Category Archives: Chiropractic Care

Chiropractic care is a science, art, and philosophy that concerns itself with the relationship between the nervous system and the health of the body.

Spinal Cord Manipulation Reduces Opioid Use

Elizabeth Hofheinz, M.P.H., M.Ed. • Fri, March 10th, 2017

 

New research from Thomas Jefferson University in Philadelphia is giving new hope to those suffering with chronic pain. The research, sponsored by Abbott Laboratories, involved the examination of opioid usage in more than 5,400 patients both prior to and after receiving a spinal cord stimulation (SCS) system implant. According to the January 20, 2017 news release, the researchers found that “opioid use declined or stabilized in 70% of patients who received an SCS system.”

 

“As our society has been seeking ways to stem opioid abuse and [in] addition, our company offers treatment options that can reduce their exposure to opioid medication,” said Allen Burton, M.D., medical director of neuromodulation at Abbott. “Data like these are critical to helping us demonstrate that spinal cord stimulation can reduce exposure to opioids while giving patients comprehensive pain relief.”

 

Morphine equivalent dose (MED) in patients with effective SCS (blue) and those who had their SCS explanted (gray) before and after SCS implant (dashed line). Left: solid lines are median and shaded areas are interquartile ranges. Right: solid lines are mean and shaded areas are SE./Courtesy of Congress of Neurological Surgeons

 

Ashwini Sharan, M.D. is director of Functional and Epilepsy Surgery at Vickie and Jack Farber Institute for Neuroscience at Jefferson. He told OTW, “I have always felt that spinal cord stimulation works very effectively in managing patients’ pain but did not know if the therapy helped reduce medication use, as well. We had to complete a population-based study using thousands of patients to find out what is happening with their medication management. We wanted to see if there was a secondary benefit and how it can be measured objectively.”

 

Asked why this hasn’t been demonstrated previously, Dr. Sharan noted, “The problem is in the process; unless doctors go out and collect data then there will be no compiled evidence. The doctor has to have a passionate about it in order to make the study happen. Also, companies don’t do post-marketing studies. It’s just not the culture. It comes down to time and resources.”

 

“If they see that patients are taking more and more pain killers then they have to identify that something is wrong. There should be a correlation between the patients’ pain and anxiety levels. An increase in the use of narcotics often just means that patients are developing a tolerance. Narcotic use is almost never a solution to chronic pain.”

 

“The study needs to be replicated. We need to be able to provide tools to physicians to help identify when patients are developing this narcotic tolerance and identify earlier when patients are candidates for these types of therapies. Right now these tools don’t exist.”

WHERE DOES THAT BACK PAIN REALLY COME FROM?

Elizabeth Hofheinz, M.P.H., M.Ed. • Thu, February 16th, 2017

Ah, the pain that travels…so fun. There are loads of patients who live with low back pain that radiates to the buttock, groin, thigh, and even knees. But where does the pain start? A new article published in the February Journal of the American Academy of Orthopaedic Surgeons (JAAOS) describes the identical symptoms associated with hip and spine pain and discusses the diagnostic steps and tests required to treat them appropriately. The article is entitled, “Differentiating Hip Pathology From Lumbar Spine Pathology: Key Points of Evaluation and Management.”

“In these instances, similar or overlapping symptoms may delay a correct diagnosis and appropriate treatment,” said article author Afshin Razi, M.D., an orthopedic surgeon and clinical assistant professor at New York University Langone Hospital for Joint Diseases, in the February 6, 2017 news release.

“Plain and advanced imaging studies and diagnostic injections also can be used to further delineate the primary problem and guide the appropriate sequence of treatment,” said Dr. Razi.

“Focusing on both the spine and the hip as potential causes of pain and disability may reduce the likelihood of misdiagnosis, and the management of conditions affecting the spine and/or hip may help reduce the likelihood of persistent symptoms,” said Dr. Razi.

