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While much is known regarding the pathophysiology surrounding concussion injuries in the acute phase, there is little evidence to support many of the theorized etiologies to post-concussion syndrome (PCS); the chronic phase of concussion... more
While much is known regarding the pathophysiology surrounding concussion injuries in the acute phase, there is little evidence to support many of the theorized etiologies to post-concussion syndrome (PCS); the chronic phase of concussion occurring in ∼10-15% of concussed patients. This paper reviews the existing literature surrounding the numerous proposed theories of PCS and introduces another potential, and very treatable, cause of this chronic condition; cervical spine dysfunction due to concomitant whiplash-type injury. We also discuss a short case-series of five patients with diagnosed PCS having very favorable outcomes following various treatment and rehabilitative techniques aimed at restoring cervical spine function.
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While much is known regarding the pathophysiology surrounding concussion injuries in the acute phase, there is little evidence to support many of the theorized etiologies to post-concussion syndrome (PCS); the chronic phase of concussion... more
While much is known regarding the pathophysiology surrounding concussion injuries in the acute phase, there is little evidence to support many of the theorized etiologies to post-concussion syndrome (PCS); the chronic phase of concussion occurring in ∼10-15% of concussed patients. This paper reviews the existing literature surrounding the numerous proposed theories of PCS and introduces another potential, and very treatable, cause of this chronic condition; cervical spine dysfunction due to concomitant whiplash-type injury. We also discuss a short case-series of five patients with diagnosed PCS having very favorable outcomes following various treatment and rehabilitative techniques aimed at restoring cervical spine function.
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Objective. To develop a novel animal model of persisting lumbar facet joint pain. Methods. Sprague Dawley rats were anaesthetized and the right lumbar (L5/L6) facet joint was exposed and compressed to ~1 mm with modified clamps applied... more
Objective. To develop a novel animal model of persisting lumbar facet joint pain. Methods. Sprague Dawley rats were anaesthetized and the right lumbar (L5/L6) facet joint was exposed and compressed to ~1 mm with modified clamps applied for three minutes; sham-operated and naïve animals were used as control groups. After five days, animals were tested for hind-paw sensitivity using von Frey filaments and axial deep tissue sensitivity by algometer on assigned days up to 28 days. Animals were sacrificed at selected times for histological and biochemical analysis. Results. Histological sections revealed site-specific loss of cartilage in model animals only. Tactile hypersensitivity was observed for the ipsi- and contralateral paws lasting 28 days. The threshold at which deep tissue pressure just elicited vocalization was obtained at three lumbar levels; sensitivity at L1 > L3/4 > L6. Biochemical analyses revealed increases in proinflammatory cytokines, especially TNF-α, IL-1α, and...
Research Interests: Pain and Pain Treatment
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To develop and validate NeckPix(©), a multi-image instrument for assessing daily activities in the context of pain-related fear, in order to allow its use in patients with chronic neck pain (NP). The measure was developed by means of item... more
To develop and validate NeckPix(©), a multi-image instrument for assessing daily activities in the context of pain-related fear, in order to allow its use in patients with chronic neck pain (NP). The measure was developed by means of item generation followed by reduction/selection. The psychometric testing included exploratory factor analysis; content validity by investigating clarity, specificity, appropriateness for the target population, relevance and completeness; reliability by internal consistency (Cronbach's alpha) and test-retest stability (intra-class coefficient correlation, ICC); and construct validity by comparing NeckPix with the Tampa Scale of Kinesiophobia (TSK), the Pain Catastrophising Scale (PCS), the Neck Disability Index (NDI) and a Numerical Rating Scale of pain intensity (NRS) (Pearson's correlation). The measure, which includes ten images used to assess everyday activities in the context of pain-related fear, was administered to 118 subjects with chronic non-specific NP, and proved to be acceptable and feasible. Factor analysis revealed a one-factor solution (which explained 71.12 % of variance). The content of the images was considered adequate, appropriate for the target population, comprehensive, and relevant for evaluating activity-related kinesiophobia. The instrument's internal consistency was good (α = 0.954), as was its test-retest stability (ICC 0.979). Construct validity demonstrated a close correlation with the TSK (r = 0.759), and moderate correlations with the PCS (r = 0.583), the NDI (r = 0.520), and a NRS (r = 0.455). NeckPix(©), which was successfully developed following international recommendations, proved to have a good factorial structure and satisfactory psychometric properties. Its use is recommended for research purposes.
