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Are You Suffering from Back Pain?

The following link is a chiropractic public service announcement produced by the WestHartford Group, a chiropractic think tank dedicated to the advancement of the chiropractic profession.

Are You Suffering from Back Pain?


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Congressional Committee Calls Chiropractic

Members of the House Armed Services Committee have approved the inclusion of a strong, pro-chiropractic directive in their official committee report accompanying the FY 2013 National Defense Authorization Act. The committee language asserts that services provided by doctors of chiropractic (DCs) for our nation's men and women in uniform is of "high quality" and has become a "key" benefit within the military health care system. Read relevant pages from the committee report here.

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FoxNews.com Highlights the Benefits of Chiropractic Care

This week, ACA President Dr. Keith Overland was quoted in a story on FoxNews.com about the benefits of the services provided by doctors of chiropractic. The articles cites research from the Journal of Manipulative and Physiological Therapeutics that found that an integrated approach to health care--including chiropractic care--results in a 51.8 percent reduction in pharmaceutical costs and 43 percent fewer hospital admissions.

To view the full story click on the link below.

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Dr. Michael Simone Elected Chairman of the American Chiropractic Association

Arlington, Va.-- The American Chiropractic Association (ACA) today announced that Michael Simone, DC, CCSP, FICC, of Dacono, Colo. was elected Chairman of the Board of Governors (BOG). ACA is the world's largest professional association representing doctors of chiropractic.

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Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain A Randomized Trial

 

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From our ACA Delegates Drs. Herd and Wolfson: Good news on the national legislative front

On March 27, we received the following from Senator Schumer's legislative aide, "I apologize for the delay in response but its appropriation season so it has been hectic. I wanted you to know that we signed Senator Schumer as a cosponsor to S. 1147." On February 16th while in Washington, DC attending the ACA National Legislative Conference we visited Capitol Hill with Dr. Bazakos, Dr. Nicchi and NYCC students. We explained to Senator Schumer's legislative aide the importance of obtaining his co-sponsorship of S1147 (see below for issue). This is an exciting and positive step in gaining support for S1147.

Senator Schumer adding his name with his senior and respected status in the Senate, sends a clear message to fellow senators of the importance to support our veterans! Please feel free to send a quick thank you to his office for his co-sponsorship and the importance this bill has in helping one of our most important national treasures...our veterans!


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CCE Leadership Hosts Meeting with Stakeholders

Arlington, Va.-- On Friday, March 16, leaders of the Council on Chiropractic Education (CCE) met with representatives from the American Chiropractic Association (ACA) and 36 other stakeholder organizations-including FCLB, ICA, IFCO, MCQI, NBCE and the presidents of all U.S. chiropractic colleges-in an effort to improve communication and the transparency of its operations.

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Chiropractic Groups Unite to Make Greater Impact on Capitol Hill

ACA Hosts Annual Leadership Meeting in Conjunction with Legislative Conference



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Government Report Notes Benefits of Spinal Manipulation

The National Prevention Council (NPC), recently called for the development of a National Prevention Strategy to outline goals and recommendations for improving health and wellness for all Americans. The National Prevention Strategy highlights several preventative measures throughout the report including alternative therapies for back and neck pain.

According to the report, one key aspect of expanding preventive services is to “enhance coordination and integration of clinical, behavioral and complementary health strategies.” The report also specifically touts the benefits of spinal manipulation stating, “Complementary and alternative therapies for back and neck pain (e.g., acupuncture, massage, and spinal manipulation) can reduce pain and disability.”

 Read the full report
here
.



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Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence

Abstract

Objectives: To compare occurrence of repeated disability episodes across types of health care providers who treat claimants with new episodes of work-related low back pain (LBP).

Method: A total of 894 cases followed 1 year using workers’ compensation claims data. Provider types were defined for the initial episode of disability and subsequent episode of health maintenance care.

Results: Controlling for demographics and severity, the hazard ratio [HR] of disability recurrence for patients of physical therapists (HR = 2.0; 95% confidence interval [CI] = 1.0 to 3.9) or physicians (HR = 1.6; 95% CI = 0.9 to 6.2) was higher than that of chiropractor (referent, HR = 1.0), which was similar to that of the patients non-treated after return to work (HR = 1.2; 95% CI = 0.4 to 3.8).

Conclusions: In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than in chiropractic services or no treatment.


