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U.S. Doctors Continue Prescribing Unnecessary Drugs, Survey Says

The headline above comes from a December 5, 2016, United Press International story reporting on the results of a survey of doctors. The survey, conducted by the American College of Physicians, asked 5000 of their members to identify two drug treatments frequently used by internists that were unlikely to provide high value care to patients.

In spite of the fact that the doctors knew that the drug treatments they were prescribing were of no value or little value, 27% said that they administered antibiotics even though they knew the drugs would not be effective. The most common scenario described was for upper respiratory illnesses that are mostly caused by viruses. Viruses are not affected by antibiotics making the use of those drugs totally worthless in those situations.

Other scenarios revealed by the survey showed that 9% of the aggressive treatments for terminally ill patients were of “questionable value.” Additionally, 7% of medications for chronic pain were determined to be of little value according to the survey of doctors who gave out these drugs.

Dr. Amir Qaseem, vice president of clinical policy for the American College of Physicians (ACP) and chair of the ACP’s High Value Care Task Force, commented, “There is a lot of waste in our health care system, and we need to acknowledge that.”

The overuse of antibiotics has contributed to the increase of deadly superbug bacteria that are resistant to antibiotic treatments. The UPI article reports that according to the U.S. Centers for Disease Control and Prevention, in the United States alone, more than 2 million people a year are infected with bacteria that are resistant to antibiotics. Even worse is that at least 23,000 of these people die each year as a direct result of these untreatable infections.

The CDC estimated that half of all antibiotics given to patients are not necessary. This translates into approximately 47 million unnecessary prescriptions for antibiotics in the U.S. each year.

Dr. Qaseem tried to explain why some doctors are adding to this situation by saying, “If a patient shows up in a physician’s practice and they have an upper respiratory tract infection, it is most often viral and will resolve itself in a few days,” Qaseem said. “You tell the patient to go home, rest, and it will be OK, but generally the expectation of a patient is that you will do something more than that.”

December 12, 2016
Athletes at World Games Utilize and Benefit from Chiropractic According to Study

The Journal of Manipulative and Physiological Therapeutics published a retrospective study in their November/December 2016 edition that reviewed the usage of chiropractic care during the World Games in Cali, Colombia, from July 25 to August 4, 2013.

The study begins by noting the overall increase of chiropractic utilization in the United States and Canada has risen from 4% in 1980 to 14% in the U.S. by 2015. They report that a high percentage of the people seeking chiropractic care do so for musculoskeletal issues related to back pain.

The authors also reported that in another study of 1.7 million people, having access to insurance that includes chiropractic care caused a significant reduction in overall medical expenditures with specific decreases in spinal surgery and all back-related medical treatments.

Chiropractic care was rendered at the games by 40 doctors of chiropractic and observed by six researchers. This was arranged by the International World Games Association (IWGA) who contracted with the Fédération Internationale de Chiropratique du Sport (FICS) to provide free chiropractic care to athletes and support staff who were accredited at this event.

In the review of chiropractic utilization at the 2013 World Games the study showed that 537 of 2964 accredited athletes received chiropractic care during the games. This represents a utilization rate of 18.1% for the athletes. The utilization for the accredited non-athletes was lower with 403 of 4131 in this group receiving chiropractic care. This showed a utilization rate of 9.8% for non-athletes.

Athletes seeking chiropractic care were from 68 of the 93 participating countries. Of the total of 33 sporting events at the games, athletes from 28 of those sports sought chiropractic care. The breakdown showed that the largest utilization rates were from bowling scored at 48%, with water skiing being second at 42%, then fistball at 41%, and wushu with 41% of those athletes seeking chiropractic care.

Of the athletes who sought chiropractic, 37% had an acute or newer conditions, while 55% had chronic or long-term problems. The non-athletes presented themselves for chiropractic at a ratio different from the athletes with only 20% having acute conditions, while 61% were suffering from a chronic condition. Those receiving chiropractic reported good results. The study showed that 86.9% patients reported immediate improvement after receiving chiropractic.

In their conclusion, the study authors reported, “The majority of people seeking chiropractic care at an international sporting competition were athletes. For those seeking care, the injury rate was higher among athletes than among non-athletes. The majority of patients receiving chiropractic care reported improvement after receiving care.”

December 12, 2016
Chiropractic Helps Patient with Depression, Insomnia, Premenstrual Syndrome and Headaches

The Annals of Vertebral Subluxation Research published a case study on November 21, 2016, documenting a patient suffering from depression, insomnia, and premenstrual syndrome improving under chiropractic care for the correction of vertebral subluxations.

