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HEALTHBEAT SHOW NOTES .... Episode #82 - Recorded February 2, 2007

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 –  

• Migraine Headaches and Electronic Diaries

• Pathogenesis of Headaches

• An In-depth look at the FCER’s Response to a recent Pediatrics Article on Chiropractic Manipulation

• And Finally, Health Corner presents a Discussion on Single Payer Health Insurance

For HealthBeat, This is Dr. Todd Eglow.

Welcome to HealthBeat Podcast #82, recorded February 2, 2007.  HealthBeat is Chiropractic OnLine Today’s radio program, providing current news and commentary about Chiropractic and Health.

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And Now for some news ….

Migraine Headaches and Electronic Diaries

A study in the journal Headache: The Journal of Head and Face Pain presented a study to evaluate an electronic diary as a tool to evaluate the occurrence and relationship of headaches and premenstrual syndrome (PMS) symptoms throughout the menstrual cycle in women with migraine.

Menstrually related headache and PMS significantly impact the quality of life of many women. The time relationship of these 2 menstrually related problems is not well understood and not well described.

The study concluded that an electronic diary may have potential as a diagnostic tool in studying headaches and PMS symptoms throughout the menstrual cycle. The occurrence of headache and PMS symptoms in migraineurs follows similar time courses.

If you suffer from headaches, discuss these results and treatment options with your Doctor of Chiropractic. 

Surf to our Show Notes for more about this study - http://www.blackwell-synergy.com/doi/abs/10.1111/j.1526-4610.2006.00441.x

Pathogenesis of Headaches

Head pain arises within the trigeminal nociceptive system. Current theories propose that the trigeminal system is intimately involved in the pathogenesis of migraine. Short-latency responses can be recorded in sternocleidomastoid muscles after stimulation of the trigeminal nerve (trigemino-cervical reflex). This brainstem reflex could be a suitable method to evaluate the trigeminal system in migraine and cluster headaches (CH).

A recent study looked to further elucidate the pathophysiology of migraine and cluster headache (CH) with special reference to the involvement of the central trigeminal system in the different forms of primary headache.

The study presented in the journal Headache: The Journal of Head and Face Pain found that significant abnormalities were observed in a great number of patients with both types of migraine and CH during the headache attacks, but only in migraine patients during the interictal period. The alterations are bilateral in migraine, unilateral in CH.

Interictal referring to “occurring between seizures”.

The results of this study further support the relevance of brainstem mechanisms in the pathogenesis of migraine rather than of CH. These data, taken together with that from experimental head pain and functional imaging studies, demonstrate that primary headache syndromes may be distinguished on a functional basis by areas of activation specific to the clinical syndrome.

Surf to our Show Notes for more information - http://www.blackwell-synergy.com/doi/abs/10.1111/j.1526-4610.2006.00529.x

FCER Responds to Pediatrics Article

Norwalk, Iowa—It’s a battle that the chiropractic profession is familiar with—a “scientific” article appears in a medical journal decrying the risks of chiropractic cervical manipulation, and newspapers and television news programs spread the conclusions without either comparison to risks associated with common medical treatments or rebuttal from within chiropractic.

The latest front in this battle is over the chiropractic treatment of the pediatric population. Published in the January 1, 2007 issue of Pediatrics, the journal of the American Academy of Pediatrics, the article “Adverse Events Associated With Pediatric Spinal Manipulation: A Systematic Review,” has quickly reached the airwaves of the popular media.

In response to this latest media cacophony, the Foundation for Chiropractic Education and Research’s (FCER) Director of Research, Anthony L. Rosner, PhD, drafted a response to the editors of the journal. To provide the practicing chiropractors with the rebuttals necessary to answer patient, medical colleague, and possibly local media questions, a version of that response has been drafted. That response follows:

Safety issues surrounding spinal manipulation have received much attention in recent years. However, there has been very little discussion of this topic as it applies to pediatric patients. A new review recently published in the journal Pediatrics addresses this very concern, in what has been labeled as a "systematic review." This is supposed to mean that all the published material in the medical journals has been retrieved, with specific articles having passed certain criteria for their more intensive review and analysis.

Because this approach has not been previously followed for pediatric populations who have experienced spinal manipulation, this study pursues an important goal in today's world of assessing risks and benefits of all medical interventions.

It also avoids a common limitation in reviews of this type, in that it embraces case and cohort studies which occur in live doctors' offices as well as clinical trials.

Described in the 13 papers accepted for review are 14 cases of direct adverse events following spinal manipulation. These include 9 cases of serious events (subarachnoidal hemorrhage and paraplegia), 2 moderately adverse events requiring medical attention (severe headache), and 3 minor occurrences (mid-back soreness).  Another 20 cases of indirect adverse events involved delayed diagnosis or the inappropriate provision of spinal manipulation for such serious medical conditions as meningitis (or rhabdomyosarcoma).

It is both important and commendable that these events have been brought to light in Vohra's report. However, they must be viewed in the larger framework of three factors:

(1) the total number of treatments administered to children;

(2) the relative risks of medical procedures for the same conditions treated; and

(3) the benefits of spinal manipulation in children which have been amply described in the research literature. Lacking these considerations, this review presents a distorted and one-sided assessment of pediatric spinal manipulation.

Unfortunately, the review by Vohra falls short of its goals in its pursuits:

• Important studies involving pediatric patients who have successfully undergone spinal manipulation in resolving their complaints of ear infections (otitis media) have gone unnoticed.

• Another study in which the authors attribute adverse events to chiropractors in the United States instead involves physical therapists, most likely practicing in Germany.

• Yet another citation of adverse events occurring in a clinical trial describes nothing more than a short period of mid-back soreness and irritability, difficult to distinguish from a period of extended crying in another subject who was not even manipulated but was instead assigned to the placebo group.

• A final group of patients suffered from delayed diagnosis—which the authors erroneously attribute to one study that made no such mention of diagnoses at all but rather focused upon the direct consequences of manipulation per se.

So the question remains whether the authors have truly accomplished their minimal objective. Did they actually present an accurate and balanced assessment of the literature addressing the adverse events associated with spinal manipulation? The answer appears to be in the negative.

It is also not at all clear whether all the spinal manipulations described were in fact administered by qualified chiropractors, an important consideration when one considers the risks involved with individuals who have not received complete training in manipulating areas of the neck.

Only when the following criteria are met will a truly "accurate and balanced" assessment of the scientific literature have been made:

• The precise maneuvers applied to the patient;

• The complete qualifications of those administering these treatments;

• The several benefits of manipulations of the cervical area which in the literature have been shown to include the relief of headache, carpal tunnel syndrome, otitis media, colic, and enuresis (bed-wetting).

None of these standards have been met by Vohra's review, such that it can only be greeted with extreme skepticism.

For more information, surf to the FCER at www.fcer.org

Health Corner –In this edition of HealthBeat’s Health Corner, we present a story from PBS’s news show, NewsHour with Jim Leher, concerning President Bush’s new Health Insurance Proposal.

The interview begins with a defining of the 2 main points of the President’s proposal.

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.

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

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