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Musculoskeletal Chest Pain and the Cost-Effectiveness of Chiropractic Care

chestpain1Chest pain is a common presentation to health care practitioners, and requires careful and often urgent assessment. Although it is critical to rule out potentially life-threatening conditions, in the general practice/primary care setting, musculoskeletal conditions are the most common causes of chest pain (1). The evidence suggests a prevalence in the general practice population of from 20.6%to 46.6%. By contrast, musculoskeletal conditions were diagnosed in only 6.2% of patients presenting to the emergency department (1).  An attack of acute chest pain can have many causes, not all of which are critical.  Once serious pathology such as myocardial infarction (heart attack) has been ruled out, these patients are often discharged from the emergency department (ED) with the diagnosis of undifferentiated chest pain, i.e. chest pain of unknown origin (2). An often over-looked cause of acute undifferentiated chest pain is pain from the neck and mid back (thoracic spine), creating a sub-category of this condition often called ‘musculoskeletal chest pain’.

A recent Danish randomized controlled trial by Dr. Stochkendahl, a chiropractor and PhD clinical researcher compared chiropractic care, including spinal manipulation of the thoracic and/or cervical spine to the normal self-management program for patients presenting to a University Hospital with acute musculoskeletal chest pain (3, 4) The study results demonstrated improvement in self-perceived chest pain and less pain intensity in favor of chiropractic care. In addition, patients receiving chiropractic care reported significantly less thoracic spine and shoulder-arm pain. This study suggested that chiropractic care could help speed recovery for patients with acute musculoskeletal chest pain presenting to the emergency department.

A study that just came out in 2016 has examined the cost-effectiveness of chiropractic care versus self-management in patients with musculoskeletal chest pain (5). An interesting finding is that patients with non-specific chest pain feel equally or more disabled than patients with cardiac chest pain and are a major burden on healthcare resources. This new study found that in terms of health-related quality of life, primary care in the form of chiropractic care has similar effectiveness as self-management in patients with musculoskeletal chest pain. For patients with musculoskeletal chest pain, community-based chiropractic care is more cost-effective than self-management as it is associated with fewer hospital admissions and lower healthcare costs (5).

 

References:

1: Winzenberg T, Jones G, Callisaya M. Musculoskeletal chest wall pain. Aust Fam Physician. 2015 Aug;44(8):540-4. PubMed PMID: 26510139.

2: Donovan J, Cassidy JD, Cancelliere C, Poulsen E, Stochkendahl MJ, Kilsgaard J, Blanchette MA, Hartvigsen J. Beyond the spine: a new clinical research priority.  J Can Chiropr Assoc. 2015 Mar;59(1):6-12. PubMed PMID: 25729080; PubMed Central PMCID: PMC4319449.

3: Stochkendahl MJ, Christensen HW, Vach W, Høilund-Carlsen PF, Haghfelt T, Hartvigsen J. Chiropractic treatment vs self-management in patients with acute chest pain: a randomized controlled trial of patients without acute coronary syndrome. J Manipulative Physiol Ther. 2012 Jan;35(1):7-17. doi: 10.1016/j.jmpt.2010.11.004. Epub 2011 Dec 19. PubMed PMID: 22185955.

4: Christensen HW, Vach W, Gichangi A, Manniche C, Haghfelt T, Høilund-Carlsen PF. Manual therapy for patients with stable angina pectoris: a nonrandomized open prospective trial. J Manipulative Physiol Ther. 2005 Nov-Dec;28(9):654-61. PubMed PMID: 16326234.

5: Stochkendahl MJ, Sørensen J, Vach W, Christensen HW, Høilund-Carlsen PF, Hartvigsen J. Cost-effectiveness of chiropractic care versus self-management in patients with musculoskeletal chest pain. Open Heart. 2016 May 4;3(1):e000334. doi: 10.1136/openhrt-2015-000334. eCollection 2016. PubMed PMID: 27175285.

 

 

 

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Is Chiropractic Useful For Dizziness and Balance?