The study begins by noting that according to some studies, depression is one of the most common mental disorders affecting about 16% of the general population. This issue is about twice as common in women as in men. The authors list the symptoms associated with depression as including “…long-lasting depressed mood, loss of interest or pleasure in hobbies and activities that were once enjoyed, decreased energy, fatigue, feelings of worthlessness, feelings of helplessness, feelings of guilt, feelings of anxiety, difficulty concentrating, difficulty making decisions, insomnia, early-morning awakening or oversleeping, weight loss or weight gain, recurrent thoughts of death and or suicide.”

Typical medical treatment involving drugs is estimated to be only effective in lessening symptoms in half of the cases. The study also reports that about half of those with depression seek some type of non-medical care in the form of complementary and alternative medicine. The most common reasons people state they seek non-medical care was dissatisfaction with medical care, especially severe medication side-effects, and the safety of alternative care.

In this case, a 27-year-old woman suffering with the chief complaints of depression, insomnia, severe effects from premenstrual syndrome (PMS), and headaches went to a chiropractor in hopes of finding help. In addition to her primary complaints, she also reported that she occasionally suffered from dizziness, mood swings, buzzing in ears, stiff neck, constipation, menstrual pain, irritability, back pain, urinary problems, nervousness, upset stomach, cold feet, and heartburn.

A chiropractic examination was performed that consisted of a posture analysis, complaints-related subjective questionnaires, autonomic nerve system activity analysis, surface electromyography (sEMG) and thermal scan. From this examination, a determination was made that multiple subluxations were present in the woman’s spine. Specific forms of chiropractic care were started to address the subluxations.

After three months of care, a reassessment was performed that showed many of the original examination findings had improved. Additionally the patient reported improvement in her symptoms noting that her depression, sleep issues, PMS, headaches, and digestive issues had all significantly improved.

In their discussion, the authors of the study explained, “Although there are many approaches for depression, chiropractic is considered a viable management option. The major motivating factors behind the use of chiropractic care is its safety and its natural, health-oriented approach.” They summed up the results this woman received in this case by stating, “The patient’s overall health was not optimal, quality of life and well-being was decreased. After three months of chiropractic care, the patient’s depression-related symptoms significantly decreased and the patient reported an increase in overall health, well-being and quality of life.”

December 12, 2016
Erectile Dysfunction and Chronic Low Back Pain Helped with Chiropractic

Published on December 5, 2016, in the journal Annals of Vertebral Subluxation Research is a case study of a man who was suffering from lower back pain and erectile dysfunction being helped by chiropractic.

According to the study authors, erectile dysfunction (ED) is defined as a man’s inability to attain or sustain an erection satisfactory for sexual intercourse. They report that there are two classifications of ED, primary and secondary. Primary ED is a man who has never been able to have an erection, while secondary is the case where a man used to be able to have an erection but is currently unable to.

According to the University of Wisconsin School of Medicine and Public Health website, “About 5 percent of men that are 40 years old have complete erectile dysfunction, and that number increases to about 15 percent of men at age 70. Mild and moderate erectile dysfunction affects approximately 10 percent of men per decade of life (i.e., 50 percent of men in their 50s, 60 percent of men in their 60s).”

In this case, a 47-year-old man went to the chiropractor on three separate occasions for the complaints of lower back problems and neck pain. At those times, he did not report that he had also been suffering from ED since the age of 22 years. He did have a history of spinal trauma at the ages of 16 and 20 years.

An examination performed on this first set of visits to this chiropractor yielded the conclusion that subluxations were present in the man’s spine. Care was given in the form of specific adjustments and the man reported a significant recovery. He thereafter decided not to continue with chiropractic wellness and he discontinue his care.

Several years later, the man returned to the chiropractor again suffering from lower back pain. Once again care was given and the man experienced a significant recovery. This time he was able to resume sports and activities fairly quickly which led to him suffering a neck injury several months later.

Although the man did not share his history of having ED with the chiropractor initially, upon returning for chiropractic care related to his neck injury, the man noticed the correlation between the correction of his ED and the time he was under chiropractic care. Because of this connection, the man continued his chiropractic on a wellness basis and was able to report to the chiropractor that his ED was effectively eliminated while under chiropractic care.

The man commented about his ED improvement by saying, “For a short time after receiving an adjustment it is much easier and highly more likely that (he) will attain and maintain a strong erection.” When asked by the doctor if he will be maintaining his chiropractic care since he has made the connection between that and the improvement in his ED, he commented, “Of course!”