Dr. Razi told OTW, “As an orthopaedic surgeon specializing in spine surgery I encounter many patients who present with concomitant back and hip pain. Many of these patients are also referred to me by surgeons who solely take care of hip problems such as total hip replacement or sport medicine specialist who treat younger patients with hip pain. It can be very difficult to properly diagnose the main issue and as such some patients go on to have unnecessary treatments, including surgery, because of their persistent symptoms.”

“It was our goal to try to educate physicians, including orthopaedic surgeons, on the common differential diagnoses, appropriate clinical history and physical examination, diagnostic tools and their evaluations appropriately, as well as treatment options and priorities of which one to be treated first. More recently, it has been noted that some patients who have undergone total hip replacement with significant curvature of the spine had postoperative dislocation of the hip after reconstruction of the spinal malalignment. This article also talks about this newly seen problem.”

“We did an extensive literature search and through our two previous seminars on this topic we were able to gather information to aid our colleagues on best ways of differentiating causes of hip and back pain.”

“There is a major need for obtaining a thorough clinical history, performing a complete physical examination, and ordering with analyzing appropriate diagnostic tests followed by diagnostic and therapeutic injections can differentiate between hip problems versus back related pathologies. There also should be patient education with regard to complex hip-spine problems to make sure they’re aware that despite addressing one problem the other problem may also need to be addressed at some point.”

Tension headaches and sciatic pain – by Dr. David Greif

Imagine you have a muscle tension headache, or sciatic pain going down your leg. Is the headache or the sciatic pain the problem or the symptom? I run into people every day that would identify these things as the problem, yet when you look closer they’re the symptoms.

 

Muscle tension headaches are caused by the spine moving improperly in the upper neck, causing the nerves in the area to become irritated and cause the symptom of the headache. Taking a pain reliever, like Tylenol, is the equivalent to ignoring the problem. Even though it alleviates the pain the problem persists in the long run.

 

The same concept applies to sciatic nerve pain. A lot of healthcare practitioners like to state sciatica as if it’s the diagnosis when in fact it’s the sciatic pain in the symptom. A lot of times they ignore probable causes of the sciatic pain and just label the pain as sciatica. What’s causing the inflammation to the sciatic nerve? Wouldn’t treating the cause rather than the symptom make more sense?

 

If you answer “yes”, then your thought process is moving into the realm of chiropractic medicine. Chiropractors work on removing nervous interference by stimulating better ergonomics within the skeletal system and restoring better movement to areas of the spine that are moving improperly.

 

Going back to the Tylenol example for muscle tension headaches and sciatic pain, you should remember that pain is your body’s way of telling you something is not right within your body. By restoring normal movement to the spine, you can lessen the pain by removing the nervous interference. The choice is yours; you can choose to mask the pain with drugs or you can choose to correct the problem.

Hashimoto’s Disease of the Thyroid

Hashimoto’s thyroiditis is an autoimmune disease of the thyroid gland. Left unattended the thyroid gland can gradually be destroyed.[i] Over time, symptoms may develop that include an enlargement of the thyroid gland called a goiter, which is usually painless. As an engine drives a car, the thyroid drives the body.

 

What is Hashimoto’s Disease?

 

The disease was first noted in 1912 by Dr. Hakaru Hashimoto. In 1957 it was recognized as an autoimmune disorder. Hashimoto’s thyroiditis is thought to be due to a combination of genetic and environmental factors, especially if there is family history of the disease or any other autoimmune conditions. The disease is believed to be the most common cause of primary hypothyroidism in North America. Diagnosis is confirmed by blood tests for (TSH) thyroid-stimulating hormone, T4 Thyroxine test and anti-thyroid antibodies.

