consumerhealthchoices.org/wp-content/uploads/2014/09/ChoosingWiselyBackPainBedRestNASS-ER.pdf

Tobacco Smoking is a risk factor for back disorder and back pain

My patients are usually surprised when I inform them that smoking is a risk factor for back disorders/pain. The main theory is that this is due to decreased blood flow to the spine and discs.
This is a 30 second video by the North American Spine Society. This is a multidisciplinary group of providers in which more than 50% of the practice is devoted to spinal care and includes MD's, osteopaths, chiropractors and physical therapists.
Did you know that smoking was a risk factor for back pain?
https://www.youtube.com/watch?v=Js2_fIVd2Rk

American Chiropractic Association - Acquiring Skills – Steven Santolin, DC

Here is an article in the latest edition of the American Chiropractic Association's monthly news publication that mentions my recent certification as a medical examiner for DOT examinations.

http://www.acatoday.org/content_css.cfm?CID=5562

High Cancer Risk from CT Scans

29,000 future deaths due to radiation exposure from CT scans performed in 2009! This study was published 5 years ago and the CT rates have continued to rise substantially in the following years. CT's scans give a massive dose of radiation and are many times overused or used when an MRI ( which does not produce any radiation) could be just as appropriate or more appropriate. 
I always order MRI before CT scan if possible as I believe in doing the least amount of harm as possible to patients.
Why do you think CT's scans are so commonly ordered?

High Cancer Risk from CT Scans

People with leg pain related to back problems had more short-term relief if they received chiropractic care along with exercise and advice, rather than exercise and advice alone, a new study from the Annals of Internal Medicine has found.
A researcher was quoted as saying “This of course, must be considered in light of alternatives for this condition, such as epidural steroid injections or surgery, which are not only much more costly but also associated with important (and serious) adverse events,”.

http://www.reuters.com/article/2014/09/15/us-sciatica-backache-chiropractors-idUSKBN0HA27Z20140915

With Elbows, Cortisone Shots May Hurt More Than Help

This study from JAMA is the most recent in a long list of studies showing that cortisone injection for elbow tendon problems such as tennis elbow do more harm than good in the long run. Although cortisone can be beneficial for acute new injuries it is not very effective for the more common chronic injuries like tendinitis ( now commonly called tendinosis or tendonopathy). We are getting away from the term tendonitis because research studies have shown these are not inflammatory conditions, but rather are degenerative conditions. Cortisone weakens tendons so it is probably not a good idea to inject it into a degenerated weakened tendon unless a person is severely disabled.

http://www.npr.org/blogs/health/2013/02/05/171169477/with-elbows-cortisone-shots-may-hurt-more-than-help

A Better Way to Approach Pain, and America's Pain-Pill Epidemic

As a nation we constitute only about 5% of the world's population, but we consume some 80% of the prescription drugs called opioids (another name for narcotics), the strongest and most addictive pain pills, that go by names like Vicodin, OxyContin, Dilaudid, codeine, and Percocet. We consume 99% of the global supply of a particular opioid called hydrocodone. Today opioids kill one American every 30 minutes. Those are quite some stats!
Here is a great article co-authored by Dr. Deepak Chopra that discusses some of the non-physical mechanisms involved with pain and suggesting that in many cases painkillers should come after a patient has explored the power of the mind-body connection.
Any comments on this information?
http://www.sfgate.com/opinion/chopra/article/A-Better-Way-to-Approach-Pain-and-America-s-5709973.php#page-1

One person dies every 19 minutes from a prescription drug overdose in the United States. I have recently posted several articles concerning the dangers of prescription narcotic drugs. Last Thursday the US Drug Enforcement Agency changed the classification of hydrocodone combination drugs ( such as Vicodin and Tylenol III) which are the most misused of the narcotic drugs from schedule III to schedule II. This puts more restrictions on the prescriptions. This ruling goes into effect in 45 days.
Do you think this was a good idea?
http://www.cnn.com/2014/08/22/health/hydrocodone-dea-rules/

