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HEALTHBEAT SHOW NOTES .... Episode #20 - Recorded November 25, 2005

In this week’s news:

• Traction and Low Back pain

• Dr. Haldeman Responds to Neurovascular Article

• National Board of Chiropractic Lowers Exam Fees

• Consumer Driven Health Care Insurance Plans

• Work Related Disorders

• Colas and Risk of Hypertension

• iPod Finger

• And finally, Health Corner looks at Prescription Drug Errors

For HealthBeat, This is Dr. Todd Eglow.

Welcome to HealthBeat Podcast #20, recorded November 25, 2005.  HealthBeat is Chiropractic OnLine Today’s radio program, providing current news and commentary about Chiropractic and Health.  For our US Listeners, a slightly belated Happy Holiday wishes.

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And Now for some news ….

Traction and Low Back pain

A recent review from the Cochrane Review web site, looked at a study from Wiley InterScience entitled - Traction for low-back pain with or without sciatica.

The premise of the study was that Various types of traction are used in the treatment of low-back pain (LBP), often in conjunction with other treatments, and the objective of the study was to determine the effectiveness of traction in the management of LBP.

From the Abstract of the study, the authors appeared to focus on traction in a Physical Therapy environment, with reference to a physical therapy program that includes Tru-Trac traction.

The Cochrane Review's Synopsis states that - The evidence suggests that traction is probably not effective.

For patients with a mixed duration of low-back pain (LBP), with or without sciatica, continuous or intermittent traction by itself was no more effective than placebo, sham or other treatments in improving pain, function or work absenteeism.

In studies that examined only patients with sciatica, the evidence was inconsistent as to whether continuous or intermittent traction was more effective than placebo, sham or other treatments for improving pain and function. There was moderate evidence that autotraction was more effective than mechanical traction for global improvement in the same population.

This review included 24 RCTs, and 2177 patients with a mix of acute, sub-acute or chronic LBP, with or without sciatica. Traction was compared to placebo, sham, no treatment, or other treatments. Different types of traction were examined by themselves or as part of a multi-treatment program.

Chiropractors commonly use a form of traction, known as Flexion-Distraction, popularized by Dr. James Cox.  In a 1997 study published in the Journal of the Neuromusculoskeletal System, Flexion-Distraction was Successfully Used to help Disc Herniation Patient

Lumbar radicular symptoms can be caused by lumbar intervertebral disc herniations.  Flexion/distraction manipulation is a therapeutic alternative that may offer relief for subjective complaints and elimination of objective signs. Success with this technique might spare the patient an operative procedure. This is a case report of one such incidence.

Flexion/distraction manipulation is a treatment developed by Dr. James M. Cox. It is often used for lumbar disc injuries (herniation, bulges, etc.), and for other low back and lower extremity radicular conditions. The technique involves the use of a specialized table which allows for passive distraction, flexion, lateral bending, and rotation. These different planes of motion, along with the use of appropriate adjunctive therapy and exercises, allow for reduction of symptoms attributable to lumbar disc syndromes.

Contraindications and indications for flexion/distraction manipulation have been identified and discussed in the study.

The conclusion of the study was that Flexion/distraction manipulation is a treatment that should be investigated as a part of the algorithm for presurgical therapies of lumbar intervertebral disc injuries. This alternative in conservative care may be of benefit to a large number of patients. The surgical option for treating intervertebral disc herniations might be reduced with propagation of flexion/distraction manipulation.

For more information, surf to our Show Notes at ChiropracticRadio.com for links and References.

http://www.update-software.com/abstracts/AB003010.htm

http://www.coxtechnic.com/careofdischerniation.html

Dr. Haldeman Responds to Neurovascular Article

According to the ChiroWire eNewsletter, the Spine Journal recently published a reply by renowned author and Chiropractor Dr. Scott Haldeman.  Dr. Haldeman responded to an article that purportedly studied a recent retrospective series of 18 cases (1) where patients claimed to have suffered a severe nonvascular complication after spinal manipulation were studied.

These cases were gleaned from a neurosurgical practice over a period of 6 years. The authors of the paper conclude that "Spinal manipulation can be associated with significant complications, often requiring surgical intervention. Pretreatment scanning may help identify patients with significant risk factors, such as substantial disc herniations or occult malignancies. Prompt evaluation and intervention is necessary when symptoms worsen or neurological deficits develop." The scanning the authors refer to include Pretreatment MRI or CT scanning.

Dr. Scott Haldeman (2) provided a short commentary on this article in which he illustrates the shortcomings and methodological weaknesses of the article. Some key points from his commentary include "If a practice with three neurosurgeons was aware of only 18 serious adverse events from 60 chiropractors over a 6-year period, the incidence of these complications is so small that it would be the envy of any other medical or surgical spinal treatment approach."

Dr. Haldeman (2) points out that the suggestion resulting from the study ”that all patients who consider spinal manipulation should have a magnetic resonance imaging scan before treatment ”simply cannot be supported. He notes that with approximately 10% of the entire population receiving chiropractic care each year, such a recommendation would produce first-year costs of over $20 billion (i.e., 30 million magnetic resonance imaging scans at $700 each). More importantly he notes that there is no evidence that such screening by advanced imaging would change the adverse event rate. Large case series have demonstrated that disc herniation without neurological deficits does not pose a contraindication to most routine forms of manipulation.