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To evaluate the responsiveness and minimal important changes (MICs) for the Italian Neck Disability Index (NDI) and Neck Pain Disability Scale (NPDS) as well as which questionnaire was the most responsive in subjects with chronic neck... more
To evaluate the responsiveness and minimal important changes (MICs) for the Italian Neck Disability Index (NDI) and Neck Pain Disability Scale (NPDS) as well as which questionnaire was the most responsive in subjects with chronic neck pain (NP). At the beginning and end of an 8-week rehabilitation programme, 200 patients completed the NDI and NPDS. After the programme, the global perceived effect (GPE) was also evaluated and collapsed to produce a dichotomous outcome (improved vs. stable). Responsiveness was calculated by distribution [effect size (ES); standardised response mean (SRM)] and anchor-based methods (ROC curves; correlations between change scores of NPDS and NDI, and GPE). ROC curves were also used to compute the best cutoff levels between improved and stable subjects (MICs). The ES was 0.66 and 0.73, and the SRM was 1.09-1.26 for the NDI and NPDS, respectively. The ROC analyses revealed AUCs of 0.96 and 0.91 for the NDI and NPDS, respectively; the MICs were 7-percentage points for the NDI (sensitivity: 98 %; specificity: 81 %) and 10 for NPDS (93; 83 %), showing equivalent responsiveness properties. Baseline NPDS scores did not affect MIC estimate for the NPDS, while, for the NDI, higher MICs were found for patients with worst disability levels. Correlations between change scores of the NDI and NPDS and GPE were, respectively, high (0.71) and moderate (0.59). The Italian NDI and NPDS were equally sensitive in detecting clinical changes in subjects with chronic NP undergoing rehabilitation. We recommend taking the MICs into account when assessing patient improvement or planning studies in this clinical context.
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A cross-sectional study to develop a cultural adaptation of the Marathi-neck disability index (NDI) and to investigate its validity and reliability. To conduct a study concerning the cultural adaptation of the NDI and investigate the... more
A cross-sectional study to develop a cultural adaptation of the Marathi-neck disability index (NDI) and to investigate its validity and reliability. To conduct a study concerning the cultural adaptation of the NDI and investigate the validity and reliability of its Marathi version in patients with neck pain. The NDI is a reliable instrument for evaluating self-rated disability due to neck pain, but there is no published Marathi version and also it has not been tested on a rural population yet. Successful linguistic and cultural translation may allow appropriate cross-cultural comparison for clinical and laboratory research analysis, even in the rural parts of the Maharashtra state of India, where English is not the language of communication. Eighty-one patients having neck pain for at least 3 months were included in the study. The NDI and visual analogue scale for pain were completed by all subjects. Test-retest reliability was determined by using intraclass correlation coefficient and Pearson correlation analysis. For the determination of construct validity, the relation between the NDI and visual analogue scale was examined by Pearson correlation analysis. Intraclass correlation coefficient score for test-retest reliability was 0.95 and the Cronbach α was 0.97. For construct-related validity the correlation of the NDI-Marathi version was found to be 0.95 (P < 0.0001). These results showed that the construct validity of the Marathi version of the NDI was excellent. The results suggest that the Marathi version of the NDI that is validated in this study is an easy to comprehend, reliable, and valid instrument for the measurement for the limitation of activities of daily living and pain caused by neck disorders in the Marathi-speaking population.