December 12, 2016
Severe Neck Pain, Anterior Head Positioning and Spondylolisthesis Helped with Chiropractic

The Annals of Vertebral Subluxation Research published a case study on November 7, 2016, reporting on chiropractic helping a woman suffering with severe neck pain, neck stiffness, and pain in the upper back associated with spondylolisthesis in her neck.

On the website WebMD, spondylolisthesis is defined as “…a condition in which one bone in your back (vertebra) slides forward over the bone below it. It most often occurs in the lower spine (lumbosacral area). In some cases, this may lead to your spinal cord or nerve roots being squeezed. This can cause back pain and numbness or weakness in one or both legs.”

The authors of this study further describe this condition as it relates to the neck by stating, “Spondylolisthesis of the spine refers to an anterior or posterior displacement of vertebrae relative to the vertebrae below. In the cervical spine, anterior or posterior vertebral displacement typically results from degenerative or traumatic causes.” This form of spondylolisthesis is known as degenerative cervical spondylolisthesis (DCS).

In this case, a 52-year-old woman suffering from neck pain, neck stiffness, and thoracic pain went to the chiropractor seeking relief. The woman reported that she experienced the pain frequently. She described the pain as severe, resulting in a tense and swelling sensation in her lower neck and upper back areas.

X-rays of the woman’s neck showed that the fourth vertebrae in her neck (C4) had moved significantly forward over the top of the fifth neck vertebrae (C5). Additionally, her C6 vertebrae had also move forward over her C7 neck vertebrae. The x-rays also showed that, overall, the woman’s head was significantly forward of a normal head position.

Based on the x-rays and a chiropractic examination, specific chiropractic care was started. After 30 visits, a re-evaluation was performed. This new examination with x-rays showed that the woman’s spondylolisthesis had been measurably reduced in both areas of her neck. Additionally, her overall head position had greatly improved. Due to these positive changes, the woman reported a complete resolution in her pain, stiffness, tension, and swelling.

In explaining how the mechanism for spondylolisthesis occurs, the authors of the study stated, “Abnormal posture, translational instability of vertebral segments, and abnormal facet angles have all been found to be predisposing factors for cervical degeneration and spondylolisthesis. These physiological changes can result in altered biomechanics leading to increased stress on the intervertebral discs and joints of the spine.”

November 14, 2016
Speech and Coordination Developmental Delays Helped by Chiropractic – A Case Study

The Journal of Pediatric, Maternal & Family Health published a study on October 10, 2016, reporting on the case of a toddler suffering with developmental delays in speech and coordination being helped through chiropractic care.

The study begins by discussing the increased usage of complementary alternative medicine (CAM) by children. CAM consists of a wide variety of non-medical forms of health care. While some classify chiropractic as a separate and distinct form of healthcare, many classify it within the umbrella of CAM professions. The authors note that several studies have shown that chiropractic is the most popular form of CAM for children in the U.S. since an initial study in 2007. They report that one in four children with common neurological conditions use some form of CAM.

In this case, a 2-year-old boy was brought to a chiropractic clinical training center for evaluation. The toddler had developmental delays in speech and coordination. According to his mother, her son was delayed and had consistently failed to meet developmental milestones. His symptoms included below average locomotion skill, delayed hearing comprehension and expressive communication, and difficulty swallowing certain food textures. The boy was born several weeks pre-mature and had suffered one seizure when he was three months old.

The boy had been receiving speech and physical therapy for one year prior to any chiropractic care. The therapy did show some signs of improvement. The therapy consisted of 30-minute sessions twice a month for six months designed to increase the child’s motor skills through the use of therapeutic play, gait training, ball skills and a home program. The boy’s physical therapist performed several standardized tests prior to chiropractic care that measured and confirmed the boy was developmentally delayed.

An examination was performed which included a visual inspection, palpation, and a postural analysis. Based upon the history and the examination, subluxations were determined to be present affecting the child’s spine and nervous system. Specific chiropractic adjustments were given to address the subluxations.

The study records that the boy responded well to care with a steady improvement in his speech and coordination. His mother also reported that his “outbreaks” had decreased to only occurring rarely, late at night, if her son was tired. In a follow up examination performed by the physical therapist after starting chiropractic care, there was a continual improvement in the boy’s developmental issues.

In their conclusion the authors wrote, “This case report informs clinical practice and research on the possible benefits of chiropractic care in children with developmental delays through chiropractic adjustments to address the presence of subluxations.”

November 14, 2016
Patient with Neck Pain and History of Neck Surgery Helped with Chiropractic

A case study published in the September 2016 issue of the Journal of the Academy of Chiropractic Orthopedists reported on a case of an elderly man with neck pain and a history of carotid artery surgery being helped by chiropractic.