Journal of Occupational & Environmental Medicine:
April 2011 - Volume 53 - Issue 4 - p 396–404









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Senate Bill to Expand Veterans’ Access to Chiropractic Care Introduced

 

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Conservative Pain Management a First-Line Defense Against Prescription Drug Abuse Crisis

(Arlington, Va.) -- The American Chiropractic Association (ACA) applauds federal efforts to curb prescription drug abuse following the U.S. government’s announcement in late April that the problem has reached crisis level. ACA encourages patients and health care providers to explore drug-free, conservative approaches to pain management as a first-line defense against painkiller abuse.
 
The government’s report, “
Epidemic: Responding to America’s Prescription Drug Abuse Crisis,” notes that while the use of some illegal drugs has diminished, the abuse of prescription medications has sharply increased, particularly prescription opioid pain relievers such as Oxycontin and Vicodin. It points out unintentional opioid overdoses—once almost exclusively the fate of heroin abusers—are today increasingly caused by prescription painkiller abuse.
 
“This new report shows that while sometimes the use of these powerful drugs may be necessary, their overuse and abuse can lead to deadly consequences. The chiropractic profession offers non-drug interventions for pain relief,” said ACA President Dr. Rick McMichael. “We urge health care providers, whenever possible, to recommend drug-free conservative care interventions for their patients before prescribing medications that may be associated with harmful side effects. It’s critical that patients know their options.”
 
The government report outlines a four-part strategy to reduce the incidence of overdose caused by painkiller abuse, including increased education; monitoring of “doctor-shoppers” who obtain multiple prescriptions; the safe disposal of prescription medications; and cracking down on “pill mill” clinics that dispense hundreds of pills per patient. ACA believes prevention is also key and that increased use of conservative approaches for pain management may curb the need for painkillers and thereby reduce the likelihood of patient dependency, overuse and possible overdose.
 
Chiropractic care is best known for its effectiveness in treating painful conditions such as back pain, neck pain, and headaches—which are serious causes of disability in the United States. According to the U.S. Bone and Joint Decade, the number of prescription medications has increased in the past 10 years. Chiropractic care may lessen or eliminate the need for medications in some cases and help patients avoid unnecessary surgery. Chiropractic physicians treat the whole person, promote wellness and strive to address the underlying cause of patients’ ailments, not just their symptoms.
 
Current evidence-based guidelines support the use of conservative care such as chiropractic for conditions such as chronic lower back pain. In 2007, the Annals of Internal Medicine published low back pain guidelines developed by the American Pain Society and the American College of Physicians recommending that, for patients who do not improve with self-care, doctors should consider non-pharmacologic therapies such as chiropractic care, massage therapy and acupuncture.










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Creating European guidelines for Chiropractic Incident Reporting and Learning Systems (CIRLS): relevance and structure

Abstract (provisional)

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Ethics and Boundaries Examination Introduction and Retake Policy

 

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Record Breaking Attendance at ACC/RAC 2011 Conference

ACC/RAC combines the ACC’s annual business meeting and working group sessions along with the educational and research or RAC’s (Research Agenda Conference’s) focus on scientific knowledge - a powerful combination intended to cultivate an increasingly intimate relationship between chiropractic scholarship and education. Chiropractic research, fittingly held to serve as the backbone for chiropractic’s successful progression, is appropriately highlighted at the conference known to attract high caliber educators and scientists. The theme this year was “Integration: Chiropractic Education and Practice in Integrative Healthcare.”

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The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain

Abstract
 
Background context
Evidence-based clinical practice guidelines (CPGs) for the management of patients with acute mechanical low back pain (AM-LBP) have been defined on an international scale. Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments. To date, the value of implementing full and exclusively CPG-based treatment remains unclear.
 
Purpose
To determine if full CPGs-based study care (SC) results in greater improvement in functional outcomes than family physician–directed usual care (UC) in the treatment of AM-LBP.
 
Study design/setting
A two-arm, parallel design, prospective, randomized controlled clinical trial using blinded outcome assessment. Treatment was administered in a hospital-based spine program outpatient clinic.
 
Patient sample
Inclusion criteria included patients aged 19 to 59 years with Quebec Task Force Categories 1 and 2 AM-LBP of 2 to 4 weeks’ duration. Exclusion criteria included “red flag” conditions and comorbidities contraindicating chiropractic spinal manipulative therapy (CSMT).
 
Outcome measures
Primary outcome: improvement from baseline in Roland-Morris Disability Questionnaire (RDQ) scores at 16 weeks. Secondary outcomes: improvements in RDQ scores at 8 and 24 weeks; and in Short Form-36 (SF-36) bodily pain (BP) and physical functioning (PF) scale scores at 8, 16, and 24 weeks.
 