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Translation and psychometric testing. To translate and culturally adapt the Neck Disability Index (NDI) and to assess the reliability and validity of the Japanese version of the NDI (NDI-J) in Japanese outpatients with neck pain. To date,... more
Translation and psychometric testing. To translate and culturally adapt the Neck Disability Index (NDI) and to assess the reliability and validity of the Japanese version of the NDI (NDI-J) in Japanese outpatients with neck pain. To date, no previous report exists on the translation process and psychometric testing of the NDI-J. The NDI was translated and culturally adapted into Japanese in accordance with published guidelines. A total of 110 outpatients with neck pain participated in the study. Psychometric testing included reliability by internal consistency (Cronbach α) and test-retest reliability (intraclass correlation coefficient), factor analysis, convergent validity by comparing the NDI-J with the short-form health survey (Pearson correlation) and responsiveness (unpaired t tests, standard error of measurement, and minimal detectable change). The Cronbach α of the NDI-J was 0.88 and the intraclass correlation coefficient for test-retest reliability was 0.91 (95% confidence interval, 0.82-0.95). Factor analysis demonstrated a 2-factor structure, explaining 61.8% of the total variance. The correlation between the NDI-J and the short-form health survey, version 36, subscales ranged from good to fair (-0.25 to -0.51). The analysis of responsiveness was calculated with an unpaired t test after 3 weeks of treatment demonstrating a statistically significant difference between the stable and improved patients (P ≤ 0.05). The standard error of measurement and minimal detectable change were calculated as 2.9 and 6.8, respectively. The NDI-J is a valid, reliable, and responsive tool that can be used to assess neck pain in Japanese outpatients.
Research Interests: Biomedical Engineering, Psychometrics, Spine, Japan, Translations, and 16 moreCross-Cultural Comparison, Humans, Female, Male, Neck Pain, Young Adult, Clinical Sciences, Aged, Middle Aged, Questionnaires, Adult, Reproducibility of Results, Health surveys, Asian Continental Ancestry Group, Pilot Projects, and Pain Measurement
Evaluation of the psychometric properties of a translated and culturally adapted questionnaire. Translating, culturally adapting, and validating the Italian version of the Neck Disability Index (NDI-I) to allow its use with... more
Evaluation of the psychometric properties of a translated and culturally adapted questionnaire. Translating, culturally adapting, and validating the Italian version of the Neck Disability Index (NDI-I) to allow its use with Italian-speaking patients with neck pain (NP). More attention is being given to standardized outcome measures to improve interventions for NP. A translated form of the NDI has never been validated in Italian patients with NP. The NDI-I was developed by forward-backward translation, a final review by an expert committee, and a test of the prefinal version to establish its correspondence with the original English version. The psychometric testing included factor analysis, reliability by internal consistency (Cronbach α) and test-retest reliability (intraclass coefficient correlation), construct validity by comparing NDI-I with the Neck Pain and Disability Scale, a numerical rating scale, the Hospital Anxiety and Depression Scale, and the 36-Item Short Form Health Survey (Spearman correlation), and sensitivity to change by calculating the smallest detectable change. The questionnaire was administered to 101 subjects with chronic NP and proved to be acceptable. Factor analysis revealed a 2-factor 10-item solution (explained variance: 56%). The questionnaire showed good internal consistency (α = 0.842) and test-retest reliability (intraclass coefficient correlation = 0.846). Construct validity showed a good correlation with Neck Pain and Disability Scale (ρ = 0.687), moderate correlations with the numerical rating scale (ρ = 0.545), and Hospital Anxiety and Depression Scale (ρ = 0.422 for the Anxiety score and ρ = 0.546 for the Depression score), and poor correlations with the 36-Item Short Form Health Survey subscales (ρ = 0.066 to -0.286). The psychometric analyses of the subscales and total scale were similar. The smallest detectable change of the NDI-I was 3. The NDI was successfully translated into Italian and proved to have a good factorial structure and psychometric properties that replicated the results of other versions. Its use is recommended for research purposes.
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Research Interests: Questionnaire and Index
Modify the Tampa Scale for Kinesiophobia (TSK) for 'fear of passive motion' beliefs. With permission, a 14-item modification, the TSK-PM (passive movement), was created. Test-retest reliability was tested first. Construct validity... more
Modify the Tampa Scale for Kinesiophobia (TSK) for 'fear of passive motion' beliefs. With permission, a 14-item modification, the TSK-PM (passive movement), was created. Test-retest reliability was tested first. Construct validity was tested in chronic whiplash patients by comparing the TSK-PM with the TSK, the Neck Disability Index (NDI) and cervical ranges of motion. The TSK-PM showed high test-retest reliability (r = 0.83) and high correlation with the original TSK (r = 0.84). Low, non-significant correlations were found with other variables. NDI scores were strongly correlated with ranges of motion. While having high test-retest reliability and a single factor structure, the TSK-PM failed to demonstrate distinctive construct validity vs the original TSK. The original TSK is likely to be sufficient to assess fear of being moved in neck pain patients in a clinical setting. Modifications to the current version of the TSK-PM might improve its construct validity in future stu...