 

Hashimoto’s thyroiditis affects about 5% of the population at some point in their life. It usually develops between the ages of 30 and 50 and generally affects more women than men; approximately 8 to 15 times more often in women. The disease may affect young women, while in men it may not occur until middle age.[ii]

 

It occurs more frequently in regions of high iodine dietary intake and among people who are genetically susceptible.[iii]

 

Signs and Symptoms:

 

There are many symptoms for the onset of Hashimoto’s and it is often misdiagnosed as depression, PMS, chronic fatigue syndrome and fibromyalgia. The most common symptoms are fatigue, weight gain, pale or puffy face, feeling cold, joint and muscle pain, constipation and depression.

 

If a goiter swelling is present, but not painful, no action may be recommended by the doctor, while others may try to reduce the size of the goiter. Those affected should avoid consuming large amounts of iodine. If TSH levels are elevated they can lead to an enlargement of the thyroid gland as the body attempts to trap more iodine and produce thyroid hormones.

 

Thyroid Gland Function:

 

The thyroid gland consists of two lobes on either side of the trachea in the neck sitting under the thyroid cartilage. This cartilage gives us the ‘Adam’s apple’ prominence. The gland produces hormones from iodine picked up from the blood circulating through the gland, which are necessary to maintain a normal level of metabolism in all body cells. Metabolism is the chemical process in our bodies resulting in the production of energy and growth. Thyroid hormone helps cells in their uptake of oxygen to support the metabolic rate in the body. Another hormone produced by the thyroid gland is secreted when calcium levels in the blood are high. It stimulates calcium to leave the blood and enter the bones.

 

Risks of Iodine Deficiency:

 

Pregnant mothers may be at risk for iodine deficiency as the growing fetus places additional pressure on the thyroid and can lead the thyroid either to have decreased function or to fail. Without sufficient iodine in the mother’s system there can be multiple adverse effects on the growth and development of the fetus, such as low birth weight, neonatal respiratory distress, fetal abnormalities, miscarriage or pre-term delivery.[iv] These risks are for women whose low thyroid function has not been stabilized by medication. Those people who have a family history of thyroid dysfunction may also be at risk, especially young women who may become pregnant.

 

As well, anyone who may already have an autoimmune disease are further at risk if the disease is untreated. Autoimmune diseases most commonly associated to Hashimoto’s thyroiditis include celiac disease, type 1 diabetes, vitiligo (loss of skin pigment) and alopecia (hair loss).[v]

Treatment:

 

Hypothyroidism caused by Hashimoto’s thyroiditis is treated with thyroid hormone replacement in tablet form, usually taken once a day. The tablets will likely be required for the rest of the person’s life and blood tests required on a regular basis to monitor the thyroid-stimulating hormone levels.

 

 

All the body’s organs are connected to our brain, nervous system and our spine; therefore, it is most important to make sure that your spine is always kept in alignment for all parts of your body to function properly. Regular visits to your chiropractor will take care of adjusting any subluxations that may interfere with your health.

[i] “Hashimoto’s Disease”. NIDDK. May 2014. Retrieved 9 August 2016.

[ii] “Hashimoto’s disease fact sheet”. Office on Women’s Health, U.S. Department of Health and Human Services, womenshealth.gov (or girlshealth.gov). 16 July 2012. Retrieved 23 November 2014.

[iii] Fabrizio Monaco (2012). Thyroid Diseases. Taylor and Francis. p.78. ISBN 9781439868393.

[iv] Budenhofer, Brigitte K.; Ditsch, Nina; Jeschke, Udo; Gärtner, Roland; Toth, Bettina (2012-10-27). “Thyroid (dys-)function in normal and disturbed pregnancy”.

[v] Akamizu, T; Amino, N; DeGroot, LJ; De Groot, LJ; Beck-Peccoz, P; Chrousos, G; Dungan, K; Grossman, A; Hershman, JM; Koch, C; McLachlan, R; New, M; Rebar, R; Singer, F; Vinik, A; Weickert, MO (2000). “Hashimoto’s Thyroiditis”. PMID 25905412.