Lastly, Dr. Haldeman (2) asks a question of the authors of the article in his commentary. "The authors clearly feel that the publication of this paper is serving a purpose. Dr. Haldeman asked the authors if they would feel it was equally reasonable for The Spine Journal to publish a similar paper written by chiropractors retrospectively reviewing charts to document patients who reported an adverse response to elective spine surgery and then recommended changes in the clinical practice of neurosurgery based on these few case reports"?

References:

1. Oppenhein JS, Spitzer DE, Segal DH. Nonvascular complications following spinal manipulation. The Spine Journal 2005;5(6):660-666.
2. Haldeman S. Commentary. The Spine Journal 2005;5(6):666-667.

For more information, please surf to www.spine.org

National Board of Chiropractic Lowers Exam Fees

National Board of Chiropractic Examiners (NBCE) President Peter D. Ferguson, D.C., announced today that, in accordance with a vote of the full Board of Directors, the NBCE will reduce its examination fees effective in 2006. The board made this decision at its fall board meeting in Charlotte , N.C.

The new fee structure will be included in the spring 2006 applications.  For more information, surf to -  www.nbce.org

Consumer Driven Health Care Insurance Plans

Over the past decade, or 2, employers and employees have been at odds over who should bear the brunt of the cost for health care.  In the late 1980’s into the 1990’s, Managed care, beginning with HMO insurance plans were touted as being the save-all. 

Here in 2005, a new type of insurance plan has arisen…. Consumer Driven Health Care (CDHC), which defined narrowly, refers to health plans in which employees have a personal health accounts such as a Medical Savings Account or a Health Reimbursement Arrangement; which they pay medical expenses directly.

The phrase is sometimes used more loosely to refer to defined contribution health plans under which employees receive a fixed dollar contribution from an employer to choose among various plans. Those opting for plans with rich benefits may have to contribute significant amounts of their own money in addition to the employer's contribution. Those choosing bare-bones health plans contribute less of their own money.

Following is an interview from CNBC which discusses this new Consumer Driven Health Care plans, along with a recent survey of Health Care costs.

http://cdhc.ncpa.org/commentaries/

Work Related Disorders

A study from the November 2005 issue of the journal Manual Therapy discusses the topic Work-related neck and upper limb disorders, abbreviated with the acronym – WRNULD.  

WRNULDs are common problems among office workers who use computers intensively and maintain prolonged static postures. These disorders have often been attributed to result from sustained muscle activity in the neck-shoulder musculature. The present study examined whether symptomatic subjects exhibited the same muscle activity patterns as asymptomatic controls when they performed a prolonged computer task under the same conditions.

The findings of the study indicate that altered muscle recruitment patterns observed in the symptomatic subjects preceded the onset of task discomfort, and this finding may have important implications for the etiology of WRNULD.

For more information, surf to our Show Notes for the link to this issue - http://www.sciencedirect.com/science?_ob=JournalURL&_cdi=6948&_auth=y&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=f914f1223a636699cbbce2df154ff126

Colas and Risk of Hypertension

A study from the November 9th issue of JAMA found that consumption of cola beverages was associated with an increased risk of hypertension, independent of whether it was sugared or diet cola.

The study, looking at the role of habitual Caffeine intake, concluded that further research to elucidate the role of cola beverages in hypertension is warranted.

For more information, surf to the November 9th issue of the Journal of the American Medical Association.

iPod Finger

According to the British Chiropractic Association, First there was text messaging injury, then came Blackberry Thumb, now the latest Repetitive Strain injury to come to fruition is iPod Finger. 

iPod finger’ is an injury that affects the finger of music-mad consumers who are constantly using the scroll-wheel or buttons on their MP3 players to organize their song library, update playlists and adjust volume of their favorite artists.

Although complaints of MP3 player-related injuries have not reached high levels as yet, the British Chiropractic Association’s Dr Carl Irwin feels that it is only a matter of time.

To find out more information about the BCA please visit www.chiropractic-uk.co.uk

As always, please surf to our Podcast Show Notes at ChiropractiRadio.com for a full listing of web references mentioned in today’s show.

Health Corner – In this edition of HealthBeat’s Health Corner, we look at the rate of errors that occurs with Prescription Drugs.

According to the US Food and Drug Administration, the FDA, a medication error is defined as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; dispensing; distribution; administration; education; monitoring; and use."

Some common types of Medication Errors can include the following –

• incomplete patient information (not knowing about patients' allergies, other medicines they are taking, previous diagnoses, and lab results, for example);

• unavailable drug information (such as lack of up-to-date warnings);

• miscommunication of drug orders, which can involve poor handwriting, confusion between drugs with similar names, misuse of zeroes and decimal points, confusion of metric and other dosing units, and inappropriate abbreviations;

• lack of appropriate labeling as a drug is prepared and repackaged into smaller units; and

• environmental factors, such as lighting, heat, noise, and interruptions, that can distract health professionals from their medical tasks.

In 1992, the FDA began monitoring medication error reports.  For more information, surf to our Show Notes for a link to the FDAs Safety Page.

http://www.fda.gov/cder/drug/MedErrors/default.htm

While the purpose of these Podcasts is to either introduce or reinforce the concept of assuming a more conservative approach to healthcare, one that minimizes the reliance on substances such as prescription medications…. We realize that during emergent situations, medications may be needed.  Following is a report from Health Central, about what is being done to reduce the chances of being a victim of a Prescription Drug Error.

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Finally, I leave you with the following quote:

"Silent gratitude isn't much use to anyone."

– G.B. Stern

For Chiropractic OnLine Today’s HealthBeat, This is Dr. Todd Eglow.

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