Millions with disabilities get heavy-duty painkillers in potentially fatal doses

I recently posted an article by Consumer Reports stating that 17,000 American now die every year from prescription narcotic drugs. Here is an article discussing a new study from Dartmouth School of Medicine revealing that roughly 4 million Americans too disabled to work are prescribed heavy-duty painkillers, such as OxyContin, Vicodin, codeine and morphine. The study also found that one in five of those prescriptions are for doses so high that they put patients at risk for serious side effects and even overdose.
Plus, it’s not even clear that the drugs help!
Does anyone have any thought on this new study?
http://www.freep.com/article/20140816/FEATURES08/308160061/disabled-painkillers-dangers-overdoses

Do Cortisone Shots Actually Make Things Worse?

Here is a good review of the research on cortisone steroid injections by a rehab center blog. The current research is showing that although cortisone can be effective for arthritis in older patients, it is much less effective for other conditions such as tendinitis, and although it can give good short term relief in many cases it can lead to a worse long term outcome. We are also learning more about the damaging effects.
The article also reviews a 2010 Lancet study showing that for tennis elbow (which is a tendinitis/tendonosis), cortisone injections gave better relief at 6 weeks than manual therapy but cortisone lead to a 63% increase in relapses over one year.
Anyone had any experienced any negative effects from a steroid injection?
Do Cortisone Shots Actually Make Things Worse?

Physical therapy including manual therapy and manipulation as effective as steroid injection for shoulder pain

Study from this month's Annals of Internal Medicine found physical therapy (which included manual therapy and manipulation) to give the same improvement over one year as steroid injections. But the group that received injections used more health care services and had significantly more shoulder-related doctor visits during the year of the study.
Has anybody had experience with these two treatment approaches and which one seemed more effective?
http://consumer.healthday.com/bone-and-joint-information-4/bone-joint-and-tendon-news-72/skip-the-steroids-for-shoulder-pain-690444.html

The dangers of painkillers

New article from Consumer Reports about the dangers of prescription opioid (narcotic) drugs and acetaminophen (Tylenol).
These narcotics drugs now kill over 17,000 americans per year or 46 people per day! Acetaminophen is now the leading cause of acute liver failure and a common reason for ER visits! A not so well known fact is that although narcotic drugs can work well for acute post surgical pain and other types of acute pain and cancer pain, the research shows that they are not that effective for chronic pain.
So why are these narcotics so commonly prescribed for chronic pain when the side effects are so dangerous?
http://www.consumerreports.org/cro/magazine/2014/09/the-dangers-of-painkillers/index.htm

Acetaminophen use in pregnancy may be linked to ADHD

I had very recently posted information on the best study to date showing acetaminophen to be no better than placebo for acute back pain. This study from JAMA found a significant association between acetaminophen use during pregnancy and attention deficit hyperactivity disorder (ADHD) in children. Jeff Chapa, director of maternal fetal medicine at Cleveland Clinic was quoted as saying "We really should start looking at non-pharmacological ways to deal with pain,"
I and most DC's treat many women during pregnancy. I have several OB's that refer pregnant woman to my office.
Does that surprise anyone?
http://www.usatoday.com/story/news/nation/2014/02/24/acetaminophen-pregnancy-adhd/5782763/

Acetaminophen No Better Than Placebo for Back Pain

Hard to believe that this is the first ever randomized placebo controlled trial of acetaminophen (Tylenol) for acute low back pain. Unfortunately many common procedures in medicine and especially spine care have not been subjected to rigorous research. So you may want to save your liver and not take this drug the next time you have a back injury
Does this finding surprise anyone?
http://well.blogs.nytimes.com/2014/07/23/acetaminophen-no-better-than-placebo-for-back-pain/?_php=true&_type=blogs&_r=0

Research Based Guidelines for the Management of Low Back Disorders

This white board presentation by Dr. Mike Evans, Associate Professor of Family Medicine and Public Health at the University of Toronto does a great job in distilling the current evidence based research on the management of low back disorders...in only about 9 minutes!
The authors of my previous post on cost effectiveness for treatment on work injuries concluded that the cost savings of chiropractic treatment were probably due to the fact that doctors of chiropractic follow the research based guidelines better than other professions.
Why do you think other professions do not do a better job in following the guidelines?
https://www.youtube.com/watch?v=BOjTegn9RuY&feature=youtu.be

In have attended many health fairs and would speak with many people who believed this myth, and others who even said they heard that people could get addicted to chiropractic care! I have received regular ongoing dental treatment since I was a kid and plan on continuing with this into the forseeable future, but I don't go around saying once you go to a dentist you have to keep coming back.
Anybody have any idea where this myth originated?

