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HEALTHBEAT SHOW NOTES .... Episode #49 - Recorded June 16, 2006

Hello and welcome to this week’s edition of HealthBeat, Chiropractic OnLine Today’s Health, News and informational Podcast.

In this week’s news:  We’ll Look At –

• The palliative role of orthopedics

• Mixed Results With EHR Use

• Manual Therapies and Tension Type Headaches

• Mother’s Response to Children’s Pain

• And Finally, Chiropractic Corner will continue our conversation with Mr. Howard Wolinsky

For HealthBeat, This is Dr. Todd Eglow.

Welcome to HealthBeat Podcast #49, recorded June 16, 2006.  HealthBeat is Chiropractic OnLine Today’s radio program, providing current news and commentary about Chiropractic and Health.

This week’s Episode is sponsored by DaVinci Laboratories.  Please surf to our web site at ChiropracticRadio.com and click on the DaVinci link for your Health and Nutritional needs.

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And Now for some news ….

The palliative role of orthopedics

According to an Editorial in the May 27^th issue of the British Medical Journal, Palliative care for patients with cancer is well established and provides important benefits.

Orthopedic interventions in terminal care are, however, underused in the United Kingdom, despite the fact that conditions that are amenable to orthopedic intervention occur often in the terminal stages of cancer.

Though the evidence base for many orthopedic palliative interventions is not strong, since there are no trials, clinical experience and expert consensus opinion suggest that such interventions can ease the pain and comfort of terminally ill cancer patients with pathological fractures and other musculoskeletal effects of malignancy.

About 9000 breast cancer patients develop metastatic bone disease each year in the UK.1  The study in question showed that referral to an orthopedic surgeon is requested in less than half of these patients.  

For more information, surf to our Show Notes for a link to this Editorial - http://bmj.bmjjournals.com/cgi/content/short/332/7552/1227?etoc

Electronic health records (EHRs) can act as either a benefit or detriment to the patient-physician relationship, according to a study published in the March/April 2006 Annals of Family Medicine.

Lead study author William Ventres, MD, and colleagues interviewed physicians, patients, and office staff members to identify factors that influence how EHRs are utilized in the practice. Important aspects that helped determine positive or negative experiences with EHRs included:

• Placement and mobility of monitors.

• Ease of data collection and entry.

• Nature of presenting patient symptoms.

• Physician style.

• Cost.

The authors concluded that further investigation into these factors could influence the development and implementation of EHRs in the future.

Surf to our Show Notes for a link to this Annals of Family Medicine abstract - http://www.annfammed.org/cgi/content/abstract/4/2/124

Manual Therapies and Tension Type Headaches

A systematic review was performed to establish whether manual therapies have specific efficacy in reducing pain from tension-type headache (TTH).

Only six studies met the inclusion criteria. These trials evaluated different manual therapy modalities: spinal manipulation , classic massage , connective tissue manipulation , soft tissue massage , Dr. Cyriax's vertebral mobilization , manual traction , and CV-4 craniosacral technique .

The authors found no rigorous evidence that manual therapies have a positive effect in the evolution of TTH. The most urgent need for further research is to establish the efficacy beyond placebo of the different manual therapies currently applied in patients with TTH.

A follow up editorial from the Foundation for Chiropractic Research offered the following insight from Anthony L. Rosner, Ph.D

The recent systematic review by Fernandez-de-las-Penas et al. performs a useful service in distinguishing and then pinpointing tension-type headache in its analysis of the literature to date. It offers the relatively new PEDro quality scoring method of the articles it has assessed, based upon the presence or absence of 10 methodologic criteria. Its search and inclusion criteria are exhaustive and commendable in that they accommodate open noncontrolled studies as well as randomized controlled trials. Its conclusion [that spinal manipulative therapy may have specific efficacy in reducing pain from tension-type headache is neither supported nor refuted by the published research to date] may indeed agree with other current systematic reviews.