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The mechanisms subserving deep spinal pain have not been studied as well as those related to the skin and to deep pain in peripheral limb structures. The clinical phenomenology of deep spinal pain presents unique features which call for... more
The mechanisms subserving deep spinal pain have not been studied as well as those related to the skin and to deep pain in peripheral limb structures. The clinical phenomenology of deep spinal pain presents unique features which call for investigations which can explain these at a mechanistic level. Targeted searches of the literature were conducted and the relevant materials reviewed for applicability to the thesis that deep spinal pain is distinctive from deep pain in the peripheral limb structures. Topics related to the neuroanatomy and neurophysiology of deep spinal pain were organized in a hierarchical format for content review. Since the 1980's the innervation characteristics of the spinal joints and deep muscles have been elucidated. Afferent connections subserving pain have been identified in a distinctive somatotopic organization within the spinal cord whereby afferents from deep spinal tissues terminate primarily in the lateral dorsal horn while those from deep peripher...
Cervical radiculopathy (CR), while less common than conditions with neck pain alone, can be a significant cause of neck pain and disability; thus the determination of adequate treatment options for patients is essential. Currently,... more
Cervical radiculopathy (CR), while less common than conditions with neck pain alone, can be a significant cause of neck pain and disability; thus the determination of adequate treatment options for patients is essential. Currently, inadequate scientific literature restricts specific conservative management recommendations for CR. Despite a paucity of evidence for high-velocity low-amplitude (HVLA) spinal manipulation in the treatment for CR, this strategy has been frequently labeled as contraindicated. Scientific support for appropriate outcome measures for CR is equally deficient. While more scientific data is needed to draw firm conclusions, the present review suggests that spinal manipulation may be cautiously considered as a therapeutic option for patients suffering from CR. With respect to outcome measures, the Neck Disability Index appears well-suited for spinal manipulative treatment of CR.
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... Vernon H, Guerriero R, Kavanaugh S, Soave D, Moreton J. Psychological factors in the use of the neck disability index in chronic whiplash patients. ... Nordin M, Carragee EJ, Hogg-Johnson S, Weiner SS, Hurwitz EL, Peloso PM, Guzman J,... more
... Vernon H, Guerriero R, Kavanaugh S, Soave D, Moreton J. Psychological factors in the use of the neck disability index in chronic whiplash patients. ... Nordin M, Carragee EJ, Hogg-Johnson S, Weiner SS, Hurwitz EL, Peloso PM, Guzman J, van der Velde G, Carroll LJ, Holm LW ...
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To carry out a systematic review of the literature examining the effectiveness of spinal manipulation for the treatment of headache disorders, computerized literature searches were carried out in Medline, Embase, Amed and CISCOM. Studies... more
To carry out a systematic review of the literature examining the effectiveness of spinal manipulation for the treatment of headache disorders, computerized literature searches were carried out in Medline, Embase, Amed and CISCOM. Studies were included only if they were randomized trials of (any type of) spinal manipulation for (any type of) headache in human patients in which spinal manipulation was compared either to no treatment, usual medical care, a 'sham' intervention, or to some other active treatment. Two investigators independently extracted data on study design, sample size and characteristics, type of intervention, type of control/comparison, direction and nature of the outcome(s). Methodological quality of the trials was also assessed using the Jadad scale. Eight trials were identified that met our inclusion criteria. Three examined tension-type headaches, three migraine, one 'cervicogenic' headache, and one 'spondylogenic' chronic headache. In two studies, patients receiving spinal manipulation showed comparable improvements in migraine and tension headaches compared to drug treatment. In the 4 studies employing some 'sham' interventions (e.g. laser light therapy), results were less conclusive with 2 studies showing a benefit for manipulation and 2 studies failing to find such an effect. Considerable methodological limitations were observed in most trials, the principal one being inadequate control for nonspecific (placebo) effects. Despite claims that spinal manipulation is an effective treatment for headache, the data available to date do not support such definitive conclusions. It is unclear to what extent the observed treatment effects can be explained by manipulation or by nonspecific factors (e.g. of personal attention, patient expectation). Whether manipulation produces any long-term changes in these conditions is also uncertain. Future studies should address these two crucial questions and overcome the methodological limitations of previous trials.