The article begins by noting that nearly 140,000 people die each year in the U.S. from stroke. Stroke is the third leading cause of death behind heart attack and cancer. One of the leading causes of stroke is carotid artery disease. This is when plaque builds up in the carotid arteries and can prevent blood flow to the head. One medical procedure that looks to address this issue is called carotid endarterectomy (CEA).

On the Society for Vascular Surgery’s website, Dr. Lori C. Pounds describes the procedure by saying, “A carotid endarterectomy is a surgical procedure to open or clean the carotid artery with the goal of stroke prevention.” It is estimated that 100,000 of these CEA procedures were performed in 2010.

In this case, an 83-year-old man sought care from a chiropractor. The man was suffering from right neck pain and an associated soft tender mass in the area. The pain began about a year and a half before he went to the chiropractor. There was no history of trauma or an accident as the trigger to his pain. His history revealed that he had undergone CEA surgery just less that three years earlier.

The man described his neck pain as a soreness which he rated as a 2 to 3 out of 10 in intensity, with 10 being the worst. He was taking prescription acetaminophen every 6 hours as needed for his pain. Two months before visiting the chiropractor, a computed tomography study showed cervical degeneration of his spine.

After a thorough examination, chiropractic care was started which included specific adjustments. The study reports that by the third visit, the man reported his pain to have reduced to a rate of 1 to 2 out of 10. By the following visit, he reported that he was pain free. At one point after that, the man did report a small re-occurrence of his pain which was quickly eliminated. Since that point, he has not had any neck pain.

In the study’s discussion, the authors note that, “Post-surgical pain is a common problem with a high degree of morbidity and a high overall cost effect.” They noted that this case demonstrated an effective approach to care for this case of an elderly man with pain who has had CEA surgery.

November 14, 2016
Neck Pain and Upper Neck Instability Helped by Chiropractic According to Study
A study published on October 30, 2016, in the International Journal of Clinical and Experimental Medicine (IJCEM) showed that patients with neck pain and instability in the upper neck are helped with chiropractic. The two upper bones in the neck are clinically known as the atlantoaxial joint.

The study points out that problems, such as instability of the atlantoaxial joint, are considered serious due to their high risk of neurological problems. A variety of physical approaches have been used in the treatment of atlantoaxial instability. This study was designed to see how a chiropractic procedure would affect this issue.

In this study, 128 patients diagnosed with atlantoaxial instability were divided into two groups of 64. For the participants to be included, they had to have atlantoaxial instability confirmed by x-rays, as well as be suffering from a variety of health issues, including pain in the upper neck, vertigo, nausea, vomiting, difficult in rotating the head, or being anxious. Patients with serious conditions such as heart, liver, or kidney disease were excluded.

One of the groups of 64 was the control group and only treated with a form of traction, while the other group of 64 received a chiropractic procedure. The chiropractic care and the control group care in this study was rendered for only less than a month. A follow-up evaluation was performed one year later to evaluate the effectiveness of the care in the two groups.

The results of the study were evaluated on all participants using a scale that included the following:
- Cure: The patient’s chief complaints and painful palpation are disappearing. Cervical plain film radiograph confirm normal atlanto-axial joint.
- Marked effective: The patient’s chief complaints are disappearing.
- Effective: The patient’s chief complaints are partially relieved.
- No Effect: The patient’s chief complaints are not alleviated and the cervical plain film radiograph shows no change.
The results showed that the group receiving chiropractic care were significantly more improved than the control group. In the chiropractic group, the results showed that 28 cases (43.7%) were cured, 20 cases (31.3%) were marked effective, 13 cases (20.3%) were effective, and 3 cases (4.7%) showed no effect.

In the control group, the numbers were not nearly as effective with only 16 cases (25.0%) claiming to be cured, 18 cases (28.1%) were marked effective, 16 cases (25.0%) listed as effective, and 14 cases (21.9%) had no effect.

The authors of the study concluded, “These results suggested that this chiropractic techniques were better than the control in the treatment of atlantoaxial instability with higher therapeutic effective rate and lower reoccurrence rate at the end of 1-year follow-up.”
November 14, 2016
Improvement Following Chiropractic Care in Boy with Traumatic Brain Injury

Published in the October 20, 2016, issue of the Journal of Pediatric, Maternal & Family Health is a case study showing a young boy who had suffered from issues related to a traumatic brain injury (TBI) being helped with chiropractic. According to the Mayo clinic, “Traumatic brain injury occurs when an external mechanical force causes brain dysfunction.”

