Monday, October 15, 2012
Tuesday, September 18, 2012
Chiropractic Care Benefits Veterans with Low Back Pain
Among veterans, musculoskeletal pain is one of the most common complaints, particularly low back pain (LBP). The number of veterans reporting to the Veteran’s Health Administration (VHA) with low back pain rose an average of 4.8 percent per year between 2000 and 2007, exceeding the rise in rates of diabetes, high blood pressure and depression.
A survey of 15,000 veterans from the Persian Gulf War found that 45 percent reported experiencing back pain. Chiropractic services have been added to the care options for veterans, and most chiropractors providing services to veterans within the VHA reported that LBP was the primary complaint.
A study to determine the effectiveness of chiropractic care in treating veterans with LBP was performed on 171 patients who met the inclusion criteria. The average veteran was male, obese and suffering from chronic LBP (for over 6 months, on average). Most participants also presented with other physical and psychological issues.
Post-Traumatic Stress Disorder (PTSD) is common in the veteran population and has been shown to contribute to chronic pain.
Veterans in the study received treatment from a chiropractor in the western New York area after being referred by their primary care physician. The number of treatments given to each case during the course of the study ranged from 2 to 26, with 8.7 being the mean number of treatments per person. Treatments were performed twice a week on average, and the patient was assessed after every four treatments.
Chiropractors used a range of treatment modalities on the subjects, including standard adjustments, spinal mobilization and flexion distraction. Patients were also instructed on how to perform therapeutic exercises and do stretches that were tailored to their specific condition.
Pain severity was measured by the Numeric Rating Scale (NRS), which is a verbal rating by the patient on the severity of pain using a scale ranging from 0 to 10 at the time treatment is undertaken.
The Back Bournemouth Questionnaire (BBQ) is a biopsychosocial measurement of low back pain symptoms consisting of 7 questions that measure pain, disability, and the affective and cognitive-behavioral aspects of musculoskeletal problems. Scores on the BBQ range from 0 to 70, with higher numbers indicating a higher severity of symptoms.
After only two chiropractic treatments, 60 percent of veterans showed a significant improvement of 37.4 points on the NRS and 34.6 points on the BBQ measurements.
he researchers concluded that, “Despite high levels of service-connected disability and comorbidity, veterans' chiropractic clinical outcomes in terms of mean percentage improvement from baseline to discharge for both NRS and BBQ were statistically significant and clinically meaningful.
This study adds to the understanding of chiropractic clinical outcomes for veterans with LBP and contributes to a foundation for further research.”
Tuesday, September 11, 2012
Vitamin D status predicts new brain lesion activity in MS
06 September 2012
Researchers at University of California, San Francisco set out to determine if there is a link between vitamin D status and developing new lesions in patients with relapsing multiple sclerosis (MS).
The researchers used data from a 5 year longitudinal study of MS patients. The participants have clinical evaluations, a brain MRI, as well as blood work annually.
The measured 25(OH)D levels were assessed for an association with T2 lesions on brain MRI, clinical relapses, and disability. T2 images from an MRI show both old and new inflammation on the brain since onset of MS.
The authors collected a total of 2,362 brain MRI scans from 469 patients. The researchers found that with each 10 ng/ml increase in 25(OH)D level, the risk of new T2 lesions in the brain decreased by 15%. Also, the 10 ng/ml increase was associated with a 32% lower risk of gadolinium-enhancing lesions, representing “active” lesions. They also found that higher vitamin D levels were associated with lower relapse risk, although this finding was not statistically significant (p=.037).
The authors encourage future randomized trials looking into the relationship between vitamin D and brain lesions in MS.
Mowry EM, et al. Vitamin D status predicts new brain magnetic resonance imaging activity in multiple sclerosis. Ann Neurol. 2012.
Page last edited: 07 September 2012
RCT: Vitamin D supplementation in patients with MS
Posted on September 8, 2012 by John Cannell, MD
Dr. Soilu-Hänninen and colleagues from the University of Turku in Finland recently conducted a double blind, placebo-controlled trial of vitamin D in 66 MS patients, to see if it helped as an add-on therapy with interferon.
Soilu-Hänninen M, Aivo J, Lindström BM, Elovaara I, Sumelahti ML, Färkkilä M, Tienari P, Atula S, Sarasoja T, Herrala L, Keskinarkaus I, Kruger J, Kallio T, Rocca MA, Filippi M. A randomised, double blind, placebo controlled trial with vitamin D3 as an add on treatment to interferon β-1b in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2012 83(5):565-71.
They found that 20,000 IU of vitamin D3 once a week resulted in significantly fewer lesions on brain MRI and strong trends toward lower lesion burden, reduced disability scales, and improved ability to walk, compared to controls. 25(OH)D levels only went from 22 ng/ml to 44 ng/ml in one year.
The authors note that other studies have found that in children with possible MS, each 4 ng/ml decrease in 25(OH)D has been correlated with a conversion to definite MS. Lower serum 25(OH)D values have been associated with a higher rate of MS relapses. Researchers have correlated each 4 ng/ml increase in 25(OH)D with up to 12% reduction in relapse rate in adults with MS, and each 10 ng/ml increase in 25(OH)D with a 34% decrease in relapse rate in childhood MS.
Remember, observational studies (unlike the RCT above) are likely studying the effect of sunshine, not supplements, and the 25(OH)D levels are more likely to be a reflection of how much sun exposure a subject gets than whether they are taking a supplement or not.
In spite of the above findings in a randomized controlled trial, I would never recommend only oral vitamin D for people with MS. They may well benefit from sunshine or low-pressure sun tanning beds as well.
Until it is clear oral vitamin D can fully replace sunshine, make sure all MS patients take at least 5,000 IU of vitamin D per day and sun bathe daily at midday. In the winter, use low-pressure sunbeds, the ones that replicate high intensity sunlight, on a regular basis.