However, one must realize that every set of scoring criteria introduces a certain amount of bias to an analysis, and this review is no exception. Here, one of the criteria for scoring is the blinding of therapists, rightfully described by the authors as "impossible in this kind of trial." Nevertheless, it remains as one of 10 scoring entries for PEDro. As such, it does not appear to have been adequately circumvented as a potential demerit to an otherwise deserving study--despite some indication in this review that comparing subjects' and therapists' expectations should have been carried out. Was it or was it not? A similar dilemma exists for the blinding of patients, also a criterion in the PEDro scale. Elsewhere, in supposedly objective and definitive meta-analyses, it is important to note that Juni has dramatically displayed how differing scoring criteria [with built-in biases] can deliver virtually diametrically opposing conclusions, depending upon the scales ultimately selected.1

Regarding spinal manipulation, the most important aspect to carry away from this paper is that as a specific modality it may yet lack definitive supporting evidence in the management of tension-type headaches. However: [i] that is not the case with cervicogenic headache, in which enhanced benefits can be specifically attributed to spinal manipulation;2 [ii] in comparison to medication, whatever has been offered to the patients undergoing spinal manipulation clearly shows prolonged and sustained benefits after the period of treatment has been concluded.3 In the latter trial, it is important to note that: [i] its quality rating on the PEDro scale by the authors rests solely upon its follow-up of what appears to be an undersized period of 4 weeks, despite the same authors' reference to this period in the text as "long-term." For this penalty, the Boline paper received the PEDro score of 5 which was just enough to cast it into the low- rather than high-quality echelon. [This is particularly puzzling, because elsewhere the Boline paper received the highest quality score in four separate systematic reviews.4-7] What follow-up period would have satisfied the PEDro criterion?

The composite picture of the Nilsson,2 Bove,8 and Boline3 studies is simply that spinal manipulation, while perhaps being specifically effective in managing cervicogenic headache,2 may not be necessary for treating tension-type headache since low-force applications such as soft tissue therapy may be equally beneficial8—although superior to at least certain medications.3 Of all the healthcare providers able to distinguish between these types of headaches with an accurate diagnosis and then apply an appropriate therapy, it would appear from these studies that chiropractors more than any of the other alternatives are the best equipped to do so.

For more information about this study, surf to the March 2006 issue of the Clinical Journal of Pain - http://www.clinicalpain.com/pt/re/clnjpain/abstract.00002508-200603000-00009.htm;jsessionid=GTnP25cTzWnv9TcqTc6KvbW7cj9fGNSBYjDT7c2YGvfXx1pynkkD!-1110070904!-949856144!8091!-1

Mother’s Response to Children’s Pain

A study was aimed at identifying mothers' responses to children's pain, evaluating whether these could be organized into different types of responses, and developing a questionnaire to assess these responses.

Factor analysis using principal components extraction with oblique rotation yielded 3 factors. Factor 1, Protect, reflected caretaking behaviors that placed the child in a passive sick role. Factor 2, Minimize, reflected criticism of the child's pain behavior. Factor 3, Encourage and Monitor, reflected encouragement of the child's activity while monitoring the child's symptoms.

Results suggest that mothers' responses to children's pain behavior may be classified into 3 distinct categories. Additional research is needed to assess whether observational methodologies would yield a similar typology of parents' responses to children's pain. Psychometric properties of the Adult Responses to Children's Symptoms should be examined in larger samples and in studies of the relation of the subscales to related constructs (eg, measures of parenting beliefs and behavior) and to children's pain behavior.

For more information surf to the May 2006 issue of the Clinical Journal of Pain - http://www.clinicalpain.com/pt/re/clnjpain/abstract.00002508-200605000-00010.htm;jsessionid=GTnP25cTzWnv9TcqTc6KvbW7cj9fGNSBYjDT7c2YGvfXx1pynkkD!-1110070904!-949856144!8091!-1

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

And remember - COT’s HealthBeat always recommends discussing any nutritional or exercise lifestyle modifications with a qualified healthcare professional.

Chiropractic Corner –In this edition of HealthBeat’s Chiropractic Corner, we continue our interview from HealthBeat episode #47, with Mr. Howard Wolinsky, reporter for the Chicago Sun-Times.

Mr. Wolinsky was the co-author of the book, the Serpent and the Staff.

We resume the interview, discussing the landmark 1987 decision by judge Susan Getzendanner, in the Wilk vs. AMA case, who held that the AMA was guilty of anti‑trust violations by attempting to eliminate chiropractic as a competitive form of health care.

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Finally, I leave you with the following quote:

"All life is an experiment. The more experiments you make the better."
- Ralph Waldo Emerson

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

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