TBI occurs at a high rate in the general population. According to the Centers for Disease Control, 1.7 million people sustain a TBI each year. Of these, it is estimated that 52,000 cases die, 275,000 people are hospitalized, and 1.365 million, about 80%, are treated and released from hospital emergency departments.

The study authors report that the usage of chiropractic for TBI is well documented and fairly common. However, in a literature search for research articles on chiropractic and TBI in children, this current study may be the only one that has been published.

In this case, an 11-year-old boy was brought to the outpatient clinic of a chiropractic college in Florida. The boy was experiencing decreased coordination in his left hand as well as a decrease in strength in his right leg. He was also exhibiting altered and slower speech.

The boy’s history revealed that the boy was in a motor vehicle accident five years earlier and sustained a traumatic brain injury along with a fractured right wrist, right femur, and pelvis. Prior to the accident, his mother reported that he broke his left wrist from a fall. His mother also stated that previous doctors had told her that nothing could be done to improve her son’s coordination. His family physician diagnosed the boy with traumatic encephalopathy, intellectual functioning disability, and acne.

A chiropractic examination was performed which included a postural inspection, spinal palpation, range of motion, and a variety of orthopedic testing. The conclusion based upon the examination was the presence of subluxations in the boy’s spine.

Over an eight month period of time, the boy’s coordination improved. He was also able to pronounce words more clearly, and his ability to perform certain types of exercises improved greatly. The boy’s mother reported that her son was able to perform daily living activities much better and had been hitting baseballs in the batting cage.

The study quoted one of the mother’s reports of her son’s improvement when she stated, “The other day he ran to me saying he was able to tie his shoes and had me watch him. He was not able to button his pants, dress himself, or tie his shoes before coming here to the clinic. Now he is able to button his pants, dress himself, and tie his shoes without any help. He is getting better grades in school and is now participating in sports and activities in his Physical Education class. He is so much happier and more independent.”

November 14, 2016
Anxiety and Panic Attacks Resolved Under Chiropractic Care

Published in the Annals of Vertebral Subluxation Research on October 17, 2016, is a documented case study of a woman suffering from panic and anxiety attacks being helped with chiropractic. The study begins by stating, “Anxiety disorders involve abnormal feelings of worry or fear that can interfere with daily activities such as job performance, school, work and relationships.”

The study notes that there are several different types of anxiety disorders, including generalized anxiety disorder, panic disorder, post-traumatic stress disorder and social anxiety disorder. It is estimated that 18% of the adult population in America are affected by some form of anxiety. Panic disorder has a significant impact on the quality of life and is characterized by sudden periods of intense fear. This can be accompanied by palpitations, pounding heart, or accelerated heart rate, sweating, trembling or shaking, shortness of breath, smothering or choking, and a feeling of impending doom.

Anxiety is commonly treated with medications or, psychotherapy. It has been well documented that the use of antidepressant medications has grown steadily in the past decade, and represents a growing health issue itself. In an attempt to seek alternatives to medications, more people are turning to other approaches including chiropractic care for anxiety.

In this case, a 49-year-old woman with a chief complaint of anxiety and panic attacks went to a chiropractic clinic in New Zealand. Associated with her anxiety, the woman was also suffering from tight gripping chest pains which began following three years of financial, work, family, and relationship stresses. She also had symptoms of gastrointestinal pain and discomfort, mild numbness of the arms and hands, tachycardia and headaches.

She had been prescribed an antidepressant drug which had reduced her chest pain but increased her anxiety and panic attacks. Her history included a significant amount of past physical, psychological and emotional trauma. Additionally, she had been struck by a car as a pedestrian and suffered a number of fractures and other injuries.

Chiropractic care was initiated at the rate of three visits per week. Within three weeks of beginning chiropractic care, the patient reported a reduction in anxiety and panic attacks. Overall, she reported much less anxiety and a significant reduction in the intensity and frequency of her panic attacks and chest pains. When she was experiencing panic attacks, she noted that she felt more in control, and was able to resolve them more easily. Because of this, she was able to reduce her medication.

By the tenth week of care, the patient reported that she felt better than ever and had not had a panic attack for the prior two weeks. After fourteen weeks of care, the woman reported a complete resolution of her anxiety, panic issues, as well as her related symptoms and she was able to discontinue her medication.

As part of their conclusions, the authors summed up the impact this study may have by noting, “Subluxation based chiropractic care may provide a significant contribution to the management of patients with anxiety disorders.”

November 14, 2016

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