Tips on Osteoporosis from the American Chiropractic Society

After the previous post on the 91 year old female marathon runner, this is a post about a condition that is very common to that age group and to woman...osteoporosis. I have posted the results of newer outcome studies that show that the bone density drugs do not reduce the outcome of future fracture risk in people with the more common osteopenia (the less severe stage of loss of bone density).
Here is information from the American Chiropractic Society concerning the risk factors, prevention, and management of osteoporosis.
Did you know that weight bearing exercise like walking is a very good way to build bone mass and prevent bone loss?

http://gethealthyblog.org/osteoporosis/

A retrospective analysis of vertebral body fractures following epidural steroid injections.

Cannot seem to get off the topic of epidural steroid injections. Just ran across this study from last year's Journal of Bone and Joint Surgery. It showed that each epidural steroid injection increased the risk of vertebral bone fracture by 21%! This is much higher than previously thought.
Did you know that steroids including cortisone and predisone cause bone loss and decreased bone density?

http://www.ncbi.nlm.nih.gov/pubmed/23780532

Epidural Corticosteroids for Sciatica: More Trouble Than They're Worth

Staying with the topic of epidural steroid injections ( which again are not approved by the FDA), this is an article by a chiropractic radiologist.These injections give modest improvement for sciatica which is temporary and no improvement for back pain alone ( but are often given for this reason) and can have serious side effects. In spite of this, costs for this procedure have risen 629% in the last ten years!
Do you think epidurals or chiropractic care have better average insurance reimbursement?

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56985

Spinal manipulation more clinically effective and cost effective than lumbar epidural injection for MRI confirmed disc herniation

Staying with the comparative research line, this study from last year compared manipulation to lumbar epidural injection (again this procedure is not approved by the FDA) for MRI confirmed disc herniations. The manipulation group reported 77% improvement and the epidural injection group only 63% improvement. Also the manipulation group was an average of $200 less expensive.
Any surprises here?

http://www.ncbi.nlm.nih.gov/pubmed/23706678

Chiropractic maintenance treatment

I used to attend many health fairs and had many people tell me they heard that once you started chiropractic care you had to go the rest of your life, and even a few who thought you could get "addicted" to chiropractic treatment  
The reality is that just like dental care, there is a percentage of patients who choose to continue periodic care to either control the symptoms of a chronic condition or prevent future problems.
Here is a recent study showing that patients who continued periodic treatment for 9 months after active treatment actually gained additional improvement over that time.
Has anyone heard you had to go the rest of your life or you can get addicted to chiropractic?

http://www.ncbi.nlm.nih.gov/pubmed/21245790

Tapping into controversial back surgeries

This is a very good report from CBS News based on 6 months of research concerning a controversial type of spine surgery called spinal fusion. The website has both a video and text of the story. Although this procedure has good evidence of benefit for a few conditions such as instability and sciatica from stenosis or narrowing of the spine, most of the time it is done for conditions with much less evidence of efficacy such as disc degeneration. I have patients who have had fusions and it is usually more difficult to get them relief, especially when multiple segments were fused.
Has anyone had experience with this procedure?

http://www.cbsnews.com/news/tapping-into-controversial-back-surgeries/

Epidural Corticosteroid Injection: FDA Drug Safety Communication - Risk of Rare But Serious Neurologic Problems

Epidural injections are a very common medical procedure in which cortisone type substances are injected into the spinal canal. Did you know that this practice is not approved by the FDA? There is also no evidence that they produce long term improvement.Here is a recent FDA Safety Alert from FDA website.