Methods
Patients were assessed by a spine physician, then randomized to SC (reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar CSMT, and return to work within 8 weeks), or family physician–directed UC, the components of which were recorded.
 
Results
Ninety-two patients were recruited, with 36 SC and 35 UC patients completing all follow-up visits. Baseline prognostic variables were evenly distributed between groups. The primary outcome, the unadjusted mean improvement in RDQ scores, was significantly greater in the SC group than in the UC group (p=.003). Regarding unadjusted mean changes in secondary outcomes, improvements in RDQ scores were also greater in the SC group at other time points, particularly at 24 weeks (p=.004). Similarly, improvements in SF-36 PF scores favored the SC group at all time points; however, these differences were not statistically significant. Improvements in SF-36 BP scores were similar between groups. In repeated-measures analyses, global adjusted mean improvement was significantly greater in the SC group in terms of RDQ (p=.0002), nearly significantly greater in terms of SF-36 PF (p=.08), but similar between groups in terms of SF-36 BP (p=.27).
 
Conclusions
This is the first reported randomized controlled trial comparing full CPG-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician–directed UC in the treatment of patients with AM-LBP. Compared to family physician–directed UC, full CPG-based treatment including CSMT is associated with significantly greater improvement in condition-specific functioning.
 
The Spine Journal (December 2010) Volume 10, Issue 12 Pages 1055-1064

























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Back Pain, Complementary and Alternative Medicine

Complementary and Alternative Medicine in Back Pain Utilization

Structured Abstract

Objectives:
This systematic review was undertaken to evaluate which complementary and alternative medicine (CAM) therapies are being used for persons with back pain in the United States.

Data Sources: MEDLINE®, EMBASE®, CINAHL® and Cochrane Central®
and a variety of CAM specific databases were searched from 1990 to November 2007. A grey literature search was also undertaken, particularly for clinical practice guidelines (CPG) related to CAM.

Review Methods: Standard systematic review methodology was employed. Eligibility criteria included English studies of adults with back pain, and a predefined list of CAM therapies.

Results: A total of 103 publications were evaluated; of these 29 did not present CAM therapy use stratified for back pain. There were a total of 65 utilization studies, 43 of which were American. Four publications evaluated the concurrent use of four or more CAM therapies and these suggest that chiropractic/manipulation is the most frequently used modality followed by massage and acupuncture. A limited number of publications evaluated utilization rates within multiple regions of the back and show that CAM was used least for treating the thoracic spine and most for the low back. However, rates of use of massage were similar for neck and lower back regions. Concurrent use of different CAM or conventional therapies was not well reported.

From 11 eligible CPG, only one (for electro-acupuncture) provided recommendations for frequency of use for low back pain of all acuity levels.

Eighteen cost publications were reviewed and all but one publication (cost-effectiveness) were cost identification studies. There is limited information on the impact of insurance coverage on costs and utilization specific to back pain.

Conclusions: There are few studies evaluating the relative utilization of various CAM therapies for back pain. For those studies evaluating utilization of individual CAM therapies, the specific characteristics of the therapy, the providers, and the clinical presentation of the back pain patients were not adequately detailed; nor was the overlap with other CAM or conventional treatments.

PDF File


















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Health Care Costs for Back Pain Much Higher when Care Initiated with an MD vs DC

A new study finds that low back pain care initiated with a doctor of chiropractic (DC) saves 40 percent on health care costs when compared with care initiated through a medical doctor (MD), the American Chiropractic Association (ACA) announced today. The study, featuring data from 85,000 Blue Cross Blue Shield beneficiaries, concludes that insurance companies that restrict access to chiropractic care for low back pain treatment may inadvertently pay more for care than they would if they removed such restrictions.

Low back pain is a significant public health problem. Up to 85 percent of Americans have back pain at some point in their lives. In addition to its negative effects on employee productivity, back pain treatment accounts for about $50 billion annually in health care costs—making it one of the top 10 most costly conditions treated in the United States.

The study, “Cost of Care for Common Back Pain Conditions Initiated With Chiropractic Doctor vs. Medical Doctor/Doctor of Osteopathy as First Physician: Experience of One Tennessee-Based General Health Insurer,” which is available online and will also be published in the December 2010 issue of the Journal of Manipulative and Physiological Therapeutics, looked at Blue Cross Blue Shield of Tennessee’s intermediate and large group fully insured population over a two-year span. The insured study population had open access to MDs and DCs through self-referral, and there were no limits applied to the number of MD/DC visits allowed and no differences in co-pays.

