Lower back pain (LBP) is a common and costly musculoskeletal problem, affecting about 80% of all persons at some time in their lives. Many people with this condition seek the care of a chiropractor who may utilize a range of interventions such as spinal manipulation, massage, electrotherapy, mechanical devices, exercise, orthotics, and others. A recent large study found that chiropractic was effective in treating both acute and chronic LBP; however, there were considerable limitations of this study that question its external validity.
For this prospective cohort study adult patients with LBP who had not received chiropractic or manual therapy in the prior 3 months were recruited from multiple chiropractic practices in Switzerland [Peterson et al. 2012]. Patients were excluded if they had specific lumbar spine pathologies that are relative contraindications to chiropractic manipulative therapy, including tumors, infection, inflammatory spondyloarthropathies, fractures, severe osteoporosis, and Paget’s disease (bone deformities).
The purpose of the study was to evaluate outcomes in routine practice, so the 44 chiropractors volunteering to participate were allowed to administer their typical treatment methods (such as spinal manipulation, soft tissue mobilization, or others). Patients completed a numerical pain rating scale (NRS) and the Oswestry disability questionnaire at baseline immediately before treatment, and at 1 week, 1 month, and 3 months after the start of treatment. Subjects also self-reported perceived improvement on a Patient Global Impression of Change (PGIC) scale.
Part 1: Clinical Complexities and Medical Mandates 
The onerous specter of addiction resulting from the long-term administration of opioid analgesics in patients with chronic pain has often been raised in reports from various sources and in sensational news stories. In actuality, “addiction” is probably one of the most overused and misunderstood terms in medicine, and the absolute risks of addiction newly emerging during analgesic therapy are still uncertain. Now, a recent article suggests that addiction might be better understood in patients receiving opioid therapy as a complex persistent opioid dependence; however, this may be an oversimplification.
About 4 in 10 adults with type 2 diabetes report acute and chronic pain, and close to one quarter report neuropathy, fatigue, depression, and sleep disturbance, according to a study of more than 13,000 adults conducted by researchers in California. Patients in the study reported significant pain and non-pain symptoms across the entire course of the disease, among all age groups, with prevalence increasing as people neared the end of their lives.
By Guest Author Jeffrey Fudin, BS, PharmD, DAAPM, FCCP
The U.S. CDC (Centers for Disease Control and Prevention) has issued a strong recommendation that, even without known risk factors, all Americans born between 1945 and 1965 should have a one-time screening for the hepatitis C virus (HCV). This could be of special importance for persons in that age range, currently 47 to 67 years, with chronic pain conditions who may have received transfusions, injections, acupuncture, or other invasive medical procedures in the past, but were never specifically tested for HCV.
For persons suffering numerous headaches each month, researchers found that drinking an additional 6 glasses of water each day could ease the pain and improve quality of life. However, while news media thought this was a terrific idea, there were some limitations of this research that might temper enthusiasm for the approach.
Anyone who watched even snippets of the recent Olympic Games on TV probably noticed the intriguing, brightly-colored strips of tape adorning shoulders, arms, legs, abs, or other anatomy of many athletes. Apparently, the stretchy cotton bands called Kinesio® Tape are liberally applied when and wherever performance-robbing musculoskeletal pain strikes. But, is this product a clever marketing ploy, a sporty fashion statement, a colorful placebo, or the real deal? And, is this something that non-athletes with pain should look into?
People who have a tendency to form kidney stones, or are concerned about developing the painful disorder, should skip that extra glass of iced tea this summer. According to John Milner, MD, a urologist at Loyola University Medical Center, Maywood, IL, iced tea contains high concentrations of oxalate, one of the key chemicals that lead to the formation of kidney stones — a fairly common disorder that affects about 1 in every 10 persons in the United States.
As discussed in recent Pain-Topics UPDATES [
A recent Citizen Petition to the United States Food and Drug Administration (FDA) by Physicians for Responsible Opioid Prescribing, or PROP, requests labeling changes for all opioid analgesics when it comes to their prescription for noncancer pain. The changes would limit the dose, impose time limits, and restrict opioid use for only severe pain.
By guest author Lynn Webster, MD, at the LifeSource Blog 
Featured Items: delayed-release prednisone (Rayos) approved for rheumatoid arthritis and 5 additional indications; generic pregabalin approved; FDA REMS approval for long-acting and extended-release opioids; makers of unapproved oxycodone products warned to stop; defective Hospira injectable vials recalled. — All brand names are trademarks of their respective manufacturers. Compiled by Winnie Dawson, MA, RN, BSN.
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