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The purpose of this study was to develop a novel instrument for assessing headache-related disability focusing solely on important activities of daily living. Part 1: A literature search was conducted in PubMed and Google Scholar,... more
The purpose of this study was to develop a novel instrument for assessing headache-related disability focusing solely on important activities of daily living. Part 1: A literature search was conducted in PubMed and Google Scholar, supplemented by hand searches in bibliographies to retrieve the original article for any instrument for the assessment of headache-related disability. Each instrument was evaluated for item categories, specific item content, measurement scale format for each item, and instructions to users. Together, these features constituted the construct validity of these instruments. Qualitative evaluations of these results were summarized with respect to the adequacy of each component. Psychometric features such as reliability and validity were not assessed. Part 2: An existing instrument for assessing self-rated disability, the Neck Disability Index, was modified for content and format and subjected to 2 rounds of clinician and patient review. Item contents and formats received final consensus, resulting in a 9-item instrument: the Headache Activities of Daily Living Index (HADLI). This instrument was tested in a sample of headache patients. Cronbach α and individual item correlations were obtained. Principal Components Analysis was performed. Part 1: The search identified 6 reports on 5 preexisting instruments for self-rating of headache-related disability. Problems in content were found in all instruments, especially relating to the lack of items for specific activities of daily living. Problems were noted in most of the instruments for scaling and instructions with respect to the effect of headache on activities of daily living. Part 2: The authors first identified suitable items from an existing instrument for self-rating of disability. These were supplemented by items drawn from the literature. A panel of 3 clinicians and 2 laypersons evaluated these items. Two more focus groups of 7 headache sufferers each reviewed the new instrument. After this, a 9-item instrument for assessing activities of daily living in headache sufferers, the HADLI, was finalized. After this, 53 participants were recruited to study the face validity of the instrument. The sample consisted of 41 women and 12 men with a mean age of 37.3 (12) years; mean duration of headaches was 7.4 (8.3) years; mean frequency of headaches per week was 3.4 (2.4); and the intensity was 6 (2.4). The mean HADLI score was 26.2 (13.4), or 52%. There were no floor or ceiling effects for total score. The total Index Cronbach α was 0.96. The Principal Components Analysis identified one component which accounted for 75% of the variance. The HADLI was created using theory and empirical-based methods. Face validity was assessed by focus group input and by first-level psychometrics. The HADLI has good face validity and is suitable for further reliability and validity testing.
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... 95-104. Single or multiple copies of this article are available from The Haworth Document Delivery Service [1-800-342-9678, 9:00 am - 5:00 pm [EST]. ... I need help every day in most aspects of self care. Q 1 do not get dressed, I... more
... 95-104. Single or multiple copies of this article are available from The Haworth Document Delivery Service [1-800-342-9678, 9:00 am - 5:00 pm [EST]. ... I need help every day in most aspects of self care. Q 1 do not get dressed, I wash with difficulty and stay in bed. Page 8. ...
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Complex regional pain syndromes (CRPS) represent curious and difficult syndromes for both patient and clinician. CRPS presents as a triad of signs and symptoms, usually after a seemingly trivial injury to a peripheral joint or appendage.... more
Complex regional pain syndromes (CRPS) represent curious and difficult syndromes for both patient and clinician. CRPS presents as a triad of signs and symptoms, usually after a seemingly trivial injury to a peripheral joint or appendage. The clinical triad includes severe pain, vasomotor changes in and around the affected area, and trophic changes in the affected limb. Many of the acute symptoms are similar to those seen after many acute injuries, which makes an early diagnosis often times difficult. Current treatment protocols revolve around aggressive physical therapy plus pharmacologic interventions aimed at limiting sympathetic nervous system activity. To review the literature on CRPS regarding symptoms, diagnosis, treatment, and causal mechanisms and to discuss alternative treatment approaches and the possible role of chiropractic care in patient rehabilitation. Texts, review articles, and randomized clinical trials investigating treatments, causes, and epidemiology. Recent research calls into question the predominant theories that view excessive sympathetic nervous system activity as the cause of CRPS. No evidence of an increase in sympathetic nervous system activity has been found, and new theories suggest that an increase in the sensitivity of neurotransmitter receptors may be the cause of CRPS. Alternatively, other research has suggested that a local inflammatory process may in fact cause CRPS. Although no research has been completed examining the role of chiropractic care in the treatment of CRPS, there is reason to believe that spinal manipulation may be beneficial to patients with CRPS.