42184199_sDizziness and imbalance are amongst the most common complaints in older people, and are a growing public health concern since they put older people at a significantly higher risk of falling. A recent study explored the role of chiropractic in the treatment of dizziness/balance disorders through analysis of data from the 2008 National Health Interview Survey (the only year that included a subset of questions about balance and dizziness).  Questions were asked about dizziness, balance and  accompanying health conditions as well as their perceived causes and effects of the dizziness or balance problem. The survey data queried whether people were helped by a variety of practitioners, including chiropractors.   Balance or dizziness problems were reported by 11% of all respondents.  The reported prevalence was 35% for those aged 65 or older.  The authors found that although a small proportion (4.2%) sought chiropractic care for balance and dizziness, those who did were very likely to report that it had helped (OR, 1.73). For those in whom the cause of their balance or dizziness problem was head or neck trauma, the odds ratio for perceiving that they had been helped by a chiropractor was 9.5, compared with OR 0.53 for medical physicians. For those respondents aged 65 years and older, and for those reporting the cause of their balance and dizziness were trauma or neurological or musculoskeletal issues, the OR was even higher (OR, 13.78).

Reference:
Ndetan H, Hawk C, Sekhon VK, Chiusano M. The Role of Chiropractic Care in the Treatment of Dizziness or Balance Disorders: Analysis of National Health Interview Survey Data. J Evid Based Complementary Altern Med. 2016 Apr;21(2):138-42. doi: 10.1177/2156587215604974. Epub 2015 Sep 11. PubMed PMID: 26362851.

Podcast

Dr. Christine Goertz

007- Advancing Chiropractic Research with Dr. Christine Goertz

Dr. Goertz
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Learn about the largest study of chiropractic to date, chiropractic effectiveness and cost studies and why there is so much heterogeneity in chiropractic research.  My guest on this episode of chiropractic science is Christine Goertz, D.C., Ph.D.  Dr, Goertz is Vice Chancellor of Research and Health Policy at Palmer College of Chiropractic. Dr. Goertz has extensive experience in the administration of both Federal and non-Federal grants, serving as both a PI (Palmer College of Chiropractic and the Samueli Institute) and as a funding official (NCCIH/NIH, Samueli Institute and PCORI).  She is a veteran integrative healthcare researcher, author and speaker.  Dr. Christine Goertz has served as a principal investigator or co-principal investigator for a number of large-scale, federally funded research studies including a $7 million, Department of Defense-funded collaboration with RAND and the Samueli Institute conducting the largest study of chiropractic to date (currently ongoing).  For over 20 years, she has addressed multidisciplinary science and health policy issues at the state and federal levels, serving as a member of the American Medical Association’s Measures Implementation and Evaluation Advisory Committee, Chair of the American Chiropractic Association’s Performance Measurement Task Force, and a program officer of the NIH National Center for Complementary and Alternative Medicine managing a portfolio focused on musculoskeletal disease, pain and health services research. She is a Fellow of the International College of Chiropractors. She received her doctor of chiropractic from Northwestern Health Sciences University and a PhD in Health Services Research Policy and Administration from the University of Minnesota.

20 for 20 Campaign to benefit chiropractic research

With $20, We can #ChangeLives.

We can be part of a small effort that will have a big impact. We can use research to help children with headaches or middle ear infections. We can improve access to chiropractic care nationwide. We can help train the chiropractic researchers of the future.

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1995 – 2015: The Palmer Center for Chiropractic (PCCR) has significantly impacted the science of chiropractic for two decades, and has grown to become the largest and most productive chiropractic research center in the world.

Our goal is to celebrate 20 years of chiropractic research at Palmer by connecting with 20,000 friends who are willing to donate $20 each year toward the following key research efforts at the PCCR:

  • Initiate pilot studies in new areas of research that could lead to federal funding opportunities, such as studies on chiropractic for headaches in adolescents
  • Conduct research on how to improve access to chiropractic care within patient centered medical homes and accountable care organizations
  • Study the cost-effectiveness of chiropractic care in a rigorous manner
  • Provide training grants to help chiropractic students and professionals to become skilled chiropractic researchers
  • Develop studies focusing on chiropractic co-management for conditions for which antibiotics are no longer considered the first line of defense, such as chiropractic/pediatric co-management of otitis media in children, or chiropractic/primary care co-management of chronic bronchitis

Your support enables us to conduct rigorous clinical studies designed to provide evidence that lends validity, reliability, and continuity to the work of chiropractors worldwide.

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