Results show that paid costs for episodes of care initiated by a DC were almost 40 percent less than care initiated through an MD. After risk-adjusting each patient’s costs, researchers still found significant savings in the chiropractic group. They estimated that allowing DC-initiated episodes of care would have led to an annual cost savings of $2.3 million for BCBS of Tennessee.

“As doctors of chiropractic, we know firsthand that our care often helps patients avoid or reduce more costly interventions such as drugs and surgery. This study supports what we see in our practices every day,” said ACA President Rick McMichael, DC. “It also demonstrates the value of chiropractic care at a critical time, when our nation is attempting to reform its health care system and contain runaway costs.”

The American Chiropractic Association, based in Arlington, Va., is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients.

ABSTRACT

Cost of care for common back pain conditions initiated with chiropractic doctor vs medical doctor/doctor of osteopathy as first physician: experience of one Tennessee-based general health insurer.

OBJECTIVE: The primary aim of this study was to determine if there are differences in the cost of low back pain care when a patient is able to choose a course of treatment with a medical doctor (MD) versus a doctor of chiropractic (DC), given that his/her insurance provides equal access to both provider types.

METHODS: A retrospective claims analysis was performed on Blue Cross Blue Shield of Tennessee's intermediate and large group fully insured population between October 1, 2004 and September 30, 2006. The insured study population had open access to MDs and DCs through self-referral without any limit to the number of visits or differences in co-pays to these 2 provider types. Our analysis was based on episodes of care for low back pain. An episode was defined as all reimbursed care delivered between the first and the last encounter with a health care provider for low back pain. A 60 day window without an encounter was treated as a new episode. We compared paid claims and risk adjusted costs between episodes of care initiated with an MD with those initiated with a DC.

RESULTS: Paid costs for episodes of care initiated with a DC were almost 40% less than episodes initiated with an MD. Even after risk adjusting each patient's costs, we found that episodes of care initiated with a DC were 20% less expensive than episodes initiated with an MD.

CONCLUSIONS: Beneficiaries in our sampling frame had lower overall episode costs for treatment of low back pain if they initiated care with a DC, when compared to those who initiated care with an MD.

Journal of Manipulative and Physiological Therapeutics (JMPT) 2010 Nov-Dec;33(9):640-3. Epub 2010 Oct 18.
























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Association for the History of Chiropractic to Meet in Rhode Island

The 31st Annual Meeting and Conference of the Association for the History of Chiropractic will be May 20-22, 2011, at the Crowne Plaza Hotel, 801 Greenwich Avenue, Warwick, Rhode Island. Hotel reservations can be made by calling 401-732-6000. Be sure to mention the Association to get the $135 conference rate.

Registration fee for the conference is $100, which includes the Lee-Homewood Recognition Luncheon. Registration forms are available on the AHC website [historyofchiropractic.org] and should be sent to the AHC, 4430 8th Street, Rock Island, IL, 61201.

Submissions for the Lee-Homewood Award are due by December 31, 2010 and should go to the above address. The Award is made annually to a person who has made a lifetime contribution of lasting significance toward the advancement of chiropractic in the scientific and academic communities, and the public acceptance of the profession.

The deadline for paper submission for presentation at the conference is January 15, 2011. Those also go the AHC office, address above.





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Chiropractic Associations Describe Chiropractic Care Using Conventional Terminology

(Arlington, Va.) -- The Council on Chiropractic Guidelines and Practice Parameters (CCGPP), with assistance from the American Chiropractic Association (ACA), has established terminology that describes chiropractic care using conventionally recognized terminology across the accepted continuum of care. The terminology was established by a formal consensus process conducted in early 2009.

The chiropractic profession is making great strides with integration among health care providers and insurers. Doctors of chiropractic now practice in many military and Department of Veterans Affairs (VA) sites, in hospital settings and in a variety of integrated practice models. As our nation’s health care landscape changes and the primary care shortage becomes more acute, the stage will be set for even more integration of doctors of chiropractic among other health care providers—traditional and alternative. Therefore, it is vital that the scope of appropriate chiropractic care be clearly defined relative to overall patient case management.

The terminology that was established by the CCGPP consensus process relates to levels of care across the spectrum from acute care, to chronic/recurrent care and on to wellness care. The process specifically defined the following:




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