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The purpose of this study was to develop and determine the face validity of additional cervical nonorganic simulation tests. Four simulation tests were either selected from the literature or newly designed: simulated sitting... more
The purpose of this study was to develop and determine the face validity of additional cervical nonorganic simulation tests. Four simulation tests were either selected from the literature or newly designed: simulated sitting trunk/shoulder rotation (SR; test no. 1), active vs passive cervical rotation (CR; test no. 2), Libman's test (LT; test no. 3) of pressure over the mastoid process, and side-lying passive shoulder abduction (SA; test no. 4). Three groups, 1 without neck pain (n = 44) and 2 with neck pain (n = 43 and 27), were formed. Outcome measures consisted of questions on provocation of pain (Yes/No) and appropriateness (Yes/No) as well as measurements of cervical rotation (goniometric) and pressure pain threshold (pressure algometer). Group test responses were evaluated and scored. A threshold of acceptance was established at 80% agreement for face validity. Ranges of rotation and pressure threshold values were analyzed with the Student t test. In nonneck pain subjects, all 4 tests were rated as nonpainful and 3 were rated as "appropriate" for neck pain examination (not SR). In neck pain subjects, this test and SA were rated as nonpainful, whereas LT was rated as painful in 26% of subjects. Only CR and LT were rated as "appropriate." In neck pain subjects, passive rotations exceeded actives by 10% to 14% (P = .000). On a second round of testing with a slightly modified method, SR and SA achieved acceptable "appropriateness." Once 2 tests were slightly modified, all 4 tests were found to have acceptable face validity. Further research into the reliability of these tests as well as into the combinations of these tests is warranted.
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Research Interests: Complementary and Alternative Medicine, Health Care, Chronic Pain, Clinical Trial, Treatment Outcome, and 13 moreLow back pain, Humans, Female, Male, Neck Pain, Psychometric Properties, Clinical Sciences, Rating Scale, Validity and Reliability, Specific Activity, Indexation, Instrument Design, and Outcome Assessment
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Fibromyalgia syndrome (FMS) is one of the most commonly diagnosed nonarticular soft tissue conditions in all fields of musculoskeletal medicine, including chiropractic. The purpose of this study was to perform a comprehensive review of... more
Fibromyalgia syndrome (FMS) is one of the most commonly diagnosed nonarticular soft tissue conditions in all fields of musculoskeletal medicine, including chiropractic. The purpose of this study was to perform a comprehensive review of the literature for the most commonly used treatment procedures in chiropractic for FMS and to provide evidence ratings for these procedures. The emphasis of this literature review was on conservative and nonpharmaceutical therapies. The Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) was charged with developing literature syntheses, organized by anatomical region, to evaluate and report on the evidence base for chiropractic care. This article is the outcome of this charge. As part of the CCGPP process, preliminary drafts of these articles were posted on the CCGPP Web site www.ccgpp.org (2006-8) to allow for an open process and the broadest possible mechanism for stakeholder input. Online comprehensive literature searches were performed of the following databases: Cochrane Database of Systematic Reviews; National Guidelines Clearinghouse; Cochrane Central Register of Controlled Trials; Manual, Alternative, and Natural Therapy Index System; Index to Chiropractic Literature, Cumulative Index to Nursing and Allied Health Literature; Allied and Complementary Medicine; and PubMed up to June 2006. Our search yielded the following results: 8 systematic reviews, 3 meta-analyses, 5 published guidelines, and 1 consensus document. Our direct search of the databases for additional randomized trials did not find any chiropractic randomized clinical trials that were not already included in one or more of the systematic reviews/guidelines. The review of the Manual, Alternative, and Natural Therapy Index System and Index to Chiropractic Literature databases yielded an additional 38 articles regarding various nonpharmacologic therapies such as chiropractic, acupuncture, nutritional/herbal supplements, massage, etc. Review of these articles resulted in the following recommendations regarding nonpharmaceutical treatments of FMS. Strong evidence supports aerobic exercise and cognitive behavioral therapy. Moderate evidence supports massage, muscle strength training, acupuncture, and spa therapy (balneotherapy). Limited evidence supports spinal manipulation, movement/body awareness, vitamins, herbs, and dietary modification. Several nonpharmacologic treatments and manual-type therapies have acceptable evidentiary support in the treatment of FMS.