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm394530.htm

Surge in Narcotic Prescriptions for Pregnant Women

Wow, I just posted a new study showing that 46% of adolescents were prescribed narcotic drugs for headaches and now a new study shows that 26% of pregnant women on Medicaid were prescribed narcotic drugs during pregnancy. Again the lead author of this study was surprised by the findings. Unfortunately neither this article or the journal article mentioned chiropractic treatment as a much safer alternative.

http://www.nytimes.com/2014/04/15/science/surge-in-prescriptions-for-opioid-painkillers-for-pregnant-women.html

Narcotics for Teen Headaches: Medical Care May be the Wrong Choice

Here is a blog article by a chiropractic colleague based on a study from the Journal of Adolescent Health.
Researchers looked at the insurance data from 8,373 13- to 17-year-olds who visited a medical clinician for headache (which is a common ailment in adolescents) and found a shocking amount of narcotics prescribed.
• 46% of teens were given a prescription for a narcotic.
• 23% got two prescriptions.
• 29% got three or more prescriptions.
So why and how does this happen? How can half of mainstream medicine be so distanced from the medical research as to give a child highly addictive pain medication for a condition that it should not be used for?

http://lifecarechiropractic.com/blog/headache-in-teenagers/?doing_wp_cron=1396531253.5940539836883544921875

I treat many pregnant woman and have many referred to me by their obstetricians. Tylenol (acetaminophen) is the most commonly used drug by pregnant woman. There have recently been studies showing that it is not as safe during pregnancy as previously thought. A new study from the UCLA School of Public Health and published in JAMA Pediatrics showed its use is associated with higher rates of ADHD.

http://newsroom.ucla.edu/portal/ucla/use-of-acetaminophen-during-pregnancy-250121.aspx

A study from the American Journal of Medicine shows that people with more muscle mass are less likely to die prematurely.This is a finding shown in other studies.
The BMI (body mass index) includes muscle and fat which can be misleading. Many NFL football players who have high muscle mass and low body fat of 3-5% would be considered obese if using the BMI!
Has anyone had their body fat percentage calculated?

http://www.stonehearthnewsletters.com/older-adults-build-muscle-and-youll-live-longer-ucla-research/elder-care/

Health myth: Is cracking your knuckles really bad for you?

Here is an article from Fox News with information from a hand surgeon debunking a very common medical myth. The article does not mention that there have been several other more rigorous research studies showing no harm from this habit, including the most recent study using x-rays showing that knuckle cracking results in slightly less arthritis.
Does this surprise anyone?

http://www.foxnews.com/health/2014/03/13/health-myth-is-cracking-your-knuckles-really-bad-for/?intcmp=features

Article in the Wall Street Journal that discusses possible reasons why woman have significantly higher incidence of chronic pain.
To what would you attribute the higher incidence?

Why Women Are Living in the Discomfort Zone

The musculoskeletal effects of cigarette smoking.

It usually surprises patients when I inform them that cigarette smoking is more of a risk factor than weight for back disorders. The main theory is that it diminishes blood flow to the spinal tissues.
Here is a study from the Journal of Bone and Joint Surgery concluding that it also increases the risk of sustaining a fracture or tendon injury, and it increases the risk of post surgical complications such as delayed fracture healing, infections, and soft tissue and would healing.

http://www.ncbi.nlm.nih.gov/pubmed/23636193

Association does not equal causation

Here is a response I wrote to an article reprinted in the Arlington Heights newspaper. 
"This is a reprint of an article from the Washington Post that I had previously read. As in all of medicine, it is very difficult to study rare events such as vertebral artery dissections. Several of the early studies on this topic were just surveys of neurologists. The 2008 Cassidy study of millions of medical records in Ontario, Canada showed that the incidence of this event is the same after chiropractic treatment as after treatment by a family physician ( about 5 times more likely), lending much credence to the theory that these dissections had already occurred and were causing symptoms such as neck pain and/ or headache which then brought the patient to the practitioner. This injury has also been associated with 40 everyday activities such as hair washing with neck extended such as in hair parlors, surgical intubation, and star gazing, and can occur insidiously (for no apparent reason)."

https://www.dailyherald.com/article/20140120/entlife/701209979/