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The number of studies that have investigated the direct analgesic effect of a spinal manipulation on spinal or referred pain is small, making knowledge of this crucial aspect of manipulation sparse. This paper reviews a set of studies... more
The number of studies that have investigated the direct analgesic effect of a spinal manipulation on spinal or referred pain is small, making knowledge of this crucial aspect of manipulation sparse. This paper reviews a set of studies that measure the immediate effect of manipulation on pain or pain-related phenomena in the spinal and peripheral soft tissues. The literature was accessed through MEDLINE. Key words used were "manipulation," "pain," and "chiropractic." This search was complemented by citation reviews of important research and chapters on the topic. Only studies that directly measured the effect of at least a single spinal manipulation on pain (eg, tenderness, biochemical assay, referred pain) were selected. The selected studies were reviewed descriptively; no systematic assessment of their quality was conducted. The electronic search yielded 738 citations. Six hundred and forty-two were relevant to chiropractic. Of these, most were clinically descriptive articles about diagnostic and therapeutic procedures or case management. Most of the remaining articles were clinical trial reports or letters to the editor. Only 5 studies were selected according to the established criteria. Thus less than 1% of the indexed literature on chiropractic, manipulation, and pain involved studies that explored the mechanism of the putative effect of spinal manipulation on pain mechanisms. Six other studies were retrieved from citation reviews. These 11 studies were reviewed in order publication. Few studies have investigated the effects of spinal manipulation on pain directly. If the theory of manipulation exerting its therapeutic effects posits that the sensory input created by the intervention results in some form of inhibition of pain, then the results of these studies are largely consistent with one another and with this theory. This review has highlighted the deficiencies in the extant studies and many remaining questions. Only more high-quality research will permit a full elucidation of the hypoalgesic effects of spinal manipulation.
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This article presents a personal view of the historical evolution of theories of subluxation in the chiropractic profession. TWO MAJOR THEMES EMERGE FROM THIS REVIEW: those related to the mechanical behavior of the spine and those related... more
This article presents a personal view of the historical evolution of theories of subluxation in the chiropractic profession. TWO MAJOR THEMES EMERGE FROM THIS REVIEW: those related to the mechanical behavior of the spine and those related to the neurologic implications of these mechanical issues. Chiropractic subluxation theory is one of the few health-related theories whereby these mechanical and neurologic theories have been unified into a comprehensive theory of disorder of spinal function. For this disorder, doctors of chiropractic have used the term subluxation. These theories, and their unification in the "subluxation concept," have undergone evolution in the profession's history. The "subluxation concept" currently faces challenges, which are briefly reviewed in this article. The only way forward is to strengthen our efforts to investigate the "subluxation concept" with high-quality scientific studies including animal models and human clinical studies.
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Research Interests: Primary Care, Primary Health Care, Translations, Greece, Cross-Cultural Comparison, and 20 moreFactor analysis, Humans, Female, Construct Validity, Male, Neck Pain, Missing Data, Data Quality, Exploratory Factor Analysis, Eigenvalues, Clinical Sciences, Aged, Middle Aged, Intraclass Correlation Coefficient, Questionnaires, Adult, Reproducibility of Results, Correlation coefficient, Pain Measurement, and Activity of Daily Living
Chronic neck pain is highly prevalent in Western societies, with about 15% of females and 10% of males suffering with it at any time. The course of untreated chronic neck pain patients in clinical trials has not been well-defined and the... more
Chronic neck pain is highly prevalent in Western societies, with about 15% of females and 10% of males suffering with it at any time. The course of untreated chronic neck pain patients in clinical trials has not been well-defined and the placebo effect has not been clarified. A systematic review of RCT's of conservative treatments for chronic mechanical neck pain was conducted. Studies were excluded if they did not include a control group, if they involved subjects with whiplash injuries, a predominance of headache or arm pain associated with chronic neck pain and if only one treatment was reported. Only studies scoring 3-5 out of 5 on the Jadad Scale for quality were included in the final analysis. Data on change in pain scores of subjects in both placebo (PL) as well as no-treatment (NT) control groups were analyzed. Mean changes in pain scores as well as effect sizes were calculated, summarized and compared between these groups. Twenty (20) studies, 5 in the NT group and 15 i...
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Cross-sectional clinical study. Determine if psychological factors "fear avoidance behavior" and... more
Cross-sectional clinical study. Determine if psychological factors "fear avoidance behavior" and "pain amplification," along with age, gender, duration, and pain severity correlate with scores of self-rated disability in chronic whiplash sufferers. The Fear Avoidance Model has gained acceptance in the understanding of whiplash-associate disorders (WAD). While the variables important in this model have been studied in acute/subacute samples and some small chronic samples, no study has explicitly investigated the role these and other psychosocial variables play in the self-ratings of neck-related disability in chronic WAD sufferers. Chronic WAD sufferers (>3 months) were recruited from private practice. No WAD IV subjects were included. Subjects completed a Neck Disability Index (NDI), Tampa Scale for Kinesiophobia (TSK), pain visual analogue scale, and pain diagram. Clinical and demographic data were also obtained. Univariate correlations were obtained with the Spearman rank correlation coefficient. Items achieving statistical significance on univariate analysis were loaded in a step-wise linear regression analysis. One hundred seven subjects were investigated (54 females), with a mean age of 45.4 (17) years and a mean duration of 13.4 (14.6) months. Fair to moderately strong correlations were obtained between the NDI and the TSK, pain visual analogue scale and pain drawing scores, but not with "duration." The Pain Diagram correlated with NDI scores and pain severity. A multivariate model accounting for 31% of the variance of the NDI scores (P < 0.001) was obtained with the TSK, pain severity, and pain drawing. It appears that important psychological factors (fear avoidance beliefs and pain amplification) do have some influence on self-ratings of disability in chronic WAD sufferers. This does not appear to be larger than that found in studies of acute/subacute subjects. The influence of these factors may plateau fairly early in the post-WAD period. There is some evidence that the Pain Diagram may provide insight into nonorganic pain behavior.
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Research Interests: Pain, Inflammation, Animals, Spinal Cord, Male, and 8 moreMuscles, Electromyography, Jaw, Plant extracts, Rats, Neck Muscles, Muscle Activity, and Plant Oils
The purpose of this study was to determine the role of standard and novel (cervical) nonorganic signs in patients with chronic whiplash-associated disorder (WAD). Chronic WAD I to III patients... more
The purpose of this study was to determine the role of standard and novel (cervical) nonorganic signs in patients with chronic whiplash-associated disorder (WAD). Chronic WAD I to III patients (>3 months) were recruited from private chiropractic practice in Canada. Subjects completed a Neck Disability Index (NDI), Tampa Scale for Kinesiophobia (TSK), pain visual analog scale, and pain diagram. Clinical and demographic data were also obtained. Nine standard nonorganic pain behavior tests and 4 novel cervical nonorganic simulation signs (C-NOSS) tests were applied. Bivariate correlations were obtained with the Pearson correlation coefficient. Items achieving statistical significance on univariate analysis were loaded in a sequential linear regression analysis. Post hoc analyses were conducted with analysis of variance tests of NDI and TSK scores. Ninety-one subjects were investigated (49 males and 42 females), with a mean age of 41.7 (SD, 14.7) years and a mean duration of 9.4 (SD, 11.2) months. Because mean NDI scores were 57.5 (SD, 17.8) and mean pain scores were 68.3 (SD, 21.0), this sample represents moderate-to-severe WAD. Fair to moderately strong correlations were obtained between the NDI and the TSK, pain visual analog scale and nonorganic symptoms and signs (NOS-9) and C-NOSS scores, but not with "age," "sex," or "duration." The NOS-9 and C-NOSS scores correlated most strongly at 0.70. A multivariate model accounting for 53% of the variance of the NDI scores (P < .001) was obtained with the TSK, pain severity, and NOS-9 scores. There was no significant correlation between C-NOSS and TSK scores. At least 25% of subjects scored either 5 of 9 or 2 of 4 on the NOS-9 and C-NOSS tests, respectively. Based on the findings of this study, nonorganic signs should be considered in the interpretation of self-rated disability in patients with moderate-to-severe chronic WAD.